title: Longer-term impact of cardiology e-consults.
abstract: OBJECTIVE
  Cardiac e-consults may be an effective way to deliver value-oriented outpatient cardiology care in an accountable care organization. Initial results of cardiac e-consults have demonstrated high satisfaction among both patients and referring providers, no known adverse events, and low rates of diagnostic testing. Nevertheless, differences between e-consults and traditional consults, effects of e-consults on traditional consult volume, and whether patients seek traditional consults after e-consults are unknown.
  
  
  RESULTS
  We established a cardiac e-consult program on January 13, 2014. We then conducted detailed medical record reviews of all patients with e-consults to detect any adverse clinical events and detect subsequent traditional visits to cardiologists. We also performed 2 comparisons. First, we compared age, gender, and referral reason for e-consults vs traditional consults. Second, we compared changes in volume of referrals to cardiology vs other medical specialties that did not have e-consults. From January 13 to December 31, 2014, 1,642 traditional referrals and 165 e-consults were requested. The proportion of e-consults of all evaluations requested over that period was 9.1%. Gender balance was similar among traditional consults and e-consults (44.8% male for e-consults vs 45.0% for traditional consults, P = .981). E-consult patients were younger than traditional consult patients (55.3 vs 60.4 years, P < .001). After the introduction of cardiac e-consults, the increase in traditional cardiac visit requests was less than the increase in traditional visit requests for control specialties (4.5% vs 10.1%, P < .001). For e-consults with at least 6 months of follow-up, 75.6% patients did not have any type of traditional cardiology visit during the follow-up period.
  
  
  CONCLUSIONS
  E-consults are an effective and safe mechanism to enhance value in outpatient cardiology care, with low rates of bounceback to traditional consults. E-consults can account for nearly one-tenth of total outpatient consultation volume at 1 year within an accountable care organization and are associated with a reduction in traditional referrals to cardiologists.
authors.affiliation: Cardiology Division, Department of Medicine, Massachusetts General Hospital, Harvard, Medical School, Boston, MA; Massachusetts General Physicians Organization, Massachusetts General Hospital, Harvard Medical School, Boston, MA. Electronic address: jwasfy@mgh.harvard.edu.
authors.forename: Jason H
authors.initials: JH
authors.lastname: Wasfy
authors.affiliation: Massachusetts General Physicians Organization, Massachusetts General Hospital, Harvard Medical School, Boston, MA; Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA.
authors.forename: Sandhya K
authors.initials: SK
authors.lastname: Rao
authors.affiliation: Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.
authors.forename: Neil
authors.initials: N
authors.lastname: Kalwani
authors.affiliation: Division of Interventional Radiology, Department of Radiology, Massachusetts General Hospital, Boston, MA.
authors.forename: Melissa D
authors.initials: MD
authors.lastname: Chittle
authors.affiliation: Massachusetts General Physicians Organization, Massachusetts General Hospital, Harvard Medical School, Boston, MA.
authors.forename: Calvin A
authors.initials: CA
authors.lastname: Richardson
authors.affiliation: Heart Center, Massachusetts General Hospital, Boston, MA.
authors.forename: Kathleen M
authors.initials: KM
authors.lastname: Gallen
authors.affiliation: Cardiology Division, Department of Medicine, Massachusetts General Hospital, Harvard, Medical School, Boston, MA; Healthcare Transformation Laboratory, Massachusetts General Hospital, Boston, MA.
authors.forename: Eric M
authors.initials: EM
authors.lastname: Isselbacher
authors.affiliation: Massachusetts General Physicians Organization, Massachusetts General Hospital, Harvard Medical School, Boston, MA; Department of Dermatology, Massachusetts General Hospital, Boston, MA.
authors.forename: Alexandra B
authors.initials: AB
authors.lastname: Kimball
authors.affiliation: Massachusetts General Physicians Organization, Massachusetts General Hospital, Harvard Medical School, Boston, MA; Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA.
authors.forename: Timothy G
authors.initials: TG
authors.lastname: Ferris
mesh_terms: D000553:Ambulatory Care / Q000458:organization & administration*; D002309:Cardiology / Q000379:methods*; D002318:Cardiovascular Diseases / Q000175:diagnosis* / Q000453:epidemiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009017:Morbidity / Q000639:trends; D009511:New England / Q000453:epidemiology; D009819:Office Visits / Q000639:trends*; D010865:Pilot Projects; D012017:Referral and Consultation / Q000458:organization & administration*; D012189:Retrospective Studies