The Veterans Affairs New England Healthcare System saw a rapid increase in preoperative electronic consultations over a four-year period driven by perceived workflow efficiencies by clinicians at four specific sites.
Anesthesia e-consults at the VA New England system skyrocketed beginning in 2012 following a broader push from leaders at the regional and national level to enhance communication between primary care providers and specialists. E-consults allow providers to consult with one another using a platform integrated into the VA’s EHR.
In 2015, the New England system reported more than 5,000 anesthesiology e-consults, up from just 103 in 2012, according to a new study published in Health Affairs. Four of the systems' eight medical centers accounted for 97% of those consultations, including the Providence VA Medical Center in Rhode Island—an early adopter that led the way with more than 1,800 e-consults in 2015.
Adoption was driven by more than just the initial push from senior leadership. For the Providence facility, e-consults offered a way to develop an anesthetic plan with the surgeon without having to manage the overbooking or staff conflicts frequently associated with a face-to-face meeting. Those workflow efficiencies generated more interest from clinicians and were later passed along to a Maine facility that was able to eliminate unnecessary patient visits in the lead up to surgery.
Each site varied in its implementation—Providence virtually did away with in-person consultations, while others adopted a hybrid approach, using e-consults for certain surgeries. But adoption was closely tied to the perceived value by clinicians.
“Stakeholders at sites with high use of e-consults appreciated the convenience for patients and the improvement in workflow, and they believed that the quality of care was maintained,” researchers at the VA, Harvard and Partners HealthCare wrote. “Many stakeholders at sites with lower use of e-consults believed that a face-to-face visit with an anesthesiologist offered better care to patients, and some interviewees expressed concern that shifting work from face-to-face visits to e-consults did not reduce the workload burden.”
The drastic increase also shows the ability for health systems to repurpose innovative technologies in places where they are needed most. Although e-consults were initially rolled out to be a resource for primary care providers, clinicians in the VA’s New England system quickly discovered the benefits for anesthesia consultations.
Research from the Los Angeles County Department of Health Services has shown off how e-consults can positively impact wait times and reduce patient visits. Meanwhile, the Human Diagnosis Project is attempting to create a national e-consult service by combining specialty expertise and national language processing on an online platform.