eConsult services are most often conducted on an asynchronous, or store-and-forward, telemedicine platform, enabling both the primary care provider and the specialist to work at their own pace within a specified time period.
For primary care providers and specialists connecting through a typical store-and-forward platform, the process of consulting on a case is relatively straightforward:
- Through an online portal, the PCP will present the patient case along with any necessary data, such as images or test results.
- The specialist gets an alert (such as a text message) that an eConsult is available in the portal. He or she reviews the case and makes a diagnosis, consulting other decision support resources if necessary. That diagnosis is then sent back to the PCP.
- In cases where the specialist has answered the PCP’s concerns, the PCP can then treat the patient more confidently and effectively – eliminating the need for an appointment with the specialist.
In cases where a diagnosis can’t be rendered online, the PCP then makes an appointment for the patient to be seen by a specialist in person. The eConsult lays the groundwork for that office visit, giving the specialist access to all the information he/she needs prior to the meeting.
eConsults offer convenience to providers as well as to patients.
In safety net populations, patients often can’t afford to see specialists or face significant barriers to access, such as long wait times, transportation problems, or distance to the specialist’s office. Without a telehealth option, these patients would not get the care they need, putting them at a greater risk of negative health outcomes.
Safety net providers are generally the only source of care for this population – they’re tasked to do a lot within the limited time frame of a clinic visit. These patients don’t have the time, money or resources to seek specialist care, so the PCP has to find a way to bring specialists into the clinic. That’s where eConsults come in.
Connecticut-based Community Health Center, Inc., has been seeing success with an eConsult service for FQHCs launched in 2015. The service was developed by Darren Anderson, MD, CHC’s vice president and chief quality officer and director of the Weitzman Institute, a community-based research center founded to help FQHCs improve primary care services for the underserved. Anderson also worked with Safety Net Connect (SNC), a California-based digital health company.
Following a one-year pilot program in which Anderson reported 90 percent success in using the erConsult platform to facilitate specialist consults, the Centers for Medicare & Medicaid Services announced in 2016 that it would reimburse CHC for its eConsult platform through the state’s Medicaid program.
“With limited specialty providers available to treat Medicaid patients, appointment wait times can be as long as a year, leading to healthcare disparities, higher rates of disability and complications in chronic diseases,” officials said in a press release announcing the decision. “SNC’s eConsult system has been proven to increase access to timely, cost-effective specialty services for underinsured and underserved patients, many of whom live in rural areas with limited access to specialty care.”