UVM eConsults Improve Access to Care, for Both Patients and Physicians
Published Sept. 29, 2022

During such a vulnerable time for healthcare providers across the nation, UVM Health Network never falls short and continues to improve quality access to specialty care. Telehealth options, such as eConsults, provide patients and their physicians with swift peace of mind.

Since 2021, eConsults has effectively and efficiently streamlined communications between primary care physicians, specialists, and their respective patients. Our physicians and renowned specialists are calling eConsults a "game changer" for the healthcare space.

Dr. John King – a primary care doctor at The University of Vermont Medical Center Family Medicine in Milton, Vermont – understands his patients' overwhelming stress when navigating a potentially life-threatening diagnosis because primary care physicians experience it too. For instance, after evaluating a patient with sudden liver problems, 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. "I was at a crossroads: I could refer [my patient] 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."

Improving Access to Specialty Care with eConsults

eConsults are helping UVM's primary care providers like Dr. King get their patients the quality care they need. An eConsult is a secure digital consultation that a primary care provider can request from a medical specialist for specific 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. This system is accessible across UVM Health Network hospitals and clinics in Vermont and northern New York.

Dr. Marie Sandoval, Medical Director of Digital Health and Adult Primary Care in South Burlington, Vermont, stated, "these [digital] consultations are perfect for patient concerns where primary care providers need some specialty guidance 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 quickly."

Research by the Association of American Medical Colleges shows that telehealth tools like eConsults can produce an 84% increase in timely access to specialty care, 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 most significant impact was 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, [terrified] about the prospect of a 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 Patients

Many physicians see this telehealth service as a unique opportunity to strengthen their collaboration with their colleagues and elevate the level of care they can offer 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. Access to eConsults with medical specialists across UVMHN, from neurology and pharmacy to sleep medicine and gynecology, has improved the quality of care for her patients and has made her work as a physician more manageable.

In one instance, Dr. Jacobs worked with a patient recovering from several small strokes while coping with various cardiac issues, which raised questions about his near-term health. With her patient's blessing, Dr. Jacobs initiated an eConsult that connected her with Chris Commichau, MD, a neurologist and Director of the Stroke and Neurocritical Care at the UVM Medical Center.

During the 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. eConsults are how we should work with our specialists. We should not send our ad hoc requests or ask them for informal consultations in their private time while they're still trying to look after all of their other patients." She added, "eConsults feel like the future and a sustainable way to treat my patients."

Better Referrals Through eConsults

A vital aim of eConsults is to improve the quality of referrals to medical specialists, thereby cutting down appointment backlogs that can make it difficult for patients to receive timely care. With less patient backlog, there's also less chaos in the work environment for our health professionals and clinical teams, all treating patients with the quality care that UVMHN is known to provide.

"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 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."

Elizabeth McGee, MD, is a reproductive endocrinologist and gynecologist at UVM Medical Center. She agrees that eConsults make patient care easier for both the doctor and the patient.

"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 available at eight UVM Medical Center primary care clinics, serving about 70,000 people. eConsults cover various specialties, including gynecology, neurology, pulmonology, sleep medicine, urology, and pharmacy. 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 added. "In the near-term, we're expanding eConsults to include new specialties like endocrinology, nephrology, pelvic health, and rheumatology, with more to come."

Are you a primary care doctor or specialty physician looking to join our team of innovative minds in medicine? Learn more about the impact of our critical work at UVMHealthImpact.org.

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