e-Consults in gastroenterology: An opportunity for innovative care

J Telemed Telecare. 2019 Sep;25(8):499-505. doi: 10.1177/1357633X18781189. Epub 2018 Jul 4.


Background and aim: 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.

Study: 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.

Results: 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.

Conclusions: 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.

Keywords: E-consults; practice management; telemedicine; value.

MeSH terms

  • Distance Counseling / methods*
  • Female
  • Gastroenterology / methods*
  • Gastrointestinal Diseases / diagnosis*
  • Gastrointestinal Diseases / therapy*
  • Humans
  • Male
  • Medical Records
  • Program Evaluation
  • Surveys and Questionnaires