Growth of electronic consultations in the Veterans Health Administration

To evaluate the growth and variation of electronic consultation, or e-consult, use in the Veterans Health Administration (VHA) across regions and specialties.

Observational cohort study using administrative data of all veterans who received an e-consult for 41 specialties across 1269 VHA medical centers and associated clinical sites from January 1, 2012, through December 31, 2018.

Assessments included (1) the number and characteristics of all e-consults, (2) growth of e-consult use, (3) e-consults as a proportion of all consults by region and by specific specialty, (4) need for an in-person visit with the same specialty within 12 months after an e-consult, and (5) potential miles of driving saved for patients and mileage reimbursement costs avoided for VHA due to e-consult use.

Over the 7-year study period, VHA providers completed 3,117,998 e-consults (5.5% of all specialty consults). e-Consults increased by 309% for all specialties. By 2018, for 16 of 41 specialties, e-consults accounted for greater than 10% of all consults. Overall, 21.5% of e-consults resulted in an in-person visit with the same specialty within 12 months. On average, each e-consult resulted in approximately 84.3 (SD, 89.9; interquartile range, 25.1-115.0) miles in driving saved, equating to potential driving reimbursement savings of $46 million.

Use of e-consults in the VHA grew substantially between 2012 and 2018, with variability across specialties. In-person follow-up after an e-consult was low, suggesting that e-consults may substitute for in-person visits and reduce considerable patient travel burden.