In 2012, the Veterans Affairs Boston Healthcare System (VABHS) implemented e-consults, directly connected to their electronic health record, for specialty evaluations.

We’ve previously covered a number of virtual visit medical apps for patients like OnDemand from New York-Presbyterian Hospitals, which generally replace urgent care or internal medicine visits. However, it’s often far more difficult for patients to get in to see a specialist like an endocrinologist or infectious disease physician. The Virtual Care Clinic from University of Southern California is a medical app that is addressing that with some specialties launching virtual evaluations. In this study by Strymish et al, we get a sense of what kind of impact these specialty virtual visits could make. Styrmish et al looked at what happened after implementing an infectious disease e-consult service that was directly embedded into their EHR.

After implementation of e-consults, 285 e-consults and 195 FTF (face to face) visits took place in the ID section, compared with 193 FTF visits before implementation. Over the course of a year, more patients were seen with e-consults than FTF, and for patients whose queries could be answered offsite, they were able to obtain an answer within an average of 0.6 days (SD 3.6) compared with 16.5 days (SD 12.4) for FTF patients.

In terms of overlap, only 6 patients required FTF consultation after an e-consult. This study showed that the scope of the visit can be a fairly good indication of whether a FTF consultation is required. For example, queries related to antimicrobial use for bacterial infections, diagnosis and management of latent TB, Lyme disease, UTI, C. difficile, perioperative advice, and immunizations were more frequently addressed with e-consults. Invasive infections often required FTF consultations. Interestingly, e-consults seem to encourage queries on new topics, such as management of positive urine cultures, perioperative prophylaxis, and immunizations unrelated to travel.

A key advantage of this platform is that it is embedded directly within the EHR, allowing both easy access to records as well as simplification of continuity of care. A platform like this could address many simple, common questions, potentially making clinic slots available so that sicker patients can be seen sooner. It can also serve as a first screen, enabling clinicians to triage patients’ queries and immediately address those that can be resolved remotely without in-person examination or further testing.