Electronic consultations between primary providers and radiologists improve patient care

According to ARRS' American Journal of Roentgenology (AJR), electronic consultation not only offered primary care providers (PCPs) easy access to expert opinions by radiologists, it promoted collaboration between physicians that improved patient care, including avoiding unnecessary imaging tests.

"The eConsult (Champlain BASE) electronic consultation platform was developed to provide a secure method for PCPs to ask a specialist patient-specific questions supported by relevant clinical information," explained first author Daniel Walker at the University of Ottawa.

Of the 20,678 eConsults completed through the service to all participating specialists from September 2012 to January 2017, 307 (1.48%) were sent to radiologists—classified by subspecialty (neuroradiology, thoracic, abdominal, musculoskeletal, or pediatric radiology), question type (workup, surveillance, education, specialist referral query, discharge, or other), anatomy, and pathology.

To evaluate timeliness, value, and impact on patient care, Walker and team had PCPs complete feedback surveys after each consultation.

The Canadian researchers excluded five eConsults from their analysis due to insufficient clinical information, so of the 302 total consultations they reviewed, the subspecialties broke down accordingly:

• abdominal (94/302 [31%]),
• neuroradiology (74/302 [25%]),
• musculoskeletal (61/302 [20%]),
• thoracic (56/302 [19%]),
• pediatric (17/302 [6%]).

With regard to anatomic subclassification, eConsults most often pertained to the brain (47/302 [16%]), lungs (30/302 [10%]), spine (29/302 [10%]), and liver (27/302 [9%]).

Further subclassification revealed the most common conditions were cystic lesions (38/302 [13%]), pain (24/302 [8%]), bone lesions (21/302 [7%]), and nodules (18/302 [6%]).

The majority of consultations pertained to patient workup (112/302 [37%]), surveillance of imaging findings (95/302 [31%]), and provider education (48/302 [16%]).

Patient management was altered in 167 cases (55%), and unnecessary testing was avoided in 84 cases (28%). Meanwhile, in 227 cases (75%), PCPs rated the perceived value of the eConsult platform as "excellent."

"It may be helpful for radiologists to alter their reporting style to include clear follow-up guidelines for incidental findings," Walker et al. concluded, adding that PCPs may also benefit from continuing medical education on cystic lesion imaging, as well as imaging's role in the workup of patient pain.