Background: Cardiology electronic consults (e-consults) are asynchronous communications between cardiologists and primary care providers that can replace some traditional in-person consults. We have previously evaluated the initial and intermediate-term impact of e-consults in cardiology. To improve clinical value, e-consults should substitute for traditional consults while avoiding excessive diagnostic testing. Little is known, however, about the rates of in-person follow up or diagnostic testing in a mature e-consult program.
Methods: We conducted detailed medical record reviews of all patients with cardiology e-consults at the Massachusetts General Hospital from January 9, 2014 to September 11, 2015. Charts were reviewed to determine (1) the proportion of e-consults that were followed by in-person cardiology visits within 6 months and (2) the proportion of e-consults that recommended further cardiac testing.
Results: From January 9, 2014 to September 11, 2015, 454 cardiology e-consults were performed. Of those, 304 had six months of follow-up available for review. In 254/304 (83.6%) cases, patients had no in-person visit with a cardiologist within six months of the e-consult (see Figure 1). In 37/304 (12.2%) cases, patients had an in-person visit that was recommended by the e-consult. Additional testing was recommended in 155/454 (34.1%) e-consults, including echocardiograms recommended in 98/454 (21.6%) e-consults, Holter/event recorders recommended in 58/454 (12.8%) e-consults, and stress tests recommended in 50/454 (11.0%) e-consults. Medication changes were recommended in 87/454 (19.2%) e-consults.
Conclusions: In this cohort of patients receiving cardiology e-consults, only one sixth subsequently presented for traditional in-person cardiology visits within six months. E-consults therefore appear to replace traditional consults, rather than simply postponing them. Furthermore, e-consults do not appear to be associated with high rates of downstream testing. These results reflect nearly two years of experience with a mature e-consult program, and imply that e-consults may be an effective tool to improve value in cardiology care.