title: Electronic consultations (e-consults) to improve access to specialty care: a systematic review and narrative synthesis.
abstract: BACKGROUND
  We define electronic consultations ("e-consults") as asynchronous, consultative, provider-to-provider communications within a shared electronic health record (EHR) or web-based platform. E-consults are intended to improve access to specialty expertise for patients and providers without the need for a face-to-face visit. Our goal was to systematically review and summarize the literature describing the use and effects of e-consults.
  
  
  METHODS
  We searched PubMed, EMBASE, the Cochrane Library, and CINAHL for studies related to e-consults published between 1990 through December 2014. Three reviewers identified empirical studies and system descriptions, including articles on systems that used a shared EHR or web-based platform, connected providers in the same health system, were used for two-way provider communication, and were text-based.
  
  
  RESULTS
  Our final review included 27 articles. Twenty-two were research studies and five were system descriptions. Eighteen originated from one of three sites with well-developed e-consult programs. Most studies reported on workflow impact, timeliness of specialty input, and/or provider perceptions of e-consults. E-consultations are used in a variety of ways within and across medical centers. They provide timely access to specialty care and are well-received by primary care providers.
  
  
  CONCLUSIONS
  E-consults are feasible in a variety of settings, flexible in their application, and facilitate timely specialty advice. More extensive and rigorous studies are needed to inform the e-consult process and describe its effect on access to specialty visits, cost and clinical outcomes.
authors.affiliation: Center for Healthcare Organization and Implementation Research (CHOIR), US Department of Veterans Affairs, Bedford, Massachusetts, USA Section of Endocrinology, Diabetes, and Nutrition, Boston University School of Medicine, Boston, Massachusetts, USA varsha.vimalananda@va.gov.
authors.forename: Varsha G
authors.initials: VG
authors.lastname: Vimalananda
authors.affiliation: Department of Health Policy and Management, Boston University School of Public Health, Boston, Massachusetts, USA.
authors.forename: Gouri
authors.initials: G
authors.lastname: Gupte
authors.affiliation: Department of Health Policy and Management, Boston University School of Public Health, Boston, Massachusetts, USA.
authors.forename: Siamak M
authors.initials: SM
authors.lastname: Seraj
authors.affiliation: VA Boston Healthcare System, Boston, Massachusetts, USA Section of General Internal Medicine, Boston University School of Medicine, Boston, Massachusetts, USA.
authors.forename: Jay
authors.initials: J
authors.lastname: Orlander
authors.affiliation: Center for Healthcare Organization and Implementation Research (CHOIR), US Department of Veterans Affairs, Bedford, Massachusetts, USA Department of Health Policy and Management, Boston University School of Public Health, Boston, Massachusetts, USA.
authors.forename: Dan
authors.initials: D
authors.lastname: Berlowitz
authors.affiliation: Center for Healthcare Organization and Implementation Research (CHOIR), US Department of Veterans Affairs, Bedford, Massachusetts, USA.
authors.forename: Benjamin G
authors.initials: BG
authors.lastname: Fincke
authors.affiliation: Center for Healthcare Organization and Implementation Research (CHOIR), US Department of Veterans Affairs, Bedford, Massachusetts, USA VA Boston Healthcare System, Boston, Massachusetts, USA Division of General Internal Medicine, Brigham and Women's Hospital, Boston Massachusetts, USA Harvard Medical School, Massachusetts, USA.
authors.forename: Steven R
authors.initials: SR
authors.lastname: Simon
mesh_terms: D057286:Electronic Health Records / Q000706:statistics & numerical data; D006297:Health Services Accessibility; D006801:Humans; D020407:Internet; D019114:Remote Consultation / Q000379:methods*; D013038:Specialization
keywords: e-consults; remote consultation; teleconsulting; telehealth; telemedicine