Visits to specialists constitute more than half of physician visits in the United States, but unfortunately there are breakdowns and inefficiencies in all components of the specialty-referral process. Possibly the most troubling is the lack of lack of timely access to specialty care which is a persistent challenge for vulnerable populations including those in rural communities and safety-net systems. This is a problem that I have described in detail.

To improve this process, health systems have implemented eReferral and eConsult systems. Though the terminology is not always consistent, eReferrals is using technology to improve the process. For example, all consultations are put in a single platform. eConsults build upon eReferrals and lead to more fundamental changes. In an eConsult system, primary care providers submit all non-emergent consultations via an electronic platform to a given specialty providing patients’ clinical background, the nature of the problem, and when necessary, images or other media. Each request is then read by the assigned reviewer for that specialty who can engage in a secure, electronic, iterative dialogue with the primary care provider. Based on the clinical scenario, the specialist reviewer either recommends a face-to-face visit or resolves the eConsult without a visit by providing relevant input on treatment or diagnosis through electronic dialogue. In our work, we have demonstrated that both eReferrals and eConsults can improve access to specialty care.

• Mehrotra A, Forrest CB, Lin CY. Dropping the baton: specialty referrals in the United States. Milbank Q. 2011;89(1):39-68. PMCID: PMC3160594.
• Ray KN, Drnach M, Mehrotra A, Suresh S, Docimo SG. Impact of Implementation of Electronically Transmitted Referrals on Pediatric Subspecialty Visit Attendance. Acad Pediatr. 2018;18(4):409-417. PMCID: PMC5936662
• Barnett ML, Yee HF Jr, Mehrotra A, Giboney P. Los Angeles Safety-Net Program eConsult System Was Rapidly Adopted And Decreased Wait Times To See Specialists. Health Aff (Millwood). 2017;36(3):492-499.
• Lee MS, Ray KN, Mehrotra A, Giboney P, Yee HF Jr, Barnett ML. Primary Care Practitioners' Perceptions of Electronic Consult Systems: A Qualitative Analysis. JAMA Intern Med. 2018;178(6):782-789. PMCID: PMC6145753.
• Barnett ML, Mehrotra A, Frolkis JP, Spinks M, Steiger C, Hehir B, Greenberg JO, Singh H.   Implementation Science Workshop: Implementation of an Electronic Referral System in a Large Academic Medical Center. J Gen Intern Med. 2016;31(3):343-52. PMCID: PMC4762816.