Low-income patients served by the Los Angeles County Department of Health Services (DHS) waited significantly less time to receive specialty care after DHS implemented an electronic system aimed at expediting access to specialists, according to a new study from Harvard T.H. Chan School of Public Health.

The findings provide some of the first evidence suggesting that using a web-based platform could improve access to specialists for underserved patients in any health system with significant constraints on specialty supply and access.

The study was published March 6, 2017 in the March issue of Health Affairs.

“In the Department of Health Services, primary care providers often had enormous difficulty getting timely specialty care for their low-income patients,” said lead author Michael Barnett, assistant professor of health policy and management at Harvard Chan School. “We found that adoption of a centralized, electronic system for specialty care led to sustainable improvements in access to care.”

In 2012, the Los Angeles County DHS rolled out the “eConsult” system—an electronic system that enabled primary care providers to request assistance from specialists via a web-based platform with rapid specialist review and triage. eConsult replaced the old system, which often left patients waiting months for face-to-face appointments.

After three years of steady growth, the eConsult system was in use by over 3,000 primary care providers, and 12,082 consultations were taking place each month. By 2015, median time to an electronic response from a specialist was one day, and one quarter of eConsults were resolved without a specialist visit.

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