Drawing on the success of other large safety-net systems, NYC Health + Hospitals built an e-consultation program that improved access to specialty care and reduced wait times for patients.
Highlighting the distinct challenges that safety-net hospitals face in ensuring Medicaid and uninsured patients receive timely specialty care, researchers at NYC Health + Hospitals outlined their ground-up approach to an e-consulting program designed to streamline patient referrals in an article for NEJM Catalyst.
In one pilot clinic, third next available appointments—a common metric used by hospitals to measure wait times—dropped from 37 days to eight days in the first six months.
Three key factors emerged during the program’s implementation.
- Build the program into existing workflows: Leaders of the e-consulting initiative sought to integrate the program into existing workflows as much as possible by building closed-loop referral tracking management into the system’s commercial EHR system. A “specialty reviewer” triaged each referral to determine if the patient required a face-to-face visit or an electronic consultation
- Two-way communication is critical: The success of an e-consulting program relies on clear communication between primary care providers and specialists and the ability to co-manage patients. During the system’s initial pilot, 30% of referrals were eligible management by the primary care provider, with support from the specialists, or required additional tests
- Prepare for shifting workloads: During the initiative, much of the workload shifted to specialists to triage referrals and book patients. The authors noted that the hospital was exploring additional options to support specialists and their administrative staff to account for this shift
Last month, Los Angeles County Department of Health Services reported similar benefits from an e-consulting program that allowed a quarter of patients to resolve health issues without seeing a specialist in person.