<s>
e-consult	B-Application
is	O
a	O
mechanism	O
developed	O
by	O
the	O
Department	O
of	O
Veterans	O
Affairs	O
that	O
enables	O
primary	O
care	O
providers	O
to	O
obtain	O
specialists	O
 '	O
inputs	O
into	O
a	O
patient	O
's	O
care	O
treatment	O
without	O
requiring	O
the	O
patient	O
to	O
go	O
to	O
a	O
face-to-face	O
visit	O
.	O
</s>
<s>
Not	O
to	O
be	O
confused	O
with	O
eConsult	B-Application
,	O
a	O
medical	O
app	O
used	O
in	O
England	O
.	O
</s>
<s>
E-consult	B-Application
is	O
a	O
web-enabled	O
system	O
and	O
process	O
,	O
where	O
primary	O
care	O
clinicians	O
and	O
specialists	O
are	O
able	O
to	O
communicate	O
,	O
share	O
clinical	O
information	O
and	O
consult	O
electronically	O
to	O
manage	O
patient	O
care	O
.	O
</s>
<s>
Closed	O
health	O
systems	O
with	O
existing	O
electronic	B-Application
health	I-Application
record	I-Application
(	O
EHR	O
)	O
can	O
incorporate	O
e-consult	B-Application
services	O
into	O
the	O
system	O
,	O
making	O
start-up	O
cost	O
minimal	O
.	O
</s>
<s>
Open	O
health	O
systems	O
must	O
create	O
a	O
secured	O
website	O
portal	O
to	O
utilize	O
e-consult	B-Application
service	O
due	O
to	O
discrepancy	O
in	O
their	O
respective	O
EHR	O
systems	O
.	O
</s>
<s>
Additionally	O
,	O
Mayo	O
Clinic	O
's	O
e-consult	B-Application
resulted	O
in	O
a	O
shorter	O
time	O
frame	O
of	O
1	O
day	O
and	O
6	O
hours	O
,	O
compared	O
to	O
7	O
days	O
and	O
20	O
hours	O
for	O
traditional	O
consultation	O
.	O
</s>
<s>
A	O
specialist	O
survey	O
at	O
Mayo	O
Clinic	O
agreed	O
that	O
e-consult	B-Application
was	O
less	O
disruptive	O
than	O
consultations	O
by	O
telephone	O
or	O
pager	O
by	O
67%	O
.	O
</s>
<s>
Disadvantage	O
of	O
e-consult	B-Application
is	O
workload	O
shift	O
from	O
specialist	O
or	O
administrative	O
staff	O
to	O
PCPs	O
.	O
</s>
<s>
E-consult	B-Application
was	O
developed	O
by	O
the	O
Office	O
of	O
Specialty	O
Care	O
Transformation	O
,	O
under	O
the	O
Department	O
of	O
Veterans	O
Affairs	O
to	O
improve	O
access	O
to	O
specialty	O
care	O
.	O
</s>
<s>
In	O
the	O
Department	O
of	O
Veterans	O
Affairs	O
system	O
,	O
e-consult	B-Application
requires	O
a	O
multi-departmental	O
collaboration	O
.	O
</s>
<s>
There	O
is	O
an	O
e-consult	B-Application
lead	O
who	O
coordinates	O
between	O
departments	O
to	O
ensure	O
that	O
e-consult	B-Application
service	O
is	O
implemented	O
correctly	O
and	O
adheres	O
to	O
both	O
facility	O
and	O
national	O
policies	O
.	O
</s>
<s>
In	O
order	O
for	O
an	O
e-consult	B-Application
program	O
to	O
be	O
active	O
in	O
a	O
specialty	O
clinic	O
,	O
a	O
location	O
name	O
and	O
note	O
title	O
must	O
be	O
created	O
in	O
the	O
VA	O
's	O
EHR	O
system	O
called	O
Computerized	B-Application
Patient	I-Application
Record	I-Application
System	O
(	O
CPRS	O
)	O
.	O
</s>
<s>
This	O
allows	O
for	O
PCPs	O
to	O
go	O
into	O
the	O
CPRS	O
system	O
and	O
have	O
the	O
ability	O
to	O
select	O
the	O
desired	O
specialty	O
e-consult	B-Application
(	O
location	O
clinic	O
)	O
to	O
send	O
an	O
e-consult	B-Application
request	O
.	O
</s>
<s>
When	O
a	O
specialist	O
answers	O
the	O
PCPs	O
e-consult	B-Application
request	O
,	O
he	O
or	O
she	O
responds	O
using	O
the	O
Note	O
Title	O
specifically	O
for	O
that	O
specialty	O
clinic	O
.	O
</s>
<s>
E-consult	B-Application
must	O
be	O
completed	O
or	O
forwarded	O
to	O
an	O
in-person	O
visit	O
within	O
three	O
business	O
days	O
of	O
it	O
being	O
requested	O
.	O
</s>
<s>
Beginning	O
in	O
2009	O
,	O
L.A.	O
Care	O
engaged	O
SynerMed	O
and	O
Partners	O
in	O
Care	O
Foundation	O
to	O
launch	O
an	O
18-month	O
e-consult	B-Application
pilot	O
program	O
.	O
</s>
<s>
Preliminary	O
results	O
indicated	O
that	O
about	O
half	O
of	O
the	O
e-consults	B-Application
generated	O
a	O
reduction	O
of	O
24%	O
to	O
48%	O
of	O
face-to-face	O
visits	O
based	O
on	O
specialty	O
.	O
</s>
<s>
With	O
the	O
goal	O
of	O
improving	O
the	O
health	O
of	O
county	O
residents	O
through	O
innovation	O
and	O
research	O
,	O
it	O
implemented	O
e-consult	B-Application
across	O
more	O
than	O
40	O
ambulatory	O
and	O
primary	O
care	O
clinic	O
sites	O
in	O
June	O
2012	O
.	O
</s>
<s>
Currently	O
,	O
e-consult	B-Application
serves	O
safety	O
net	O
patients	O
with	O
the	O
goal	O
of	O
increasing	O
the	O
access	O
to	O
specialty	O
care	O
for	O
Medi-Cal	O
recipients	O
.	O
</s>
<s>
On	O
average	O
,	O
specialists	O
responded	O
to	O
e-consults	B-Application
within	O
2.6	O
days	O
(	O
includes	O
non-business	O
days	O
)	O
.	O
</s>
<s>
35%	O
of	O
patients	O
on	O
e-consult	B-Application
were	O
managed	O
without	O
face-to-face	O
specialist	O
visits	O
.	O
</s>
