Los Angeles Safety-Net Program eConsult System Was Rapidly Adopted And Decreased Wait Times To See Specialists

Headnote

ABSTRACT

Lack of timely access to specialty care is a significant problem among disadvantaged populations, such as those served by the Los Angeles County Department of Health Services. In 2012 the department implemented an electronic system for the provision of specialty care called the eConsult system, in which all requests from primary care providers for specialty assistance were reviewed by specialists. In many cases, the specialist can address the primary care provider's question via an electronic dialogue, thereby eliminating the need for the patient to see a specialist in person. We observed rapid growth in the use of eConsult: By 2015 the system was in use by over 3,000 primary care providers, and 12,082 consultations were taking place per month, compared to 86 in the third quarter of 2012. The median time to an electronic response from a specialist was one day, and 25 percent of eConsults were resolved without a specialist visit. Three to four years after implementation, the median time to a specialist appointment decreased significantly, while the volume of visits remained stable. eConsult systems are a promising and sustainable intervention that could improve access to specialist care for underserved patients.

Lack of timely access to specialty care is a persistent challenge for vulnerable populations in the United States who have Medicaid coverage or are uninsured. Roughly a quarter of visits to community health centers require a specialty consultation.1 Yet in one study, 71 percent of federally qualified health centers reported difficulty obtaining specialty care for their patients, while another study found that almost a third of specialist physicians across the United States were unwilling to accept new publicly insured patients in 2013.1,2 There is a clear mismatch between supply and demand for specialty services for low-income patients.

This problem has also been a challenge for the Los Angeles County Department of Health Services (DHS)-the second-largest public health system in the United States, which serves 670,000 patients annually across nineteen clinics, four hospitals, and dozens of community practices.3 For example, an internal review conducted by two of the authors found that in 2011 a quarter of DHS patients referred to gastroenterology or urology specialists had to wait over nine months for an appointment. It was also common, they found, for primary care...