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Mass. General researchers have found that electronic consultations in allergy and immunology can simplify the process of providing the most appropriate care, often reducing the need for in-person specialist visits.



Streamlining care through electronic consultations

4 min read

MGH study finds they can cut wait times and reduce the need for specialist visits

A study from researchers at Massachusetts General Hospital (MGH) has found that electronic consultations (e-consults) in allergy and immunology can simplify the process of providing the most appropriate care, often reducing the need for in-person specialist visits. The paper, which has been published online in the Journal of Allergy and Clinical Immunology: In Practice, reports on the first two years of the MGH program and finds a significant reduction in the time needed to access specialist guidance.

“We found that e-consults expedite care for all patients with allergy/immunology conditions,” said senior author Kimberly Blumenthal, an assistant professor of medicine and quality director in the Division of Rheumatology, Allergy and Immunology. “Whereas wait times for an in-person patient visit with an allergist often exceed three weeks, e-consults can provide allergist guidance to referring physicians within 72 business hours. For many patients, e-consults avert the need for an in-person visit entirely; and even when an in-person consult is required, the initial e-consult provides valuable information — including additional patient history, previous diagnostic testing and treatment trials — that can make the in-person consult more productive and valuable for the allergist, the referring provider, and the patient.”

Electronic, clinician-to-clinician consultations based on data in the electronic health record do not require real-time communication and are designed to address non-urgent questions specific to the care of each patient. MGH began offering e-consults in cardiology and dermatology in late 2013 and extended the program to allergy and immunology in August 2016. As of January 2019, the MGH e-consult program involves 47 specialty areas, and in 2018 it provided almost 10,000 e-consults.

The current study, led by first author Neelam Phadke, a research fellow in rheumatology, allergy, and immunology, looked at data regarding allergy/immunology e-consults provided from August 2016 through July 2018, as well as in-person consults beginning in August 2014. Of approximately 300 e-consults completed during the study period, around 60 percent led to recommendations for in-person specialty visits, while 27 percent provided only advice and education to the referring practitioner. When the e-consult led to a recommendation for an in-person specialty visit, information from the e-consult made visits more productive by allowing the allergist to be better prepared. Educational information provided via e-consults benefited both referring physicians and patients, often providing reassurance on the appropriateness of a planned course of action.

Two-thirds of e-consults related to patients with histories of potentially allergic reactions to drugs, primarily antibiotics such as penicillin, and many were done in conjunction with a program to evaluate pregnant patients with a history of penicillin allergy. Immunology e-consults could result from patient or provider concerns about frequent infections or abnormal antibody levels. While the average wait time for an in-person allergist visit before the institution of the e-consult program was 22.5 days, the wait time reduced to 21 days after the program began. Allergists completed e-consults in an average of 11 minutes, and the average turnaround time for the referring provider to receive allergy-specialist guidance was less than 24 hours.

“E-consults have become a critical tool in our efforts to innovate in outpatient care delivery,” said study co-author Jason H. Wasfy, an assistant professor of medicine. “We believe they can increase patient satisfaction, since we always give patients the choice between e-consults and regular in-person consults, and they reduce the burden for primary care providers. We also believe they can improve the quality of care and reduce costs, since electronic consults can substitute for in-person consults that are billed to insurance companies and to patients themselves.” Wasfy founded MGH’s e-consult program in 2013 and now directs population health management at the hospital.

Phadke noted that a key limitation to broader use of e-consults is the reliance on electronic medical records systems that may not be shared between specialists and referring physicians, a problem that could disproportionately affect smaller hospitals that already lack access to subspecialists like allergists. But when the required systems are in place, she said, “E-consults can allow primary care physicians to receive guidance from one or more subspecialists, synthesize messages that may have been conveyed from multiple providers, and deliver neatly packaged recommendations to the patient.”

Additional co-authors are Susan Goldstein and Jacqueline Ngo, MGH Performance Analysis and Improvement Unit; and Anna Wolfson, Christian Mancini, Xiaoqing Fu, Aidan Long, and Aleena Banerji, MGH Rheumatology, Allergy, and Immunology.