We prove that using eConsult (an asynchronous electronic form of consultation between primary care physicians and specialists) successfully defers patients from being seen face-to-face (FTF) for the same reason. This is a unique study that tracks the individual patient 18months after they have had an eConsult to show that in 97% of cases the patient does not access the system for the same reason and there were no deaths. This is hard data never published before. eConsult costs less (eConsult 60$ (52-72) versus FTF 541$ (204-1594). A FTF visit generates 12 times more outpatient resource utilization for the same clinical reason. Our study findings support eConsult as an important and safe component of any healthcare system for its ability to improve access and care in a patient-centered and cost-effective manner.

Objectives: Although PCPs report that one third of face-to-face (FTF) specialist referrals are averted using the Champlain BASE™ eConsult service (eConsult), the long-term impact of these reported deferrals on the health care system is poorly described. We measure the impact of eConsult on the long-term deferral of a FTF visit and costs.

Methods: Retrospective study on patients (<18yo) defined in our original pilot study whose PCP reported a FTF referral had been averted by completing an eConsult visit (index case). We linked these patients to provincial administrative databases and hospital electronic medical records and documented use of healthcare for identical specialty and diagnosis (ICD-10 or OHIP Billing code) within 18 months of the index case. In addition, a retrospective case-control study compared health care utilization and costs associated with an eConsult visit versus a FTF visit for the same reasons. PCP satisfaction with eConsult was described.

Results: Less than 5% of patients accessed the health care system for the identical diagnosis and specialist within 18months of the index eConsult. On average, FTF visits generated higher outpatient visits (12.61 times more (CI 2.28-69.66, p=.002) and in-patient hospital visits (8.16 (CI 0.73-90.68, p=0.044) compared to an eConsult visit. The FTF group also incurred significantly higher costs, both on the day of their consult (median $541 [Q1-Q3; $204-$1594] vs. $60 [$52-$72]; P<.0001). PCPs (98%) found eConsult an excellent service.

Conclusion: The reported deferral of a FTF specialist visit following an eConsult visit was associated with a true long-term deferral (up to 18mos) for the same diagnosis in 97% of children. Costs were statistically lower and less healthcare utilization was seen when using eConsult. eConsult can be used in a pediatric setting to minimize FTF specialist visits in most cases, towards a more efficient and cost-effective system.

Lai L, Liddy C, Keely E, Afkham A, Kurzawa J, Abdeen N, et al. The impact of electronic consultation on a Canadian tertiary care pediatric specialty referral system: A prospective single-center observational study. PLoS One. 2018 Jan 10;13(1):e0190247. doi: 10.1371/journal.pone.0190247. PMID: 29320539; PMCID: PMC5761872.

(manuscript in preparation for this study)