Minding the gaps: assessing communication outcomes of electronic preconsultation exchange.
Outpatient practices are increasingly using electronic referrals, or eConsults, to obtain clinical input from specialists because of insufficient access to subspecialty care. In an eConsult, the referring clinician (usually a primary care physician) will provide clinical information to the specialist via email or a web-based system. The specialist will review the information in the electronic medical record and decide whether further testing, treatment, or an in-person consultation is necessary. This retrospective study evaluated the safety of the electronic referral process by reviewing the medical records of patients who had been referred to a gastroenterology clinic but were deemed to not require an in-person appointment. Few cases of potential harm were found among patients whose consultation question was addressed electronically. However, of patients whose electronic referral was unresolved (symptoms prompting referral were not resolved and the specialist did not recommend an in-person visit), more than 70% were at moderate to high risk of harm. These cases included many patients who had no documented health care visits in the 6 months after the electronic referral was placed. Although the authors did not identify any definitive cases of harm attributable to failures of the electronic referral process, this study does highlight the need for robust tracking of eConsults to ensure appropriate follow-up by referring providers.
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