June 7, 2017

eConsults: Connecting Doctors for Better Care

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Nick Mascoli, MD, Medical Director of Primary Care at Newton-Wellesley Hospital Ambulatory Services.

A patient at Newton-Wellesley Hospital (NWH) presents with joint stiffness, a fever, and fatigue. His primary care doctor knows that he is an avid hiker and suspects a case of Lyme disease. She orders an ELISA test for her patient but the results are inconclusive. She is pretty certain the patient has Lyme disease, but would like the input of an infectious disease specialist.

Instead of scheduling a patient referral—which might mean her patient waiting weeks for an appointment, having the patient retell his medical history, undergo more tests, and spend more time away from his usual daily activities, she simply logs into her computer and sends a quick message through the patient’s electronic health record. An infectious disease specialist returns the primary care doctor’s message in less than 24 hours, helping her to interpret her lab results, and getting the patient quicker treatment for a case of Lyme disease.

Physicians at Brigham and Women’s Hospital (BWH), Massachusetts General Hospital (MGH), and Newton-Wellesley Hospital can now access a Partners program called eConsults which leverages the electronic health record (EHR) platform to connect primary care physicians (PCPs) directly with specialists to streamline and improve care. Since 2012, when the program first launched at Massachusetts General Hospital and Brigham and Women’s Hospital over 9,200 eConsults have been conducted across 40 specialties with an estimated savings of $1.8 million.

Using the EHR, PCPs can request an eConsult from a specialist, such as a cardiologist, urologist, or neurologist. The process is similar to sending an email or filling out an online form. The idea of doctor to doctor consults is not new—historically it was accomplished with a quick phone call to a colleague—but eConsults now provides a formal way to track and manage these types of requests while offering PCPs access to a much larger pool of specialists.

Newton-Wellesley Hospital is the first community hospital to roll-out eConsults, starting with infectious disease and urology, with plans to add GI and cardiology in the near future. “Although we have just started to pilot e-Consults at Newton-Wellesley, we have already seen the benefits of the PCP-specialist collaborating in this manner,” says Nick Mascoli, MD, ‎ Medical Director of Primary Care, Newton-Wellesley Hospital Ambulatory Services. “We’ve had some very helpful consults on C-diff and hematuria within the first few weeks, and that’s just with the few pilot specialties. We are really looking forward to an even broader adoption.”

Matthew Leibowitz, MD, Chief of Infectious Disease at NWH, helped build the framework for the eConsults program at NWH as the hospital prepared for eCare. He explains that the biggest hindrance to specialist-PCP collaboration prior to eCare was the lack of a shared medical record and the inability for a specialist to review the patient’s chart.“Now that the eConsult is in the patient’s medical record it’s really easy,” says Leibowitz. “You can go into the history and the labs. All the pertinent information is right there, just like a one stop shop.”

With an easy, accelerated way to get guidance from specialty providers, PCPs, when appropriate, can treat certain patients themselves. For example, a post-partum patient who is breastfeeding and experiencing migraines may not need a full workup with a neurologist. Instead, the neurologist can provide a recommendation to the PCP on how to best treat and manage the patient’s migraines. The PCP can implement this care plan without sending the patient to the neurologist.

“eConsults ends up fostering really good relationships between specialty and primary care,” says Sandhya Rao, MD, Specialty Programs Medical Director in Partners Center for Population Health and Medical Director for the Massachusetts General Physicians Organization (MGPO). “Not only does it empower primary care physicians to be able to provide more care, it makes specialty care more affordable and more generally accessible to all of our patients.”

eConsults does this by freeing up time on a busy specialist schedule for sicker patients with much more complex care. It’s also more efficient for patients who need an in-person appointment with a specialist because lab results and other tests can be ordered prior to the appointment, resulting in a more productive visit.

“If the specialist reviews the question and decided the patient needs to see a specialist, I don’t view that as a failure,” says Amy Flaster, MD, MBA, Assistant Medical Director at Partners Center for Population Health and PCP at Brigham and Women’s Hospital. “I think it’s great because the specialist gets a heads up and more information than a standard referral. And I can do some additional workup before they go to the specialist office.” For patients, eConsults are convenient and the collaboration between the PCPs and specialists ultimately ensures that patients get better care.

“With eConsults, we’re trying to improve care. Very often better care will result in cheaper care, but the real focus we have is on the patient and quality,” says Jason Wasfy, MD, Assistant Medical Director of the MGPO, Director of Quality and Outcomes Research of the Massachusetts General Heart Center, as well as a Massachusetts General Cardiologist who often receives eConsults. “eConsults reminds me that population health management, when done right, is really about making care better.”

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