eConsults Offer New Pathways to Specialty Care

Patients treated sooner with new program bringing specialist expertise into the primary care.
Dr. Marie Sandoval talks with female patient

As a family medicine physician of more than 25 years, Katherine Mariani, MD, knows that peace of mind is a powerful thing when it comes to your health.

“It’s hard to go about your day-to-day and enjoy life when you’re worried about your health – that stress and anxiety can really weigh on a person,” says Dr. Mariani, from her primary care clinic in South Burlington, Vermont. “In my line of work, the faster we can get people answers, the better.”

That search for answers sometimes means consulting with a specialist on the best course of action. Perhaps that means working with a pharmacist to adjust a patient’s medication or referring them to a cardiologist to look into their heart palpitations. Or maybe it means consulting with a rheumatologist about a person’s chronic joint pain.

Whatever the case, referrals to a specialist often mean scheduling another appointment and then waiting for that date to arrive.

“That can be a stressful wait for some folks,” Dr. Mariani says. “But thankfully, eConsults have given us a new tool to tap into specialist expertise more quickly and with fewer appointments.”

Improving Access to Specialty Care with eConsults

eConsults are a secure digital consultation that a primary care provider can request from a medical specialist for certain medical concerns — typically within a week – saving their patient the need to schedule a separate, specialist appointment. The consultation relies on both providers having access to a patient’s electronic health record, a system which is now live across all UVM Health Network hospitals and clinics in Vermont and northern New York.

Launched in 2021, eConsults have quickly become a clinical essential for many primary care and specialists providers across the UVM Health Network. This comes at a time when high demand for care, coupled with a severe workforce shortage, sometimes leads to longer-than-usual wait times for certain specialties. By bringing specialist expertise into the primary care setting, these consultations get patients on the road to recovery sooner and ease the wait times for busy specialty practices. 

"eConsults are perfect for when we need just a little bit of specialty guidance to be able to handle the case ourselves. It has really been a game changer in the types of care we can deliver from our primary care office," says Anji Bhagat, MD, a primary care physician at UVM Health Network - Alice Hyde Medical Center

Dr. Bhagat is not alone. UVM Health Network clinicians initiated more than 1,400 eConsults during the past 12 months across 20 specialties, including endocrinology, cardiology, pulmonology, neurology, psychiatry, and rheumatology, among others. July saw the single highest usage of eConsults since the program kicked off, with more than 220 eConsults ordered by clinicians.

“We know that access to care can be a challenge, and we saw early on the huge potential for eConsults to transform how we deliver specialty care,” says Teresa Fama, MD, a driver of the Network’s eConsult strategy and a rheumatologist at UVM Health Network – Central Vermont Medical Center. “We’re just getting started, but they’re already elevating the care available to Vermonters and New Yorkers and producing a whole new level of collaborative care amongst our health care providers.”

Easing the Logistical Burden

eConsults aim to make health care more convenient for patients and cut down on “unnecessary” appointments with specialists. “This is particularly important in more rural areas, where we don’t have specialist clinics located nearby,” says Dr. Bhagat. “I’m protective of my patients, and I want to give them all the care we can close to home.”

For Sebrena Bess, an ongoing problem with her liver had her looking at several repeat trips to see a specialist at the UVM Medical Center – a six-hour round trip journey from her home outside Malone, New York. “For me that means asking my fiancé to take time off of work to drive me, which isn’t easy for him,” Bess says. “It’s a real inconvenience, even if I know I’ve got to do it – every trip saved is a big deal for us.”

Bess shared these concerns with Brianne Jeror, her nurse practitioner at Alice Hyde Medical Center. Using the UVM Health Network’s electronic health record system, Jeror saw that Bess’s liver condition was eligible for review by a hepatologist via an eConsult. “This felt like the ideal scenario to use an eConsult instead of asking Sebrena to travel quite a ways, perhaps unnecessarily,” Jeror says.

Ultimately, the hepatology team recommended that Bess make the trip for an additional in-person visit, which they scheduled for a week later.

"It’s still a long drive, but at least I know I’m going for the right reason. It’s also the quickest appointment I’ve scheduled in my life," says Bess.

“This is the system working the way it was intended,” says Marie Sandoval, MD, medical director of digital health and adult primary care in South Burlington. “We developed eConsults with the goal of improving the quality of in person referrals, so that those who really need to be seen in person can get an appointment when and where they need it.”

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