Mass General e-consult program expedites allergy, immunology care

Electronic consultations in allergy and immunology at Massachusetts General Hospital have slashed the time needed to access specialist guidance and the need for in-person visits.

That’s the finding of a paper, published online in the Journal of Allergy and Clinical Immunology: In Practice, which reports on the first two years of the e-consult program at MGH.

Researchers examined data regarding allergy/immunology e-consults provided from August 2016 through July 2018, as well as in-person consults beginning in August 2014. What they found is that allergists completed e-consults in an average of 11 minutes, while the average turnaround time for the referring provider to receive allergy specialist guidance was less than 24 hours.

“We found that e-consults expedite care for all patients with allergy/immunology conditions,” says senior author Kimberly Blumenthal, MD, director of allergy/immunology clinical epidemiology research within MGH’s 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,” adds Blumenthal.

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The clinician-to-clinician e-consults are based on electronic health record data that do not require real-time communication and are designed to address non-urgent questions specific to the care of an individual patient, according to researchers.

“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 delivery neatly packaged recommendations to the patient,” says first author Neelam Phadke, MD, a research fellow in allergy/immunology at MGH.

However, Phadke contends that a key limitation for broader use of e-consults is the necessity for having EHR systems in place that may not be shared between specialists and referring physicians, an obstacle faced by smaller hospitals that often lack access to allergists.

It’s not a problem for MGH which began offering an e-consult program in cardiology and dermatology in late 2013 and then added allergy/immunology in August 2016. In 2018, nearly 10,000 e-consults were provided and as of January 2019 the program includes 47 specialty areas.