300 - Calls, Computers and Cars: Using e-Consults to Create a Continuum of Care for Specialty Consultation

Publication Number: 300.4424

Alison Brent, Children's Hospital Colorado, Aurora, CO, United States; Gwendolyn S. Kerby, Children's Hospital Colorado, Aurora, CO, United States; Melanie Douglass, Children's Hospital Colorado, Parker, CO, United States; Shikha S. Sundaram, University of Colorado School of Medicine, Aurora, CO, United States; David M. Keller, Children's Hospital Colorado, Aurora, CO, United States; Maya Bunik, Children's Hospital Colorado, Aurora, CO, United States

Background: Primary care providers (PCPs), trusted partner for patients and families, often need pediatric sub-specialty providers (PSPs) expertise when new issues or complicated diagnoses arise. Referrals to PSPs can be challenging for patient families due to stress of waiting for visit, travel or time off from work or school. eConsult, an asynchronous form of telemedicine, can be an optimal choice for provider-to-provider questions not requiring an in-person (IP) visit. Our institution has multiple channels for consultation and communication, including complimentary peer-peer telephone consultation (OneCall), IP visits and a recently added e-Consult pilot. Federal guidance to States allowed our State Medicaid program to pay for e-Consults, creating an opportunity to support the clinical work of PSPs. We chose to convert our e-Consul pilot into a regular clinical service with commensurate billing.

Objective: 1) Educate community PCPs and internal PSPs to integrate e-consults into a sustainable option of subspecialty consultation without increasing telephone consultation.

Design/Methods: Communication Inventory: Team reviewed and updated existing pathways for PCP-PSP consultation, assessing each for utility, ease of use and electronic health record integration.

Establishing Expectations: Preferred methods of consultation were linked to specific clinical situations in a simple graphic format (Fig 1).

Implementation: Billing for eConsult deployed in July 2024. Physician Relations managed provider education via in-person visits and online forums. The value of eConsult for patient families and PCP’s, including rapid turnaround time, EMR inclusion, flat fee for extensive data review, temporizing option for long wait time PSPs and improved care coordination was emphasized along with peace of mind for patient, family, and providers (Fig2).

Results: Volumes of eConsult pre- and post- introduction of billing and peer-to-peer telephone consults shows an initial decrease in eConsult volume, subsequently trending upward. No significant change in the complimentary peer-peer telephone consultations (Graph 1).

Conclusion(s): Despite an initial decrease in eConsult volume with the institution of billing, there was not a commensurate increase in peer-to-peer telephone consultation. Based on the steady increase in eConsult volumes post institution of billing, and stability of telephone consults, we believe this represents ongoing acceptance of eConsult as a sustainable PCP-PSP consultation continuum. We anticipate eConsult will become an enduring PCP-PSP communication strategy with myriad benefits for patient families, PCPs, and PSPs.

Specialty Consultation Options
PAS_2025.Figure 1.jpegCommunity Provider Guidance for choosing optimal specialty consultation option.

What is an eConsult
PAS_2025.Figure2_Page_1.jpegAn eConsult guide for community providers

eConsult and OneCall volumes by week 2024
Evaluation of changes in volumes for eConsult and complimentary telephone consult after institution of billing for eConsult