P0026 - Pediatric Infectious Disease eConsults: A Novel Way to Provide Asynchronous Virtual Subspecialty Advice

Background: Pediatric infectious disease (PID) physicians are frequently contacted for informal non-urgent “curbside" questions. This work is untracked in the electronic medical record (EMR), unpaid, and uncounted with respect to clinical volume, raising concerns for care quality and safety, litigation risk, and physician satisfaction.

Program Goals: In 2013, Massachusetts General Hospital (MGH), a quaternary care center in Boston, MA, launched an eConsult program for network providers to contact subspecialists with non-urgent questions not requiring in-person visits. After a focused EMR review, consultants document recommendations in a separate EMR note and receive a small stipend from MGH. MGH PID implemented eConsults in 2018 as another modality of patient care and education in addition to traditional inpatient and outpatient consultation, as well as other telemedicine services. Pediatric ID-specific EMR order, note template, workflow and associated provider tip sheets were created with ongoing process improvement.

Results: This study is an interim analysis of all PID eConsults completed between February 2018 and October 2019. Data abstracted from EMR and additional chart review included patient demographics and visit information, ordering provider characteristics, reasons for consultation, and impact of visits with respect to specific recommendations. Each patient record was reviewed by two or more researchers to ensure accuracy. Standard statistics were applied to evaluate the results.

Of 226 unique patients with eConsult orders, there were 213 evaluable encounters; recommendations were provided via alternate communication for 5 patients, in-person consultation was recommended for 4 patients, and eConsult was not completed for 4 patients. Of patients with completed eConsults, 98 (46%) were male and 41 (19%) were under the age of 1. Primary care providers (Pediatrics, Internal Medicine-Pediatrics, Family Medicine and NPs) referred 183 (85%) of the patients. The remaining patients were referred by pediatric medical and surgical subspecialties, as well as child psychiatry. eConsult volume grew from 25 visits in the first quarter of the program to 39 visits in the last quarter (P<0.05). Of 183 eConsults with a pre-selected reason for consultation, the 3 most popular indications were next steps in diagnostic evaluation (25%), interpretation of labs/studies (20%), and tuberculosis screening (13%). Among all completed eConsults, written impressions and recommendations by PID physicians included disease counseling for referring provider (82%), suggestions for additional diagnostic studies (37%), interpretation of prior ID results (37%), preventative interventions (31%), and suggestion of therapeutic interventions (30%).

Discussion: Asynchronous eConsults are successful in providing PID advice in a formalized manner to maximize clinical and educational provider/patient benefits, while also remunerating previously unpaid work and minimizing concerns regarding unofficial “curbsides”. Next step in program evaluation will be a provider survey to assess satisfaction.