New research from Massachusetts General Hospital points to the usefulness of electronic consultations, or e-consults, during the COVID-19 pandemic. Such technology allows clinicians to ask specific questions of specialists, who then provide recommendations after reviewing a patient’s electronic health record with no direct specialist-to-patient contact involved.

An important part of telemedicine, e-consults—which have been used at Mass General since 2014 as a tool to improve population health—reduce unnecessary patient visits to specialists and decrease wait times for those patients who need in-person specialist visits.

Neelam A. Phadke, MD, Jason Wasfy, MD, and their colleagues examined daily consultation requests from February 1, 2020 through April 1, 2020 at Mass General. Their findings are published in the Journal of General Internal Medicine.

The investigators compared the use of in-person consults and e-consults before and after March 11, the day the governor of Massachusetts declared a COVID-19–related state of emergency. While both types of consult requests declined after March 11, the in-person consults declined more than the e-consults, resulting in an increase in e-consults from 8.5% of all consults before March 11 to 19.6% after March 11. Therefore, the proportion of e-consults requested more than doubled.

“We have already seen patients of all ages defer routine or life-saving care including everything from pediatric vaccinations for highly preventable diseases to evaluation for potentially fatal conditions such as strokes and heart attacks,” said Dr. Phadke, who is an Allergist/Immunologist at Mass General and a Health Policy & Administration fellow at the Mass General Physicians Organization. 

“As experts predict that our nation may see effects of this pandemic span the next 18 to 24 months, it is clear that our health care system must step up and find alternative care delivery methods so that patients feel comfortable seeking much-needed care. E-consults fulfill this demand as there is no direct patient-to-specialist contact that would require a patient to come into the hospital or clinic.”

Dr. Phadke noted that although e-consults cannot replace in-person visits for acute conditions (such as heart attacks) or those requiring procedures (such as vaccinations), they allow many patients to receive care that they may have otherwise skipped or neglected. 

In addition, this care can be provided in a manner that does not require patients to forgo physical distancing measures or health care systems to invest in additional personal protective equipment.

“By making use of an already-existing electronic health record system, e-consults add minimal cost to the health care system during a time when all sectors of the economy are struggling financially,” Dr. Phadke said.

Redeploying Cost-saving Tools in a Time of Emergency

Dr. Wasfy, Director of Quality and Analytics at Mass General's Corrigan Minehan Heart Center and a Medical Director of the Mass General Physicians Organization, added that the use of e-consults to provide care during the pandemic shows how tools developed in other settings can be deployed during an emergency.

“In 2014, e-consults were created as a tool for reducing costs and improving value. We developed these tools as a response to accountable care organizations, which are contracts that reward health care providers for reducing preventable health costs,” he said. “Now we are seeing that these programs, originally created for a different purpose, can aid in the response to a public health crisis.”

The authors note that it will be important to follow trends in the use of e-consults in the coming months. With such significant increases seen in just a few weeks, longer studies may show an even greater impact.

Paper cited: Phadke, N.A., del Carmen, M.G., Goldstein, S.A. et al. Trends in Ambulatory Electronic Consultations During the COVID-19 Pandemic. J GEN INTERN MED (2020).

About the Massachusetts General Hospital

Massachusetts General Hospital, founded in 1811, is the original and largest teaching hospital of Harvard Medical School. The Mass General Research Institute conducts the largest hospital-based research program in the nation, with annual research operations of more than $1 billion and comprises more than 9,500 researchers working across more than 30 institutes, centers and departments. In August 2019, Mass General was named #2 in the U.S. News & World Report list of "America’s Best Hospitals."