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 Pulmonology Rheumatology Nephrology Sleep Medicine Infectious Disease Hematology- Urology Colorectal Surgery Endocrinology Coagulation Orthopedics 1/2015 4/2015 7/2015 10/2016 12/2015 5/2016 6/2016 Neurology Allergy Psychiatry Cardiology Gastroenterology Hematology GI-Hepatology 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) All Lebanon Hematology Referrals by Month 2016 140 130 131 130 120 121 116 114 114 113 110 111 110 109 100 97 92 90 91 80 75 70 60 • 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 Hematology eConsults per month 35 31 30 25 22 21 20 18 17 17 16 15 15 14 13 12 11 10 9 8 8 7 7 7 6 5 5 5 2 0 0 0 0
Time Commitment 31min. Or more 5-10min. 3% 5% 11-20min. 21-30min. 5-10min. 31min. Or more • 68% of the time it takes 20 minutes 21-30min. or less 29% • Only 3% reported as taking longer than 30 minutes to address 11-20min. 63% 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
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