1 Duke Pediatric GI & Nutrition, Duke University Medical Center, Durham, NC, USA.
2 Division of Gastroenterology, Massachusetts General Hospital, Boston, MA, USA.
J Telemed Telecare. 2019 Sep;25(8):499-505. doi: 10.1177/1357633X18781189. Epub 2018 Jul 4.
Deploy and evaluate a gastroenterology (GI) electronic consultation (e-consult) program. E-consults are a promising approach to enhance provider communication, facilitate timely specialty advice and may replace some outpatient visits.
As part of our health system's efforts to provide more cost-effective care under risk-based contracts, we implemented an e-consult program where referring providers submit patient-specific clinical questions electronically via an electronic referral system. A GI consultant then reviews the patient's record and provides a written recommendation back to the referring physician. For our program evaluation, we conducted chart reviews of each e-consult to understand how the program was being used and surveyed the participating providers and consultants.
From September 2015 to March 2016, we received 144 e-consults, with most questions concerning GI symptoms or abnormal hepatology labs. Only 36% of e-consults recommended an in-person GI consult or procedure. In our survey of participating providers, referring providers strongly agreed that the GI e-consults promoted good patient care (88%) and were satisfied with the program (84%). The majority of GI consultants felt strongly that e-consults were useful for referring providers and their patients, but that current reimbursement and time allotted were not adequate.
We report on the implementation of a GI e-consult program within an ACO, showing that many clinical questions could be answered using this mechanism. E-consults in gastroenterology have the potential to reduce unnecessary visits and/or procedures for patients who can be managed by their primary provider, potentially increasing access for other patients.
部署并评估胃肠病学（GI）电子咨询（e-consult）计划。e-consult 是一种很有前途的方法，可以增强医患沟通，促进及时获得专科建议，并可能替代一些门诊就诊。
作为我们医疗系统在风险合同下提供更具成本效益的护理的努力的一部分，我们实施了电子咨询计划，其中转诊医生通过电子转诊系统提交患者特定的临床问题。然后，一名胃肠病学顾问会查看患者的记录，并向转诊医生提供书面建议。为了进行我们的项目评估，我们对每个电子咨询进行了图表审查，以了解该计划的使用情况，并对参与的医生和顾问进行了调查。
从 2015 年 9 月到 2016 年 3 月，我们收到了 144 次电子咨询，其中大多数问题涉及 GI 症状或异常肝功能检查结果。只有 36%的电子咨询建议进行胃肠病学的当面咨询或检查。在我们对参与医生的调查中，转诊医生强烈认为 GI 电子咨询促进了良好的患者护理（88%），并对该计划表示满意（84%）。大多数胃肠病学顾问强烈认为，电子咨询对转诊医生及其患者很有用，但目前的报销和分配的时间不足。
我们报告了在一个 ACO 中实施 GI 电子咨询计划的情况，表明许多临床问题可以通过这种机制得到解答。胃肠病学的电子咨询有可能减少可以由初级保健医生管理的患者的不必要就诊和/或检查，从而可能为其他患者增加就诊机会。
