Implementation of an Asynchronous E-consult Service Between Primary Care Provider and Specialist

Background: Our health system serves a vast rural population that creates care gaps for pediatric specialty services. Ask-A-Doc is a formalized “curbside consult” e-Consult service between PCP and specialist. It uses asynchronous messaging to ask a question, and have it answered and documented in the EHR within the requested timeframe. We describe the impact Ask-A-Doc has had on delivery of pediatric specialty care.

Methods: We analyzed specialty enrollment, volume of consults, number of in-person clinic referrals saved by Ask-A-Doc, average turn-around time, and referring provider satisfaction. In-person referrals saved was determined by how many Ask-A-Doc questions did not incur an in-person evaluation within 60 days of Ask-A-Doc encounter. We also analyzed utilization of Ask-A-Doc prior to and after April 2020, when the COVID pandemic began to impact our clinics.

Results: Twelve pediatric specialty services have adopted Ask-A-Doc since March 2018. The number of specialty services using Ask-A-Doc increased from 7 at the end of 2018 to 12 at the end of 2020. Volume of Ask-A-Doc consults increased from 50 in 2018, to 508 in 2019, to 1396 in 2020 (figure 1).
Of the total pediatric specialty outpatient referrals, an average of 15% are Ask-A-Doc consults. Services with higher rates of Ask-A-Doc utilization per total referrals placed are Infectious disease (67%), Nephrology (36%), and Hematology/Oncology (35%).
Average turn-around time for specialist to answer the Ask-A-Doc question is 9.6 hours.
Ask-A-Doc saved a total of 33 in-person referrals in 2018, 354 in 2019, and 1013 in 2020 (figure 1). Approximately 70% of Ask-A-Doc consults did not require subsequent in-person visits which opened new slots in the pediatric specialists’ schedules.
Referring physicians were very pleased with Ask-A-Doc consults rating an average of 4.9 stars out of 5 (n=362).
Eight services had been started on Ask-A-Doc prior to April 2019. We used these 8 services to analyze Ask-A-Doc volumes 1 year prior to and 1 year after the start of the pandemic (figure 2). There was a significant increase in average Ask-A-Doc consults per month from pre to post-pandemic years (64.8 to 106.7, p=0.0002). During this same time, average days to be seen for in-clinic consultations significantly decreased by 14.5 days, from 57.2 to 42.7 (p=0.003) for these services.

Conclusion: Ask-A-Doc e-Consult service provided considerable value to pediatric specialties. Ask-a-Doc 1) provided timely specialty care (average turnaround time of 9.6 hours); 2) avoided face to face visits that were unnecessary, opening up over 1,000 new patient slots; and 3) improved access to care, allowing sicker patients to be seen sooner. Referring providers found the service to be extremely helpful. Participation as well as use of Ask-a-Doc continues to grow in pediatrics. Ask-a-Doc has brought us one step closer to “right care, right setting, right time”.