224. Electronic consultations (E-consults) vs Face-to-Face Consults: Advancing Infectious Disease Care in a Large Veterans Affairs Healthcare System
Session: Poster Abstract Session: Clinical Practice Costs, Informatics, and Telemedicine
Thursday, October 8, 2015
Room: Poster Hall
Posters
  • Electronic consultations IDfinalpdf.pdf (1.1 MB)
  • Background:   The Veterans Affairs Boston Healthcare System (VABHS) has embraced electronic consults (EC) as a way to improve access to subspecialty care. VABHS is a large tertiary care facility, receiving Infectious Disease (ID) consults from acute inpatient settings, long term care facilities (LTCF), and outpatient clinics across New England. EC are asynchronous, consultative, provider-to-provider communications mitigating the need for a face-to-face (FTF) visit. The scope and impact of EC on FTF consultation in ID is not well described.

    Methods: The reason and frequency of consults in 2011 (FTF only) was compared to that in 2014 (FTF and EC).

    Results:    There were 193 FTF consults in 2011 compared to 195 in 2014 (during this time the total number of inpatient hospitalizations and outpatient visits at the medical center remained unchanged).  Of 308 EC in 2014, the largest group of questions (26%) included questions related to antimicrobial use for bacterial infections (fig 1). Frequency of e-consult versus FTF for Lyme disease, UTI, C diff, perioperative antibiotics, and immunization  were significantly higher (p <.05 for each) compared to FTF.  EC   were utilized more than FTF by LTC facilities [45 (14.8%) EC vs. 6 (3%) FTF] and non-Boston facilities [69 (22%) EC vs. 14 (7%) FTF].   98% of EC were done by 1 designated provider.

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    Conclusion:   The implementation of EC did not result in a compensatory decrease in the number of FTF consults. As such, the EC may represent new consultative work for the ID specialist. Whether this increased specialty involvement in care leads to improved outcomes remains to be evaluated. The EC turnaround time is significantly shorter than FTF; this may be augmented by a dedicated EC physician. Certain diagnoses such as UTI, noninvasive bacterial infections, perioperative surgical antibiotic management rarely trigger a FTF, but generate many EC, providing an opportunity to enhance antibiotic stewardship. 

    Judith Strymish, MD1,2, Gouri Gupte, PhD, MHA3, Kalpana Gupta, MD, MPH4,5, Eun Ji Kim, MD6, Varsha Vimalananda, MD MPH7,8,9,10, Katerina Devito, MS11, Steven R. Simon, MD MPH12,13,14 and Jay Orlander, MD12,15, (1)Infectious Disease, VA Boston Healthcare System, West Roxbury, MA, (2)Harvard Medical School, Boston, MA, (3)Department of Health Policy and Management, Boston University School of Public Health, Boston, MA, (4)Department of Medicine/Boston University School of Medicine, Boston, MA, (5)VA Boston Health Care System, West Roxbury, MA, (6)Boston Medical Center, Boston, MA, (7)Center for Healthcare Organization and Implementation Research (CHOIR), Edith Nourse Rogers Memorial Veterans Affairs Medical Center, Bedford, MA, (8)VA Boston HCS, West Roxbury, MA, (9)Section of Endocrinology, Diabetes and Metabolism, Boston University School of Medicine, Boston, MA, (10)Section of Endocrinology, Diabetes and Metabolism, VA Boston HCS, West Roxbury, MA, (11)Department of Nutrition, Harvard School of Public Health, Boston, MA, (12)Department of General Medicine, VA Boston HCS, West Roxbury, MA, (13)Department of General Medicine, Harvard Medical School, Boston, MA, (14)Department of General Medicine, Brigham and Womens Hospital, Boston, MA, (15)Department of General Medicine, Boston University School of Medicine, Boston, MA

    Disclosures:

    J. Strymish, None

    G. Gupte, None

    K. Gupta, None

    E. J. Kim, None

    V. Vimalananda, None

    K. Devito, None

    S. R. Simon, None

    J. Orlander, None

    Findings in the abstracts are embargoed until 12:01 a.m. PDT, Wednesday Oct. 7th with the exception of research findings presented at the IDWeek press conferences.