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2015 HSR&D/QUERI National Conference Abstract

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1061 — Above and Beyond: How Do SCAN-ECHO Consultations Facilitate Communication between Primary and Specialty Care Providers?

Koenig CJ, San Francisco VA Health Care System; Wenger M, San Francisco VA Health Care System; Taylor T, Palo Alto VA Health Care System; Kirsch S, VHA Office of Specialty Care; Asch S, Palo Alto VA Health Care System; Rongey C, San Francisco VA Health Care System;

Objectives:
Consults are the traditional method of communication between generalist and specialist providers when caring for patients with complex chronic illness. Prior literature observes that traditional consults often miss important patient clinical and social histories that can adversely affect patient care. Health information technology using video conferencing can minimize these limitations through interactive communication between providers. Our objective was to evaluate generalist-specialist communication as part of a national evaluation of the VHA's Specialty Care Access Network-Extension for Community Healthcare Outcomes (SCAN-ECHO) program for Hepatitis C (HCV).

Methods:
We used administrative data to identify two VAMC sites in different VISNs with high volumes of patient cases discussed during SCAN-ECHO. We video recorded 32 sessions among 3 liver specialist and over 20 generalist across 6 months to directly observe inter-provider communication. Recordings were professionally transcribed and uploaded into qualitative data management software. Two authors reviewed each session to identify the number of consults, including question(s) generalists asked when beginning a consult. Questions were inductively classified using qualitative content analysis according to their clinical functions.

Results:
We identified 112 consultations total (3.5 consults average per session) and a total of 122 generalist questions (1.1 questions average per consult). Providers' questions most frequently addressed treatment issues, but also asked questions related to interpreting results, diagnoses, screening and prevention, coordinating care, and communication. While questions typically focused on clinical issues, the video platform enabled additional conversation about patient's social contexts and facilitated knowledge exchange related to HCV care. Overall, SCAN-ECHO consults holistically blended clinical, social, and educational content that improved generalist-specialist collaboration around HCV specialty care.

Implications:
Video teleconferencing platforms, such as SCAN-ECHO, facilitate complex interactions that minimize limitations of the traditional consult format. The range of generalists' questions illustrates that generalists need more than knowledge of treatment to effectively manage complex chronic illnesses in the community setting. Interactive video enables generalist to tailor clinical questions according to veterans' social context and to increase collaboration among providers.

Impacts:
SCAN-ECHO sessions create an interactive collaborative space to exchange information that fosters an environment of continuous learning central to the VHA's Blueprint for Excellence essential for building a veteran-centered learning organization.