Electronic Consultations (eConsults) in Hematology: An Evaluation - - PowerPoint PPT Presentation

Electronic Consultations (eConsults) in Hematology: An Evaluation for Effectiveness

Presented by Joshua D. Hickman, MHA Practice Manager, Sr Norris Cotton Cancer Center Dartmouth-Hitchcock

Disclosures

I have no actual or potential conflict of interest in relation to this program and presentation.

Objectives

Implementation of eConsults Optimizing a system using eConsults Improvements from utilizing eConsults

The Beginning

• Started in 2014 through the Associations of American Medical

Colleges (AAMC) through a Health Care Innovations Award grant.

• AAMC launched the Coordinating Optimal Referral Experience (CORE)

project

• eConsults and Enhanced Referrals started from CORE Project
• Improve access to specialists
• Reduce marginal referrals
• Enhance the patient experience
• Reduce costs

Reference: https://www.aamc.org/initiatives/econsults/

Started With

Nephrology Infectious Disease Endocrinology Neurology Cardiology Hematology Pulmonology Rheumatology Sleep Medicine Hematology- Coagulation Allergy Gastroenterology GI-Hepatology Urology Orthopedics Psychiatry Colorectal Surgery

1/2015 4/2015 7/2015 10/2016 12/2015 5/2016 6/2016

And Continues To

What is an eConsult?

• An easy to use, condition-specific, template in the electronic medical

record that a Primary Care clinician can use to ask a specialist a question.

• Documented in the

medical record

• Response from a

Specialists within 3 business days

Easy to Use, Condition-Specific

Referrals (Internal and External)

92 114 110 116 114 130 113 131 109 97 111 75 91 121

60 70 80 90 100 110 120 130 140

All Lebanon Hematology Referrals by Month 2016

• NCCC Lebanon Hematology receives approximately 1,400 referrals a year
• 4.53 FTEs of Outpatient Hematologist in Lebanon
• 3.2 FTEs of Nurse Practitioners

Current Practice with eConsults

• eConsults has reduced the number of low complexity patients in our

clinics which can improve access to higher acuity or more complex patients.

• The rotating inpatient Hematologist now answers incoming eConsults

for the week.

Hematology eConsults

2 7 7 7 11 5 6 5 8 8 9 17 18 14 16 12 22 21 15 31 13 17

5 10 15 20 25 30 35

Hematology eConsults per month

Time Commitment

11-20min. 63% 21-30min. 29% 5-10min. 5%

• 31min. Or more

3%

11-20min. 21-30min. 5-10min.

• 31min. Or more
• 68% of the time it takes 20 minutes
• r less
• Only 3% reported as taking longer

than 30 minutes to address All times are self-reported by the completing Hematologist.

Future Considerations for eConsults

• Continued education to DH Primary Care providers about the benefit of utilizing

eConsults

• Continue to explore and develop models that make eConsults an effective tool for

non-DH Primary Care providers.

• DH Affiliate Groups
• Outside Organizations
• Investigate pathways that can use eConsults as a triage tool for incoming referrals

that might meet low complexity criteria.

• Continue to develop eConsults for malignancies within the Norris Cotton Cancer

Center

Results

• eConsults have improved access for the non-malignant hematology patients
• eConsults will continue to reduce the number of low complexity patients in clinics

and improve access for high acuity or higher complexity patients

• Of the 241 Hematology eConsults (2016), 81% of these patients did not require a

face to face consultation with the hematologist.

Questions?

Joshua D. Hickman 603-650-4690 Joshua.D.Hickman@Hitchcock.org