- Electronic consultations (e-consults) are asynchronous clinician-to-clinician exchanges that rely on information in the patient's electronic health record (EHR)
- This study assessed COVID-19–associated changes in requests for e-consults at Massachusetts General Hospital between February 1 and April 1, 2020
- After March 11, 2020, when Massachusetts declared a COVID-19–related state of emergency, ambulatory consults declined more than e-consults, resulting in an increase in absolute e-consult proportion from 8.5% to 19.6%
- After adjustment for weekends/holidays and secular trends, the e-consult proportion increased by 5% daily from pre-emergency levels
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Electronic consultations (e-consults) are asynchronous clinician-to-clinician exchanges that rely on information in the patient's electronic health record (EHR). The requesting clinician asks specific, non-urgent, patient-specific clinical questions; the specialist reviews the patient's record and responds with detailed recommendations as an EHR note.
Massachusetts General Hospital first piloted e-consults in Cardiology and Dermatology. Physicians have since completed over 35,000 e-consults in 50 subspecialties.
Neelam A. Phadke, MD, research fellow in the Division of Rheumatology, Allergy and Immunology at Mass General and Torchiana fellow in Health Policy and Administration with the Massachusetts General Physicians Organization, and Jason H. Wasfy, MD, MPhil, medical director of the Massachusetts General Physicians Organization and director of Quality and Analytics in the Cardiology Division at Mass General, recently documented that e-consults can help sustain outpatient consultative care during the COVID-19 pandemic. They report their findings in a letter to the editor of the Journal of General Internal Medicine.
For administrative purposes, the researchers evaluated COVID-19–associated changes in requests for e-consults. The primary outcome was e-consult proportion, defined as e-consult volume divided by total consult volume (e-consult volume plus traditional ambulatory consult volume) and assessed using an interrupted time series model. The defined date of "intervention" was March 11, 2020, when Massachusetts declared a COVID-19–related state of emergency.
The researchers excluded specialty areas with less than 20 e-consult requests, specialty areas that did not offer both e-consults and ambulatory consults, and psychiatry because some requests were for behavioral health resources without a need for specialist guidance.
- Between February 1 and March 11, 2020 (40 days), a median of 565 ambulatory consults and 48 e-consults were requested daily
- Between March 11 and April 1, 2020 (21 days), a median of 144 ambulatory consults and 40 e-consults were requested daily
After March 11, ambulatory consults declined more than e-consults, resulting in an increase in absolute e-consult proportion from 8.5% to 19.6%.
After adjustment for weekends/holidays and secular trends, the e-consult proportion increased by 5% daily from pre-emergency levels.
Implications for Clinical Practice
E-consults are a promising method of delivering ambulatory consultative care during the COVID-19 pandemic because they provide clinical guidance while reducing the risk of in-person visits and preserving personal protective equipment. However, the results of this study may not be generalizable to institutions without an established e-consult program already in place.
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