title: Early e-consultation face-to-face conversions.
abstract: BACKGROUND
  E-consultations are asynchronous, text-based consultations. The specialist e-consultant answers clinical questions in a similar way to a standard consultation but the questions and answers are sent electronically. The e-consultant has access to some or all of the medical record but does not have contact with the patient. Although e-consultations are meant to substitute for face-to-face (F2F) consultations, a significant proportion of e-consultations are converted to F2F consultations.
  
  
  METHODS
  We examined e-consultation content from a sample of e-consultations that had subsequent F2F visits in the same specialty as the e-consultation within 28 days of the e-consultation.
  
  
  RESULTS
  Out of 5115 e-consultations, there were a total of 547 (10.7%) early F2F conversions. One hundred and fifty-one e-consultations with subsequent early F2F conversions were reviewed in eight specialties. In 64% of the F2F conversions, specialists recommended the F2F consultations. In 75% there were complex diagnostic or treatment considerations. In only 1% was there a sense of medical urgency or a stated need for physical examination.
  
  
  CONCLUSIONS
  E-consultations convert to F2F consultations primarily at the request of the specialist. Diagnostic and treatment complexity appear to be the main reasons. We found little evidence that patients decided independently to get a F2F visit or that specialists needed a F2F visit to perform a physical examination. Although e-consultations might not be a complete substitute for F2F consultations, they may serve as an entry level consultation that could be supplemented by a video consultation as needed for cases with more diagnostic and treatment complexity.
authors.affiliation: Department of Family Medicine, Mayo Clinic Rochester, USA pecina.jennifer@mayo.edu.
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Pecina
authors.affiliation: Department of Primary Care Internal Medicine, Mayo Clinic Rochester, USA.
authors.forename: Frederick
authors.initials: F
authors.lastname: North
mesh_terms: D001291:Attitude of Health Personnel; D034742:Electronic Mail / Q000706:statistics & numerical data*; D006801:Humans; D008511:Medicine / Q000379:methods*; D057240:Patient Preference; D019114:Remote Consultation / Q000379:methods*; D012189:Retrospective Studies; D049269:Videoconferencing / Q000706:statistics & numerical data*
keywords: E-consultation; e-referral; remote consultation; tele-consultation; virtual consultation