Electronic Consultations in Allergy/Immunology

Phadke, Neelam A.; Wolfson, Anna R.; Mancini, Christian; Fu, Xiaoqing; Goldstein, Susan A.; Ngo, Jacqueline; Wasfy, Jason H.; Long, Aidan A.; Banerji, Aleena; Blumenthal, Kimberly G.

doi:10.1016/j.jaip.2019.05.039

Cited by 35 publications

(48 citation statements)

References 32 publications

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“…In one study, 13.4% of e-consults sent to an allergy service resulted in diagnostic, therapeutic, or alternative referral recommendations, 59.8% resulted in an in-person Allergy/ Immunology consult, and the rest required additional information before a recommendation could be made. 19 This led to reduced wait times for in-person visits despite an increase in the overall number of consults to the allergy service.…”

Section: Patient Carementioning

confidence: 99%

Telemedicine and emerging technologies for health care in allergy/immunology

Portnoy

Pandya

Waller

et al. 2020

Journal of Allergy and Clinical Immunology

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Telemedicine (TM) has become a popular method of accessing medical services between providers and patients and is viewed as a cost-effective alternative to more traditional episodic faceto-face encounters. TM overcomes 2 barriers that patients face when seeking health care: distance and time. It is as effective as in-person visits for outpatient treatment of asthma, and it is a convenient way to provide inpatient consultations for patients when the allergist practices outside of the hospital. TM also has been used to manage patients with asthma in schools. Patients tend to be as satisfied with TM or they prefer TM over in-person visits, but infrequently they do prefer in-person visits. In addition to virtual visits using TM, there are several emerging technologies that are relevant to the practice of allergy/ immunology including electronic diaries (eg, symptoms and medication use), wearable technology (eg, to monitor activity and vital signs), remote patient monitoring (eg, environmental exposures and medication adherence) as well as electronic medical records augmented with clinical decision support. We believe that the use of TM, particularly when combined with information technologies such as electronic health records, has the potential to cause a transformational change in the way care is delivered by altering the process of interaction between patient and provider. TM addresses the shortage of allergy specialists in rural and underserved urban communities and facilitates patient access to allergy services. As patients take more control of their health care, use of TM is likely to increase because a large part of the move to adopt TM is driven by patient preference. (J Allergy Clin Immunol 2020;145:445-54.)

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Section: Patient Carementioning

confidence: 99%

Telemedicine and emerging technologies for health care in allergy/immunology

Portnoy

Pandya

Waller

et al. 2020

Journal of Allergy and Clinical Immunology

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“…Although a previous work by Phadke et al 10 showed the applicability of A/I e-consults in the outpatient setting, our study is the first to demonstrate the feasibility and utility of inpatient A/I e-consults, including novel insights gained from provider satisfaction questions. There are unifying themes between the study by Phadke et al and ours, most notably how e-consults can help expand A/I access in the inpatient as well as outpatient settings.…”

Section: Discussionmentioning

confidence: 70%

“…Significantly reduced turnaround time to a completed e-consult and a shorter time spent on the e-consult as compared with in-person consults mirror the experience from previous studies. 10 An e-consult can be completed by a thorough review of medical records in the EHR during the course of an A/I physician's outpatient responsibilities without the need for travel to the hospital, significantly reducing work hours as compared with an in-person consult. Furthermore, our analysis shows that an econsult was completed a median of 6 hours sooner as compared with an in-person consult.…”

Section: Discussionmentioning

confidence: 99%

“…18 In addition, 88% of our e-consult recommendations were followed by the requesting providers, corresponding with previously published A/I and other specialty data. In the outpatient setting, Phadke et al 10 reported that 73% of A/I e-consult recommendations were followed, whereas Wrenn et al 19 reported that 65% to 85% of other subspecialty recommendations (cardiology, gastroenterology, pulmonary, endocrinology, nephrology, rheumatology) were followed by primary care.…”

Section: Discussionmentioning

confidence: 99%

“…1 The utility and feasibility of e-consults has been demonstrated across multiple specialties, including cardiology, 3,4 gastroenterology, 5 endocrinology, 6 infectious disease, 7 nephrology, 8 and dermatology. 9 Although the only data currently available addressing allergy/ immunology (A/I) e-consults come from the outpatient setting, 10 the inpatient setting is prime to incorporate asynchronous evaluations. Indeed, scarcity of inpatient A/I availability has been cited as a limiting factor for collaborating with inpatient antimicrobial stewardship programs, 11 and e-consults could be a strategy to bridge this gap.…”

mentioning

confidence: 99%

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Inpatient Electronic Consultations (E-consults) in Allergy/Immunology

