title: A retrospective study on how primary care providers manage specialists' recommendations after an e-consultation.
abstract: BACKGROUND
  E-consultations are asynchronous text-based consultations between providers which can facilitate patient access to timely specialty care. In contrast to traditional face-to-face consults, conveying and completing recommendations of the specialist is the responsibility of the referring provider. This presents a new workflow for primary care providers who have multiple options (face-to-face, telephone, letter, secure message) to communicate the e-consultation recommendations. This study examines how primary care providers are managing this new workflow.
  
  
  METHODS
  We performed a retrospective random sampling of e-consultations with individual medical record review and classified e-consultations by type of recommendation, how recommendations were communicated to patients, and whether recommendations were carried out.
  
  
  RESULTS
  We randomly selected 220 e-consultations in 13 different specialties for review. In all, 85% of e-consultations contained recommendations for referring providers. Recommendations on medication(s) were most common (35%) followed by recommendations on ordering laboratory tests (29%). In all, 25% of the time e-consultants gave multiple possible courses of action for referring providers to choose from. Patient notification of recommendations was found for 192 (87%) of e-consultations with providers performing the notification 63% of the time and nursing staff performing the notification 37% of the time. The communication back to the patients included communication via nurse telephone calls (37%), provider telephone calls (23%), secure messages (24%), face-to-face visits (11%), and by written correspondence (5%).
  
  
  CONCLUSIONS
  Managing recommendations from e-consultations results in a new workflow for primary care providers. Healthcare institutions that utilize e-consults should be aware of this new workflow. Further study is needed to determine best practices for this task that is now increasing in primary care.
authors.affiliation: Department of Family Medicine, Mayo Clinic, Rochester, MN, USA.
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Pecina
authors.affiliation: Department of Family Medicine, Mayo Clinic, Rochester, MN, USA.
authors.forename: Jennifer M
authors.initials: JM
authors.lastname: Frank
authors.affiliation: Division of Primary Care Internal Medicine, Mayo Clinic, Rochester, MN, USA.
authors.forename: Frederick
authors.initials: F
authors.lastname: North
keywords: E-consultation; primary care; remote consultation; tele-consultation; virtual consultation