Electronic consultations (E-consults) and their outcomes: a systematic review

Abstract

Objective Electronic consultations (e-consults) are clinician-to-clinician communications that may obviate face-to-face specialist visits. E-consult programs have spread within the US and internationally despite limited data on outcomes. We conducted a systematic review of the recent peer-reviewed literature on the effect of e-consults on access, cost, quality, and patient and clinician experience and identified the gaps in existing research on these outcomes. Materials and Methods We searched 4 databases for empirical studies published between 1/1/2015 and 2/28/2019 that reported on one or more outcomes of interest. Two investigators reviewed titles and abstracts. One investigator abstracted information from each relevant article, and another confirmed the abstraction. We applied the GRADE criteria for the strength of evidence for each outcome. Results We found only modest empirical evidence for effectiveness of e-consults on important outcomes. Most studies are observational and within a single health care system, and comprehensive assessments are lacking. For those outcomes that have been reported, findings are generally positive, with mixed results for clinician experience. These findings reassure but also raise concern for publication bias. Conclusion Despite stakeholder enthusiasm and encouraging results in the literature to date, more rigorous study designs applied across all outcomes are needed. Policy makers need to know what benefits may be expected in what contexts, so they can define appropriate measures of success and determine how to achieve them.

Acceptance of e-consult for Substance Use Disorders during the COVID 19 pandemic: A study from India

“…Studies from other health conditions have shown that HCP satisfaction was generally good for e-consults, with 70–95 % providers reporting high satisfaction ( Vimalananda et al, 2015 ). The HCPs reported satisfaction in terms of convenience, educational value, rapid turnaround, improved access to specialty input, better provider-provider communication, avoidance of unnecessary patient travel, and the perception of shorter waiting times for patients ultimately referred to face-to-face visits ( Vimalananda et al, 2020 ).…”

“…1 ). An e-consult is an asynchronous consultative communication between health care providers with a specialist over a secured electronic health record or web-based platform to obtain rapid input and often prevent the need for a face-to-face patient visit ( Vimalananda et al, 2020 ). It consists of case consultations as well as sharing of personalized educative materials between HCP and specialists ( Vimalananda et al, 2015 ).…”

Digital Health Interventions in Palliative Care: A Systematic Meta-Review and Evidence Synthesis

“…Methodological gaps: The meta-review findings echo the wider literature on digital health 46 and palliative care, 47 which point to the need for more rigorous evaluations, cost-effectiveness analyses, implementation studies and patient centred research. The lack of rigorous cost-effectiveness studies seen in the literature on DHI in palliative care, reflects findings from previous metareviews 48,49 and systematic reviews [50][51][52] in digital health. There is a need for greater clarity on what is being compared in cost-effectiveness studies, and whether the DHI is offered in addition to, or as a replacement to the standard approach.…”

Parent Perspectives on Family-Centered Pediatric Electronic Consultations: Qualitative Study

“…To date, electronic consultations have been implemented in several health care systems, including the Department of Veterans Affairs, the Mayo Clinic, San Francisco General Hospital, and the Los Angeles County Department of Health Services, and these show initial promise in their ability to efficiently meet the demand for specialty care [5][6][7]. After electronic consultations became a required preliminary step for all referrals through the LA County Department of Human Services, 25% of the electronic consultations were resolved without a specialist visit, and the percentage of referrals scheduled within 30 days improved from 24% to 30% [8].…”

“…Studies of the perspectives of adult patients are more limited, but these studies reported general acceptability [11,12]. Patients appear to value the potential for electronic consultations to improve access to specialist expertise and to place PCPs in a more central role [7], but patients raise concerns that the information transmitted may not be comprehensive and that quality of the outcome may depend on patient-PCP relationships [11,13]. In addition, adult patients also expressed a desire to be more informed about and engaged with the electronic consultation process, which often appeared to occur without patient knowledge [13].…”