E-consults Drive Increased Involvement of VA Infectious Disease Specialists

By Annette M. Boyle

BOSTON—VA physicians in facilities across New England increasingly turn to infectious disease specialists at the VA Boston Healthcare System (VABHS) with questions about antibiotic resistance, Lyme disease and other issues, but the rise in demand has not led to more travel or meetings. Instead, the infectious disease (ID) specialists use electronic consultations to respond to questions, a system that has seen rapid adoption in the region.

The e-consults allow providers to tap into the ID department’s expertise without the hassle of coordinating schedules for face-to-face meetings over video or in person—or even arranging a convenient time for a phone call.

The asynchronous consultations permit a provider to ask for a specialist’s input through the integrated electronic health record and receive an answer much more quickly than a patient appointment could be arranged. In many cases, e-consults can occur more quickly and with more complete patient information than possible through even informal conversations or phone calls, particularly for off-site physicians.

According to research published in Clinical Infectious Diseases, the addition of e-consults contributed to a nearly 150% increase in overall consultations between 2011 and 2014 without any drop in face-to-face consults. Before the introduction of e-consults in 2012, the section handled 193 consultations annually. Two years later, there were 195 face-to-face consults and 285 e-consults. The study numbers did not include in-patient consults.1

Disruptive Innovation: Implementation of Electronic Consultations in a Veterans Affairs Health Care System. JMIR Med Inform. 2016 Feb 12;4(1):e6

The “ease of access to a specialist and an answer to a clinical question in a more timely manner than face-to-face visit” drove the sharp increase in consultations, according to lead author Judith Strymish, MD, an infectious disease specialist at the VABHS. In the study, face-to-face (FTF) consults took 16.5 days to arrange, while providers received responses via the e-consult system in a matter of hours (0.6 days).

The number of infectious disease e-consults has continued to rise since 2014, Strymish told U.S. Medicine. “The most-recent data in infectious diseases for the last 12 months, July 2016 through June 2017, showed that we have done 531 e-consults,” she said.

The VABHS infectious disease section responds to consult requests from the health system’s three primary campuses and five community-based outpatient clinics as well as other regional facilities and two adjacent VA healthcare systems. Providers ask for consults for patients in acute inpatient, rehabilitation, skilled nursing, palliative, hospice and specialty care units. All requests come through the VA’s nationwide EHR.

Providers at subacute and long-term care facilities turned to e-consults at four times the rate that they requested in-person consultations and non-VABHS facilities used the consults through the EHR at three times the frequency of FTF consultations.

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  1. Sandra G. Gompf MD says:

    We’ve experienced similar growth in E-consults, and the questions are often quite interesting. I agree that ID specialists have an important role to fill in the need for real-time information, especially relevant to antimicrobial stewardship efforts.

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