Leveraging an Electronic Consultation Program for a High-Volume Hepatology Clinic

The prevalence of chronic liver disease is increasing in the United States, and a concurrent national shortage of hepatologists has resulted in long wait times for specialty care. Electronic consultations (E-consults) have emerged as a strategy to expand access by enabling asynchronous communication between referring providers and specialists. Limited data exist on hepatology-specific E-consults, particularly in the post-coronavirus disease 2019 era. This study aimed to characterize contemporary hepatology E-consult use and evaluate their impact on subsequent healthcare utilization within a health system.

We conducted a retrospective cohort study of all hepatology E-consults completed at a large academic health system between January 1, 2021, and December 31, 2024, with follow-up through June 30, 2025. Patient demographics, referring provider characteristics, clinical questions, and outcomes were extracted from the electronic health record. The primary outcome was the proportion of E-consults addressed without an in-person hepatology clinic visit within 6 months.

A total of 3,011 hepatology E-consults were requested by 663 unique providers across 39 specialties, most commonly family medicine 36.8% and internal medicine 21.9%. The most common clinical concerns were abnormal liver tests (68.9%), abnormal imaging (18.5%), and metabolic-associated steatotic liver disease (12.4%). Median completion time was 0 days, compared with 46 days for traditional referrals. Overall, 63.6% of E-consults addressed clinical questions without a subsequent hepatology visit, avoiding nearly 137,000 miles of patient travel.

Hepatology E-consults can effectively manage many low-complexity cases within primary care, preserve specialty clinic capacity, and reduce patient travel burden. These findings highlight the role of E-consults in addressing the growing demand for hepatology expertise.