E-Consult Tool

The Oklahoma University (OU) School of Community Medicine (SOCM)’s four primary care clinics Family Medicine, Internal Medicine, Pediatrics, and the Community Health Clinic) are the only practices in Oklahoma to have achieved NCQA’s Tier 3 Certification for Patient Centered Medical Homes under the advanced 2011 standards. The OU SOCM participates in the MyHealth Access Network, a non-profit HIO serving patients who receive care in Oklahoma. In 2010, MyHealth was selected as one of ONC’s Beacon Communities and since then has grown to serve more than 3,000 providers and 2.6M patients statewide with HIE, health analytics, and care transition services.

Physicians at OU SOCM use Doc2Doc for referrals and consultations. After finding that some referrals could be replaced with a conversation between providers, the Doc2Doc team added eConsult capabilities. Providers use the eConsult tool to seek the advice and guidance of the specialist consultant prior to making the referral, and work collaboratively determine a shared care plan that best meets each patient’s needs. In some cases, the consultant will determine that the patient does not need to be seen and if the sending provider agrees, the referral will not occur. In other cases, the consultant will suggest work-up or initial therapies that should be started prior to or instead of a referral. When providers deem care transition necessary, they use Doc2Doc to complete the usual scheduling and status tracking processes.

OU SOCM has achieved the following results:

• Clinics using Doc2Doc became more efficient with handling care transitions, reducing the time to make initial contact with specialists from 20 days to the same day. In addition, loop closure rates rose from 60 to nearly 90 percent of referrals achieving complete loop closure after a full year.
• The use of eConsults has significantly reduced the number of unnecessary referrals.
• The use of eConsults has improved access to care, even among the most vulnerable populations. Wait times for access to specialty care were lowered by 66%.
• The overall structured, tracked care transition process, including eConsults, resulted in significant cost savings in total cost of care analyses on Medicaid patients.

OU SOCM offers these best practices and lessons learned for others:

• Involve specialty groups to provide input on projects to achieve the Meaningful Use Transition of Care objectives.
• Think carefully about how your practice or health organization will incorporate direct messaging into this process, and monitor the efforts.
• Set up a provider directory in your EHR system and maintain it rigorously
• Involve payers in the referral process

Managing care transitions using a system from an HIO participating in eHealth Exchange will enable an entire region of providers to qualify for MU Stage 2 TOC measures and delivery higher quality care transitions.

As EHRs became more prevalent, it will be possible to build standardized interfaces to send initial referral orders to Doc2Doc automatically and return status updates back to the EHR user in a timely fashion. This would offer immediate notification to ordering providers through the EHR when their patients are seen by the specialist or fail to attend a specialist visit.