From Pilot to Practice: A Large-Scale Evaluation of Gastroenterology E-Consultations at an Academic Medical Center

Electronic consultations (e-consults) are asynchronous, provider-to-provider exchanges that allow specialists to provide clinical guidance without an in-person visit. Referring clinicians submit focused questions through the electronic health record, and specialists review relevant history and data to make recommendations. At many academic centers, waits for specialty appointments exceed months, limiting timely care and underscoring the need for alternative referral pathways. We evaluated the implementation, utilization, and provider experiences of a gastroenterology e-consult program at Massachusetts General Hospital.

We analyzed all gastroenterology e-consults from January 2023 through September 2024, extracting completion rates, turnaround times, and clinical indications from 2416 encounters. Anonymous 5-point Likert surveys assessed satisfaction, perceived utility, and implementation barriers among referring providers and consulting gastroenterologists.

Of 2416 e-consults involving 2038 unique patients, 2112 (87%) were completed, with a mean turnaround time of 2.6 business days. Hepatology and abnormal imaging findings comprised nearly half of all requests. Referring providers reported high satisfaction and educational value, with most indicating that e-consults reduced unnecessary visits and testing. Consultants recognized clinical utility but cited inadequate reimbursement and difficulty meeting turnaround targets.

Gastroenterology e-consults can operate effectively at scale, particularly for objective, data-driven questions such as abnormal liver function tests and imaging findings. However, the satisfaction gap between referring providers and consultants, driven largely by reimbursement and workload pressures, threatens long-term sustainability. Addressing these challenges through payment models that reflect cognitive work and streamlined workflows will be essential to maintain specialist engagement while expanding access to care.