Evaluation and Utility of an Electronic Consultation Program in a Children's Health System

Electronic consultations (e-consults) are asynchronous communication between primary care providers (PCPs) and specialists. Studies in adults show that e-consults improve specialty access, but the data in pediatrics are limited. We report the evaluation and utility of a large pediatric e-consult program.

We reviewed our database for the number of e-consults per specialty, indications, and completion time. We determined the utility of e-consults by assessing health care utilization for the same clinical problem within 2 months following completed e-consults. PCPs and specialists were surveyed to assess time spent on e-consults and satisfaction with the e-consult program.

Thirty-four specialists from 13 specialties completed 2192 e-consults requested by 45 PCPs over 55 months. An average response time for e-consult completion was 0.8 days. Dermatology (42%), endocrinology (16.6%), and neurology (8.2%) were the top 3 specialties with rashes, puberty questions, and seizures as common indications, respectively. Within the 2 months, 85% of patients did not present to the clinics or the emergency room for the same clinical problems addressed in the e-consults. Time spent on the e-consult was less than 20 minutes for PCPs (80%) and specialists (77%). High satisfaction was reported in PCPs (97%) and specialists (85%) with the e-consult program.

In the largest study on pediatric e-consults so far, prompt specialty advice was provided with e-consults to the PCPs by specialists. In most cases, patients did not present to our health system for the same clinical problems within 2 months. Both PCPs and specialists reported high satisfaction with the e-consult program.