Widespread Adoption

Clare Liddy, Paul Drosinis, Erin Keely, Donald M Hilty, Thomas S Nesbitt, Christina A Kuenneth, Grace M Cruz, Robert E Hales, Ronald Schachter, Beatriz Tejera, Sagrario Bustabad, Wouter Janssen, Ryan Hickson, Jeffery Talbert, William C Thornbury, Nathan R Perin, Amie J Goodin, Timothy W Kenealy, Matthew J G Parsons, A Paul B RouseRobert N Doughty, Nicolette F Sheridan, Jennifer K Harré Hindmarsh, Sarah C Masson, Harry H Rea, Cynthia Owsley, Lindsay A Rhodes, Gerald Mcgwin Jr, Stephen T Mennemeyer, Mary Bregantini, Nita Patel, Demond M Wiley, Frank Larussa, Dan Box, Jinan Saaddine, John E Crews, Christopher A Girkin, Ribeiro Sales, Paula Rejane, Beserra Diniz, Kirk H Waibel, Milena Soriano Marcolino, Renato Minelli Figueira, Clareci Silva Cardoso, Antonio Luiz Ribeiro, Maria Beatriz Alkmim, Minas Gerais, Belo Horizonte, Universidade Federal, De Minas Gerais, Belo Horizonte, Universidade Federal De Sa, Emma Pitchforth, Eleanor M Winpenny, Sarah King, Martin Roland, Jennifer M Polinski, Tobias Barker, Nancy Gagliano, Andrew Sussman, Troyen A Brennan, William H Shrank

Research output: Chapter in Book/Report/Conference proceedingChapterpeer-review


BACKGROUND: Many health organizations are exploring the potential of electronic consultation (eConsult) services to address excessive wait times for specialist care. OBJECTIVE: To understand the effectiveness, population impact and costs associated with implementation of eConsult services. METHODS: We conducted a systematic review using a narrative synthesis approach. We searched Medline and Embase from inception to August 2014 (English/French). Included studies focused on communication between primary care providers and specialist physicians through an asynchronous, directed communication over a secure electronic medium. We assessed study quality with a modified version of the Effective Public Health Practice Project Quality Assessment Tool for Quantitative Studies. We synthesized the results using the Triple Aim framework. RESULTS: A total of 36 studies were included. Most were set in the USA and focused on single-specialty services (most commonly dermatology). Population health outcomes included patient populations, adoption/utilization and provider attitudes. Providers cited timely advice from specialists, good medical care, confirmation of diagnoses and educational benefits. No clinical outcomes were reported. Patient experience of care was generally positive, with quick specialist response times (4.6 hours to 3.9 days), avoided referrals (12-84%) and satisfaction ranging from 78% to 93%. System costs were reported in only seven studies using different outcome measures and settings, limiting comparability. CONCLUSION: Though eConsult systems are highly acceptable for patients and providers and deliver improved access to specialist advice, gaps remain regarding eConsult's impact on population health and system costs. To achieve optimized health system performance, eConsult services must include specialty services as determined by community needs and further explore cost-effectiveness.
Original languageAmerican English
Title of host publicationFamily practice
Number of pages10
StatePublished - 2016

Publication series

NameFamily practice


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  • Communication
  • Eye care utilization
  • Eye health education
  • Glaucoma suspect
  • Health Services Accessibility
  • Health disparities
  • Humans
  • Internet
  • Ocular hypertension
  • Patient Satisfaction
  • Primary Health Care
  • Primary open angle glaucoma
  • Randomized Controlled Trials as Topic
  • Remote Consultation
  • Specialization
  • Spectral domain optical coherence tomography
  • Telemedicine
  • Time Factors
  • Vision impairment
  • access to care
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  • minas gerais and telehealth
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  • ocular hypertension
  • on physician time
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  • patient satisfaction
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  • primary health care
  • primary healthcare
  • primary open angle glaucoma
  • quality of healthcare
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