John King, MD, knew he had a choice.

As a primary care doctor at The University of Vermont Medical Center Family Medicine in Milton, Vermont, Dr. King had evaluated patients with sudden liver problems in the past, so he understood the extreme stress that his patient was experiencing as he navigated a potentially life-threatening diagnosis.

Dr. King’s training told him that the best way to get to the bottom of this case was to order a battery of blood tests and medical scans. But which would prove most effective and efficient? 

I was at a crossroads: I could refer him to a medical specialist, in which case he might face an anxious wait for an in-person appointment…or I could try to navigate this process myself,” Dr. King recalls. “In the end, a telehealth service – eConsults – gave me the perfect tool to take this on and get peace of mind for my patient.

Improving Access to Specialty Care with eConsults

Launched in late 2021, eConsults are helping primary care providers like Dr. King get their patients the specialty care they need.

An eConsult is a secure digital consultation that a primary care provider can request from a medical specialist for certain medical concerns — typically within a week – saving their patient the need to schedule a separate, specialist appointment. The consultation relies on both providers having access to a patient’s electronic health record, a system which is now live across all UVM Health Network hospitals and clinics in Vermont and northern New York.

These consultations are perfect for patient concerns where we primary care providers just need a little bit of specialty guidance to be able to handle the case ourselves. With eConsults and electronic health records, we can save our patients a visit to the specialist while still getting them that expert guidance, and quickly.

Marie Sandoval, MD, who serves as medical director of digital health and Adult Primary Care in South Burlington, Vermont.

Research by the Association of American Medical Colleges has shown that telehealth tools like eConsults can produce an 84% increase in timely access to specialty care, as well as fewer unnecessary visits and lower out-of-pocket costs. For patients, this also means less travel and time spent in their provider’s office.

For Dr. King, the biggest impact was on his patient’s peace of mind.

“Using an eConsult, we could quickly rule out the worst case scenario with the help of a gastrointestinal and liver specialist at the UVM Medical Center,” says Dr. King. “Here my patient was, truly scared about the prospect of a really serious illness. The eConsult saved him a lot of angst, while setting him on the road to recovery just a little bit faster.”

‘A Sustainable Way to Treat My Patients’

Many health care providers see this telehealth service as a unique opportunity to strengthen their collaboration with their colleagues and elevate the level of care they can offer their patients.

Reflecting on her growing use of eConsults, Alicia Jacobs, MD, says that eConsults have been a game changer. As a primary care provider at UVM Medical Center Family Medicine in Colchester, Vermont, Dr. Jacobs has leaned into the eConsults program, consulting with medical specialists across the UVM Health Network, from neurology and pharmacy to sleep medicine and gynecology.

Alicia Jacobs, MD, a primary care provider at UVM Medical Center Family Medicine in Colchester, Vermont.

I’m learning a lot from these eConsults. They’re particularly helpful in cases where patients are coping with multiple, overlapping health conditions, or where I have one or two clinical questions that shouldn’t require a separate appointment with a specialist for my patient to get the information they need.

Dr. Jacobs

In one instance, Dr. Jacobs was working with a patient recovering from several small strokes, while also coping with a variety of cardiac issues that raised questions about his near-term health and treatment. With her patient’s blessing, Dr. Jacobs initiated an eConsult that connected her with Chris Commichau, MD, a neurologist and director of stroke and neurocritical care at the UVM Medical Center.

During one eConsult, Dr. Commichau offered concrete guidance on several aspects of his recovery and treatment, a move that saved the patient an unnecessary neurology appointment. It also reassured the patient and Dr. Jacobs as they awaited his upcoming cardiology appointment, which was several months away.

For me, this is nothing short of leading-edge collaboration. This is how we should be working with our specialists – not sending them ad hoc requests or asking them for informal consultations in their private time, while they’re still trying to look after all of their other patients. This feels like the future and a sustainable way to treat my patients.

Dr. Jacobs

Better Referrals Through eConsults

A key aim of the eConsults program is to improve the quality of referrals to medical specialists, thereby cutting down on appointment backlogs that have at times made it difficult for patients to receive timely care.

“We receive a lot of referrals just so we can interpret a patient’s scan or offer guidance on what medications they should be taking,” says Dr. Commichau. “In most cases, these people really don’t need to be seen for a separate appointment. eConsults and our shared electronic health record system make it easy for us to remotely consult with our primary care providers on these types of issues.”

This feeling is shared by medical specialists across the UVM Health Network. Elizabeth McGee, MD, a reproductive endocrinologist and gynecologist at UVM Medical Center, says that eConsults will make it easier for ill patients to be seen by specialists in a timely manner.

“I can fit eConsults into my normal workflow and in doing so, I’m able to focus my in-person appointments on those people with more acute health problems that need an exam or complex evaluation,” says Dr. McGee. “Some of our patients travel two to three hours for their appointments, so if we can save them a visit by connecting with their provider through an eConsult, it’s a win-win for all of us.”

eConsults Expanding Across Network

The UVM Health Network telehealth service is currently available at eight UVM Medical Center primary care clinics, serving a population of about 70,000 people. eConsults span more than a dozen specialties, including gynecology, neurology, pulmonology, sleep medicine, urology and pharmacy, among others. Sarah Kessler, manager of digital health services at the UVM Health Network, says this is only the beginning.

“We are working with specialists across our health system to expand to all UVM Health Network primary care clinics in the future,” Kessler says. “In the near term, we’re expanding eConsults to include new specialties like endocrinology, nephrology, pelvic health and rheumatology, with more to come.”

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