Jt Comm J Qual Patient Saf. 2022 Feb;48(2):114-119. doi: 10.1016/j.jcjq.2021.10.007. Epub 2021 Oct 30.
Traditional specialty consults are resource intensive and may be delayed or omitted if the treating physician does not recognize the need for specialty advice. Targeted automatic e-consults (TACos) address these limitations by prospectively identifying patients using the electronic health record (EHR) and presenting pertinent information on a dashboard, enabling consultants to provide a virtual consult with written recommendations. The TACo model may improve value by facilitating more expert input without a proportional increase in cost.
Through our experience developing a TACo program, we have identified four key steps. First, identify appropriate conditions that have support from the health system and from frontline clinicians. Second, design the digital infrastructure, including lists and dashboards. Third, create a funding plan to support the consultant's time, either through internal grants, external grants, e-consult billing codes, or some combination of the three. Fourth, pilot on a select number of services, iterate, and scale.
Funding for TACos has been a major barrier to adoption. Fortunately, new e-consult billing codes may make it possible to recoup as least part of the program's cost. Technological hurdles also exist, particularly in building real-time lists within the EHR to prospectively identify patients based on complex criteria.
We look for this model to gain popularity as evidence of clinical and operational benefit mounts. We anticipate reimbursement policies may be updated to support this type of consult. Finally, we expect machine learning to play a role in identifying patients and providing recommendations in the future.
传统的专科会诊需要耗费大量资源，如果主治医生没有意识到需要专科建议，可能会被延迟或省略。有针对性的自动电子咨询（TACos）通过使用电子健康记录（EHR）前瞻性地识别患者，并在仪表板上呈现相关信息，从而解决了这些限制，使顾问能够提供带有书面建议的虚拟咨询。TACo 模式可以通过在不增加成本的情况下促进更多专家的投入来提高价值。
建立 TACo：通过我们在开发 TACo 项目方面的经验，我们确定了四个关键步骤。首先，确定有卫生系统和一线临床医生支持的适当条件。其次，设计数字基础设施，包括清单和仪表板。第三，创建一个资金计划，以支持顾问的时间，可以通过内部拨款、外部拨款、电子咨询计费代码，或三者的某种组合来实现。第四，在选定的服务上进行试点，迭代和扩展。
TACos 的资金一直是采用的主要障碍。幸运的是，新的电子咨询计费代码可能使收回该计划部分成本成为可能。技术障碍也存在，特别是在构建基于复杂标准的实时清单以前瞻性地识别患者方面。
随着临床和运营效益的积累，我们希望看到这种模式变得更加流行。我们预计报销政策可能会更新以支持这种类型的咨询。最后，我们预计机器学习将在未来在识别患者和提供建议方面发挥作用。