Mustafa

Staicu

Yang

et al. 2020

The Journal of Allergy and Clinical Immunology: In Practice

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What is already known about this topic? There are outpatient data for electronic consultations (e-consults) in allergy/ immunology (A/I) but no data for inpatient A/I consultations. What does this article add to our knowledge? We demonstrate that A/I inpatient e-consults are feasible, potentially less costly, and maintain requesting provider satisfaction for certain conditions. How does this study impact current management guidelines? E-consults are a strategy to improve A/I access in inpatient settings and are particularly relevant during the novel coronavirus infection pandemic. BACKGROUND: Electronic consultations (e-consults) are asynchronous clinician-to-clinician exchanges within the electronic health record (EHR). OBJECTIVE: We sought to demonstrate the utility of e-consults in allergy/immunology (A/I) inpatient consultations. METHODS: Inpatients ‡18 years of age for whom an A/I consultation was requested were eligible for an e-consult. An econsult was completed if considered appropriate by the A/I physician with recommendations made in the EHR. In-person consultation was performed for inpatients if deemed necessary. Likert scale satisfaction data were collected from requesting providers after the e-consultation. Cost was calculated using time-based billing codes plus the cost of penicillin allergy evaluation, if appropriate. RESULTS: Of the 109 inpatient consults, 78 (71.6%) were completed through an e-consult and 31 (28.4%) were completed by an in-person consult. The most common indication for an inpatient consult was evaluation of penicillin allergy in 73 (67%) patients. The most common reason to complete an in-person consult was the need to complete penicillin skin testing in 17 of the 31 (55%) patients. E-consults were completed in less time than in-person consults (15 minutes, interquartile range [IQR]: 10-15 vs 60 minutes, IQR: 45-60, P < .001) and had a shorter turnaround time (1 hour, IQR: 0.5-2 vs 7 hours, IQR: 3-19, P < .001). Management recommendations were followed at a similar rate regardless of type of consult (88% of e-consults vs 96% of in-person consults, P [ .162). A total of 97% of requesting providers reported an "excellent" or "good" impression of e-consults. E-consults were less costly than in-person consults. CONCLUSIONS: E-consults have utility in providing inpatient A/I consultation and may have advantages over in-person evaluation, while adequately maintaining provider satisfaction.

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Family Physician–to–Hospital Specialist Electronic Consultation and Access to Hospital Care

Peeters,

Reichel,

Muris

et al. 2024

JAMA Netw Open

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ImportanceGlobally, health care systems face challenges in managing health care costs while maintaining access to hospital care, quality of care, and a good work balance for caregivers. Electronic consultations (e-consultations)—defined as asynchronous, consultative communication between family physicians and hospital specialists—may offer advantages to face these challenges.ObjectiveTo provide a quantitative synthesis of the association of e-consultation with access to hospital care and the avoidance of hospital referrals.Evidence ReviewA systematic search through PubMed, MEDLINE, and Embase was conducted. Eligible studies included original research studies published from January 2010 to March 2023 in English, Dutch, or German that reported on outcomes associated with access to hospital care and the avoidance of hospital referrals. Reference lists of included articles were searched for additional studies. Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) scores were assigned to assess quality of evidence.FindingsThe search strategy resulted in 583 records, of which 72 studies were eligible for data extraction after applying exclusion criteria. Most studies were observational, focused on multispecialty services, and were performed in either Canada or the US. Outcomes on access to hospital care and the avoidance of referrals indicated that e-consultation was associated with improved access to hospital care and an increase in avoided referrals to the hospital specialist, although outcomes greatly differed across studies. GRADE scores were low or very low across studies.Conclusions and RelevanceIn this systematic review of the association of e-consultation with access to hospital care and the avoidance of hospital referrals, results indicated that the use of e-consultation has greatly increased over the years. Although e-consultation was associated with improved access to hospital care and avoidance of hospital referrals, it was hard to draw a conclusion about these outcomes due to heterogeneity and lack of high-quality evidence (eg, from randomized clinical trials). Nevertheless, these results suggest that e-consultation seems to be a promising digital health care implementation, but more rigorous studies are needed; nonrandomized trial designs should be used, and appropriate outcomes should be chosen in future research on this topic.

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Electronic Consultations in Allergy/Immunology

Cited by 35 publications

References 32 publications

Telemedicine and emerging technologies for health care in allergy/immunology

Telemedicine and emerging technologies for health care in allergy/immunology

Inpatient Electronic Consultations (E-consults) in Allergy/Immunology

Family Physician–to–Hospital Specialist Electronic Consultation and Access to Hospital Care

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