Electronic consults improve access to specialty care in Los Angeles

As patient access to primary care physicians has increased, the ability for specialists to keep up with referrals has not kept pace. E-consultations, in which primary care physicians submit referrals through their electronic health record system, have shown promise as a way to streamline the process, particularly among underserved populations.

RELATED: E-consults improve communication between clinicians, specialists

Now, a Los Angeles program demonstrates potential for electronic consultations with specialists to deal with that gap in access to care.

The Los Angeles County Department of Health Services implemented such a system, called eConsult, in 2012. According to a new study, the system has produced some remarkable results:

  • Overall system use grew to over 3,000 primary care providers between 2012 and 2015.
  • Consultations per month have grown to over 12,000 in 2015 from fewer than 100 per month in 2012.
  • The median wait for a specialist to respond electronically to a referral was one day.
  • A quarter of the referred consultations got resolved without the patient having to visit the specialist in person.
  • When patients did need to see a specialist, the median time between referral and an appointment decreased significantly.
  • The monthly volume of specialty visits remained stable, leading the study’s authors to conclude there was no evidence of either unmet demand for specialist care or an increase in the number of referrals by primary care physicians.

The authors believe the results “are likely relevant to any health system with significant constraints on specialty supply and access,” and not only to safety-net systems resembling the ones involved in the Los Angeles County program.

“These results should be encouraging to health systems interested in investing in eConsult systems and suggest that efforts to optimize specialist reviewers’ use of eConsult may lead to even greater efficiency in specialty care delivery,” they wrote.