Electronic Health Reporter

By Emilie de Ocampo, MD, pediatrician, Golden Valley Health Centers.

As primary care providers (PCPs), we’re increasingly trying to manage total patient care for more patients and facing worsening challenges in ensuring our patients can access the care they need.

In 2009, a short ten years ago, there were an estimated 209,000 PCPs providing services for a patient population that has now already exceeded 325 million individuals. The number of specialist referrals has doubled since 1999, increasing wait times and potentially diminishing overall healthcare quality for patients. Even more worrisome and adding to the challenge of access to specialty care is the projected shortage of up to 104,900 physicians in the United States by 2030—61,800 of whom will be specialists.

This worsening shortage in specialty care physicians adds to other factors challenging access, including Medicaid and Medicare acceptance rates, geographic barriers, and financial burden. eConsults can provide a solution for this growing problem. eConsults help mitigate access challenges by providing rapid specialist insights to PCPs who allow us to provide more comprehensive care, improving patient outcomes and satisfaction, all while reducing healthcare costs for patients and paying entities.

From my experience, there are three main benefits that eConsults contribute to delivering timely access to high-quality care:

1. At community health center practices, a routine referral can take 1 to 2 months before patients are able to be seen face-to-face by a specialist. For our patients, barriers to specialty care access are multi-faceted including limited regional specialist availability, patient transportation to and from visits, as well as a multitude of cost factors such as missed work, childcare, and out-of-pocket expenses. The use of eConsults provides a method of collaborating with specialists via an online portal to quickly provide access to specialty care for many patients—some of whom may otherwise go without.

2. Leveraging eConsults allows us to identify whether a face-to-face specialist referral is necessary for a patient, or if they can be treated within primary care with specialist guidance. eConsults are capable of replacing a large percentage of face-to-face referrals, but even in cases where the eConsult specialist does recommend a face-to-face visit, PCPs gain insight prior to the appointment on any workup that can be done in advance of the patient’s specialist visit. This saves time for both patients and overworked specialists. AristaMD’s eConsult platform is a guide to help PCPs provide patients with comprehensive, efficient, and effective care. It gives us the ability to provide “double the care for the patient” as they are being cared for by their primary physician and the consulting specialist.

3. In my experience, eConsults have been particularly successful with endocrinology cases. Typically, these cases don’t require a face-to-face visit, but instead require diagnostics that can be ordered by a PCP and reviewed by a specialist who provides a quick recommendation on the patient’s treatment plan. I’ve had cases in the past where a specialist’s treatment plan included diagnostic lab testing every 4 to 6 months for the patient. In this case, the patient was able to avoid numerous specialist visits and was able to do the routine lab regimen within primary care.

As PCPs, it’s our responsibility to do what we can to positively impact the health of our communities. As part of this duty, it’s imperative we shepherd innovative solutions, such as different types of telehealth. I’ve used eConsults as an effective tool to reduce specialist referrals, which results in low-acuity patients being treated quickly within primary care. This ensures many patients are able to access care within days, opposed to months. For many patients, this is the difference between a worsening condition and sending them to the ER, versus managing their conditions within the comfort of their PCP’s office.