By Tamara Mathias

When allergy specialists advise other doctors via “e-consults,” everyone – patients included – saves time, a new study suggests.


In an e-consult, specialists review a patient’s electronic medical record through a secure portal and answer questions from primary care doctors who seek their advice and opinion.


This system is intended to replace the informal “curbside” practice of clinicians seeking medical opinions from specialists by walking into their offices, or over the phone.


Informal consultations don’t get documented in the medical record, and furthermore, specialists may get very limited or nonspecific information “and they’re trying to use that to make a recommendation,” said study author Dr. Neelam Phadke from the Massachusetts General Hospital in Boston, where the new study was conducted.


Phadke’s team analyzed roughly 300 allergy e-consults and found more than one in four provided advice and education without the patient needing to go for further diagnostic testing or to see a subspecialist.


Half the time, allergists needed no more than 11 minutes to complete an e-consult.


“That includes the amount of time the allergist took to read the questions, to review the charts, to make their recommendations and to send these recommendations back to the primary care doctor,” Phadke told Reuters Health by phone. “There’s no doubt that for all of the people who are key players here, there is a significant time saving.”


The study also found that half the time, allergists were able to respond to requests from other clinicians within 22 hours.


Traditional wait times are about a month for patients whose cases have been flagged to allergists by primary care doctors that don’t use e-consults, because patients must then wait for an appointment with the allergist.


Although the study was not designed to look at costs, previous studies suggest nearly $125 is saved for every traditional new patient consult replaced with an e-consult.


Still, e-consults are not yet popular among allergists.


One reason might be that e-consults are not currently recognized by health insurers for reimbursement, Phadke said.


Dr. Tania Elliott, an allergist at NYU Langone Health in New York City, who was not involved in the study, also noted that administrative, operational and educational barriers need to be addressed in order for e-consults to become mainstream.


She agreed that e-consults can reduce unnecessary referrals and diagnostic tests.


“There is particular potential to use them to treat drug allergy, particularly penicillin allergy, and even skin allergies such as atopic dermatitis and urticaria, if high resolution photos are uploaded and sent to the allergist,” she said.


Dr. Nathaniel Hare, an allergist at the UPMC Susquehanna Health Allergy Clinic in Williamsport, Pennsylvania, believes e-consults could become quite popular.


“I live in a relatively rural area in central Pennsylvania and take care of patients that sometimes drive an hour or more to see me,” Hare, who was not involved in the study, said. “There are times when I am simply taking a history that could be done without them there and then scheduling testing for a future date. I think having an e-consult first could help address these sorts of issues.”


For the study, researchers reviewed outcomes of 306 e-consults performed between 2016 and 2018. They found that 60% of patients who received an e-consult required an in-person consult to complete diagnosis and management, while 13% of patients received exclusively electronic guidance for diagnostic, therapeutic, or referral recommendations that were followed nearly 75% of the time.


“The idea put forward in this study holds water only if you can do e-consults (that can replace) an in-clinic visit … in a fashion that is cheaper and more efficient,” Hare cautions.


“The closer I get to constructing a patient schedule that is 100% full of patients who need to see me, the better use I am making of my time and patients’ time.”


SOURCE: Journal of Allergy and Clinical Immunology: In Practice, online June 3, 2019.