Valuable partnerships between specialists and PCPs
In addition to reducing referral delays, participants say one of the most important successes has been improved partnerships between specialists and PCPs. Referral processes vary dramatically, Cameron says. “Many of our PCPs do not have a great way to interact with specialists,” he says. “It’s usually a binary approach—either they refer, or they don’t. The optimal spot is somewhere in the middle.”
Brian A. Shaner, MD, a Duke family medicine physician who has had experience as a practice medical director, says specialist interactions have been productive. “Physicians participating in eConsults are now managing more complex cases because of the involvement with the specialist,” Shaner says. “But when a referral is necessary, we go directly to the nephrologist with a more packaged, worked-up case. Patients do not have to wait for a specialist visit to get evaluations that I can perform in my clinic."
The future of scalability is harder to assess, Shah says. “Scaling raises a whole new set of questions around operations, financing, and growth far from Durham that require new solutions and planning,” Shah says. “It won’t be as simple as ‘flipping a switch.’”
But he acknowledges that eConsult demonstrates progress as physicians move away from an old way of executing a transaction—the traditional referral—to the new eConsult approach. “Primary care physicians are now improving care for their patients by building partnerships,” Shah says. “We clearly see that PCPs learn with each eConsult. The next time, they improve the process. Our hope is that in a scaled model we could measure this effectively.”