Electronic system lowers wait times for access to specialists

Low-income patients served by the Los Angeles County Department of Health Services (DHS) waited significantly less time to receive specialty care after DHS implemented an electronic system aimed at expediting access to specialists, according to a new study from Harvard T.H. Chan School of Public Health.

The findings provide some of the first evidence suggesting that using a web-based platform could improve access to specialists for underserved patients in any health system with significant constraints on specialty supply and access.

The study will be published March 6, 2017 in the March issue of Health Affairs.

"In the Department of Health Services, primary care providers often had enormous difficulty getting timely specialty care for their low-income patients," said lead author Michael Barnett, assistant professor of health policy and management at Harvard Chan School. "We found that adoption of a centralized, electronic system for specialty care led to sustainable improvements in access to care."

In 2012, the Los Angeles County DHS rolled out the "eConsult" system—an electronic system that enabled primary care providers to request assistance from specialists via a web-based platform with rapid specialist review and triage. eConsult replaced the old system of phone calls, emails, and faxes, which often left patients waiting months for face-to-face appointments.

After three years of steady growth, the eConsult system was in use by over 3,000 primary care providers, and 12,082 consultations were taking place each month. By 2015, median time to an electronic response from a specialist was just one day, and one quarter of eConsults were resolved without a specialist visit.

In addition, the median wait time to see a specialist decreased 17.4%, from 63 to 52 days. And the percentage of appointments scheduled within 30 days of the initial request increased from 24% to 30.2%.

"eConsult has helped Los Angeles County transform itself from a health system characterized by fragmentation of care and long wait times into an integrated health system in which a community of connected providers works together to meet the needs of our patients," said Paul Giboney, director of specialty care at the LA County DHS and senior author of the study.