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Maya Styner, MD, and Spencer Dorn, MD, MPH

eConsults are making access to high quality, specialty care easier, while also helping to increase care value. eConsults are a digitized version of ‘curbside consults’, launched in 2019 through the Value-Care Action Group which encourages redesigning care in ways that increase value. Since then, specialists in the UNC Department of Medicine have completed over 1,000 eConsults.

Maya Styner, MD, associate professor of medicine in the division of endocrinology and metabolism, says eConsults have been instrumental in keeping visit numbers down during COVID, while improving patient care, particularly for those who live in remote areas of the state. The endocrine e-consult service has increased accessibility to specialty information and recommendations for a diverse array of UNC providers and patients, providing guidance on appropriate testing or workup, which has helped determine if a patient requires an in-person visit, or not. She explains how it helps providers.

eConsult logo“In the past, referring providers cultivated close relationships with consultants from medical school, residency, and other work/social realms, and this older model of curbside consultation skewed consultant access to providers/patients who were well-connected or financially well-off.” Styner said. “If my best friend from medical school happened to be a pulmonary critical care specialist, I could regularly rely on her to answer curbside pulmonary questions over the years; however, what if my patient needs info from other sub-specialists? Would I be less likely to reach out to a rheumatologist I do not know?”

Styner acknowledges referring providers probably hesitate to turn to consultants for curbside questions knowing they are time-consuming and usually go uncompensated.

Think eConsults logo“Considering how busy referring providers are on a daily basis, it’s unlikely that they would reach out for a curbside each time it is needed, even if they know the patient might not actually need to see the consultant to obtain the answer. This is especially true for patients with mildly abnormal thyroid function tests for whom referring providers are asking whether treatment/workup is needed.”

Spencer Dorn, MD, MPH, MHA, associate professor of medicine in the division of gastroenterology and hepatology, and vice chair for care innovation, led the launch of eConsults last year. He says eConsults are far more convenient because the referring clinician and specialist do not need to know each other nor be available at the same place and time.

“eConsults enable specialists to review relevant clinical information before formally documenting their recommendations in the electronic health record. Patients receive expert recommendations quickly, without the time, travel, and cost of a clinic visit. Referring clinicians can expand their scope of practice and coordinate care more closely. And, by reducing unnecessary in-person consultations, eConsults free-up specialists to evaluate patients with more complicated conditions and perform procedures.”

All UNC physicians and advanced practice providers can use Epic to request an eConsult from any UNC Department of Medicine specialty, including allergy and immunology, cardiology, endocrinology, gastroenterology and hepatology, geriatrics, hematology, infectious diseases, nephrology, oncology, pulmonary, and rheumatology. Within two business days, specialists will make specific recommendations. The average turnaround is 1.7 days, and 77% of the time the consult can be answered without seeing the patient in clinic.

To learn more about eConsults, visit https://go.unc.edu/econsults to learn more. For questions about the service, please contact DOMeconsults@med.unc.edu.

Value-Care Action Group

The eConsult initiative is one of many Value-Care Action Group improvement efforts taken up by the UNC Department of Medicine. Ron Falk, MD, chair of the department created the group and appointed champions in each medicine division, encouraging the review of current practices that look for improvements for high-value outcomes in healthcare. High-value is defined by the quality of patient-centered care achieved per unit of cost. Scott Keller is the director of business development keeping the team focused on value-oriented care models. Darren DeWalt, MD, serves as medical director for the team and helps define the projects. John Vargas is the project manager.