Improving Access to Specialty Care

A new pilot program at UVA Health System aims to address a common challenge faced by primary care doctors across the country: the discrepancy between available specialists and the need for specialty care. Using its EpicCare electronic medical record system, UVA will offer eConsults or eReferrals to UVA physicians, making additional specialist appointments available to those patients with more complex medical conditions.

“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,” says Chris Ghaemmaghami, MD, UVA’s chief medical officer.

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. The pilot program is being introduced in four specialties: endocrinology, cardiology, digestive health and neurology.

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,” says 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 says.

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, says 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 says.

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