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January 22, 2015

Improving access to specialty care through technology

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The University of Virginia Health System is piloting a new program that uses its EpicCare electronic medical record to speed patients’ access to specialists.

UVA is one of five academic medical centers in the U.S. testing the eConsults/eReferrals model; the five centers are supported by a $7 million grant from the federal Center for Medicare and Medicaid Innovation. UVA began examining the model this month with four specialties: endocrinology, cardiology, digestive health and neurology.

The program addresses a common challenge faced by primary care doctors across the country: There aren’t enough specialists to accommodate the needs for specialty care. This new program aims to make available additional appointments with specialists for patients with more complex medical conditions through technology; eConsults or eReferrals will let specialists answer more straightforward questions in some cases without requiring an appointment.

“If you can answer the least complex questions using this model and reduce appointments by 10 percent, you can open up more appointments for patients who will truly benefit from face-to-face interactions with specialty physicians,” said Chris Ghaemmaghami, MD, UVA’s chief medical officer.

How do eConsults and eReferrals work?

Here’s a look at how primary care physicians will use eConsults and eReferrals:

eConsults: Primary care physicians can ask specialists a quick question about a patient – for instance, consulting an endocrinologist on whether to adjust the insulin level for a diabetes patient. The primary care physician will send a message through EpicCare to a specialist, who can review the patient’s medical history before making a recommendation. “This will ensure a specialist has all the information they need and that the consult is documented in the patient’s medical record,” said Mohan Nadkarni, MD , a primary care physician at University Medical Associates in Charlottesville. eReferrals: For cases requiring a more detailed review – such as a patient experiencing occasional chest pain – the primary care physician will fill out a template and answer a series of questions about the patient’s condition and medical history that is sent to the specialist. After a review of the eReferral, the specialist can determine if a patient needs an appointment. “This should greatly improve collaboration between primary care physicians and specialists,” Nadkarni said.

Benefits for patients

For patients who don’t need to be seen in person by a specialist, they can get the information they need to improve their health sooner, said Daniel McCarter, MD , a primary care physician at Stoney Creek Family Medicine in Nellysford. For McCarter’s patients – who often travel long distances to see him – not having to make a second appointment with a specialist could spare them from taking a day off from work.

For patients with more serious conditions who need to make an appointment, this new model should enable them to get an appointment sooner.

“This is all part of UVA’s ongoing efforts to get patients the right care in the right place at the right time,” McCarter said.

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