eConsults technology shakes up traditional doctor referral process

Getting patients to see a healthcare specialist can take weeks, months, or in some cases up to a year—assuming they can find one nearby who accepts their health insurance. And even when those appointments happen, sometimes primary care doctors learn that they could have treated the conditions all along.

To avoid that, some health systems, insurers, and practices have adopted electronic consulting (eConsult) and referral management platforms to connect primary care doctors with a wider network of specialists. Together, the primary doctor and the specialist can determine whether a patient needs specialty care and—if needed—find nearby, in-network providers.

The embrace of electronic platforms marks a major shift away from how referrals and consults have traditionally occurred in healthcare. For decades, primary care providers largely reached out to consult with colleagues (or friends) on an informal basis, or just blindly referred patients to specialists—a practice that does not always take into account whether that doctor accepts a patient’s insurance.

Backers of the new technology, like CEO Brooke LeVasseur of AristaMD, a digital health company that’s developed eConsult and referral management solutions, argue that it’s a win-win for the healthcare industry and patients alike because it improves access to specialists, which are in short supply, and cuts down on unnecessary speciality or emergency department visits—not to mention all the associated costs.

“What we’re trying to do is just more effectively leverage all the resources that we have,” LeVasseur said. “An eConsult can be just as effective a setting as person-to-person, and it can resolve it within a day.”

However, some providers have raised concerns that it merges specialty work into primary care and can contribute to physician burnout, according to a 2018 study that surveyed Los Angeles County safety net providers in 2016 and 2017.

The benefits for health systems

Stanford Medicine is among the health systems that have turned to eConsults to help clinicians advance patient care without needing full referrals. Christopher Sharp, the system’s chief medical information officer, told Healthcare Brew that it’s “been revolutionary” in facilitating Stanford Medicine primary care providers to better serve patients while alleviating access challenges for its specialists. The technology has also allowed Stanford Medicine to create new partnerships.

“It’s been really effective and really exciting for us,” he said. “The power of having a regional physician be able to say, ‘I’ve checked in with my Stanford specialist, and I know we’re on the right path with our care for you,’ we think, is a real value statement.”

Since 2015, 70% of eConsults through AristaMD’s platform—which now covers 50 million members across almost every state (and which claims Stanford Medicine as a client)—have been resolved with primary care providers treating patients immediately with guidance from specialists, LeVasseur said.

That means patients on waitlists can potentially see specialists faster, while those who don’t need specialty care can be treated by a doctor they already know and trust, she said. LeVasseur added that eConsults can save hundreds of dollars per case (depending on contracted rates) by reducing unnecessary testing and screenings, as well as emergency room visits that can result from delayed care.

For eConsults that result in a referral for specialty care, LeVasseur said, providers can use AristaMD’s referral management system to match patients with the best specialists who take insurance and are in their area—instead of relying on “a series of sticky notes on their computer” or Excel spreadsheets.

“We get rid of things like phone and fax—which people are still shocked about, but it’s how referrals are ordered today—and make it more traceable so the primary care clinic always knows whether the patient has actually been booked and can be in communication with the clinic,” she said. “It’s kind of an information vacuum without this sort of functionality.”