What do primary care physicians think about eConsult systems?

Primary care physicians (PCPs) quite often consult with specialty providers or refer patients to other healthcare providers, particularly when their patients have chronic or complex conditions. A relatively new technology enabling the use of electronic consultations may help reduce the costs to patients when they need the care of such specialty providers. Electronic consultations (eConsults) are “non–face-to-face (F2F) consultations between a PCP and a specialist that utilize secure messaging to exchange information.”

A recent study published in The American Journal of Managed Care (AJMC) examined the use of eConsults among primary care physicians, to determine their effect on healthcare costs. The study also revealed the physicians’ attitudes toward the new technology. The study involved a “total of 369 Medicaid patients (who) were referred for cardiology consultations by primary care providers who were randomly assigned to use either eConsults or their usual face-to-face referral process.” All sites studied used an integrated electronic health record (EHR) system.

The results of the study suggested that “eConsults are associated with total cost savings to payers due principally to reductions in the cost of cardiac outpatient procedures.” However, the study also found that some primary care physicians were adverse to the use of such technology, for varied reasons.

A total of 36 primary care physicians participated in the study. Although a number of the physicians saw improvements in efficiencies, particularly in the reduced time involved in a consultation, some of the participating primary care physicians viewed eConsults as actually adding to their own workload. Some also felt that the wait time for an eConsult was longer than for a traditional face-to-face consultation. The use of eConsults, in most cases, reduced the amount of administrative work involved in coordinating visits, which may have staffing implications for the practice.

The researchers noted that the appeal of eConsults may be outweighed by “patient visit volume, staff support shortages, perceptions about compensation, the excessive burden of administrative and clerical tasks, and institutional culture” and so needs further study.