Providers who think electronic consultations are beneficial are more likely to adopt the technology, according to a new study in the February 2018 issue of Health Affairs.
While providers who used electronic consultations tended to be more enthusiastic about their benefits, those who didn't use them tended to value in-person consultations more, according to the authors of the study, led by Melissa Afable, a project manager in Partners HealthCare System's department of quality, safety and value.
"The adoption of innovations depends a lot on the perceptions of stakeholders," Afable said.
Afable and her fellow authors looked at the use of electronic consultations for anesthesiology in the Veterans Affairs New England Healthcare System. In the system's hospitals, electronic consultations have grown far more common in recent years, with 50 times more electronic consultations in anesthesiology in 2015 as there were in 2012. At sites with greater use of electronic consultations, clinicians said the consultations made workflows more efficient, whereas at sites with less use, clinicians said they preferred in-person consultations.
"Stakeholders' perceptions of the value of e-consults tended to parallel the degree of adoption at each site," the researchers wrote. This pattern demonstrates a theory about the spread of innovation, they wrote, in which an innovation is more likely to spread when it's perceived as beneficial.
In this case, clinicians in favor of electronic consultations found that it not only helped with efficiency, but it also helped patients. "Any possible issues are identified earlier than they would (have been) if the patient had come in for a pre-op visit," said a clinician at one of the sites studied. "It reduces (patients') time to surgery since they don't have to have a separate visit just for scheduling lab tests."
But others found electronic consultations to be cold. "I find it very impersonal when you walk in five minutes before the procedure and say, 'Hey, I am your anesthesiologist and you are going to go to sleep, and I am going to give you the same drug that Michael Jackson got,' " said one of the doctors, as quoted in the study.
Despite some hesitance on the part of clinicians, electronic consultations could be widely adopted, the researchers wrote, especially given the shift toward value-based care and the implementation of electronic health records. "The increasing adoption of e-consultation in healthcare systems and e-consults' promise for improving access while controlling costs under new payment models make e-consults an attractive intervention," the authors wrote.