Veterans Health Administration Electronic Consultations:  Women’s Health Primary Care Providers’ Perceptions

Cordasco KM, Zuchowski J, Hamilton AB, Canning MT, Bell-Lewis L, Chrystal JG, Kirsh S, Washington DL. Veterans Health Administration Electronic Consultations:  Women’s Health Primary Care Providers’ Perceptions. Poster session presented at: Society of General Internal Medicine Annual Meeting; 2015 Apr 23; Toronto, Canada.

Related HSR&D Project(s)

• CRE 12-031 – Controlled Trial of Tele-Support and Education for Womens Health Care in CBOCs

BACKGROUND: Primary care providers (PCPs) and specialists are increasingly using electronic consultations (e-consults) as a communication modality. We sought to capture Veterans Health Administration (VHA) PCP perceptions of the benefits, barriers and limitations of e-consults as implemented within VHA. METHODS: Using a mixed-methods approach, we surveyed and interviewed VHA PCPs across four VHA healthcare systems who have been designated as women's health PCPs (WH-PCPs). WH-PCPs who utilized a gynecology e-consult were sent, within 7 days of the completed consult, an e-mail invitation to complete a survey assessing their experience with that e-consult. Since PCPs could request multiple e-consults over time, we sent invitations to WH-PCPs no more frequently than every 21 days (e-consults within this 21 day window were ineligible.) Separately, as part of semi-structured interviews assessing for needs and perceptions of virtual care consultations and education, we asked WH-PCPs about their use of and experiences with e-consults across all specialties. All interviews were professionally transcribed and then summarized. Summaries were reviewed by two team members to identify themes related to e-consult benefits, barriers and limitations. RESULTS: Between June and December, 2014, there were 114 completed gynecology e-consults. Forty-nine of these e-consults were eligible and survey invitations were sent to the WH-PCPs who had requested them. Twenty-five surveys were completed (51% response rate) by 16 WH-PCPs. Twenty-three (92%) of the surveys indicated that implementing all recommendations contained in the e-consult would be "very" or "somewhat" easy. The remaining two surveys (8%) indicated that it would be "neither easy nor difficult" to implement the recommended treatment plan. Twenty (80%) surveys indicated that the e-consult "definitely" provided the WH-PCPs with information that they could apply to the care of other patients. Between October 2012 and October 2014, we interviewed 32 WH-PCPs. All interviewees reported overall having a very positive experience with e-consults. All interviewees identified one or more benefits; including improving clinical efficiency, with both improving care timeliness and replacing/facilitating in-person specialty visits; being more convenient for patients; facilitating primary-care specialty communication ; and enhancing WH-PCPs' knowledge and care quality. Nine WH-PCPs identified one or more barriers or limitations to e-consults including increased workload for primary care practices and providers implementing the specialist recommendations; specialists providing unclear or incomplete responses, specialists needing time to engage in e-consults; and an in-person specialist visit being needed, rather than an e-consult, for some patients or aspects of care. Conclusions: VHA WH-PCPs have an overall positive assessment of the role of e-consults in patient care, with a majority specifically benefitting from use of gynecology e-consults. However, some barriers and limitations were reported that should be addressed when pursuing expansion or modification within VHA, or implementation in other care settings. As settings outside of VA expand use of electronic health records and consider uptake of e-consults, research should be directed toward quantifying e-consult benefits and cost-effectiveness.