Using Telehealth to Improve Quality of Care in Connecticut

Topic(s): Health Care Quality, Telehealth
Geographic Location: Middletown, Connecticut
Health Center: Community Health Center, Inc.
Date Posted: June 2019

Use of Electronic Consults

The Community Health Center, Inc. (CHCI) has been operating for over 45 years in Middletown, Connecticut. The health center was started by a group of community activists and university students to provide medical services to people in need and has been funded by Health Resources & Services Administration (HRSA) since 2002. In 2018, HRSA awarded more than $500,000 in Quality Improvement Awards (QIA) to CHCI in recognition of their achievements for improving the overall quality, efficiency, and value of health care to their community. CHCI continues to improve access to comprehensive quality care by conducting research on primary care, using health information technology, and connecting patients to specialty care. This collaboration between research and delivery of primary care has led to recent work to further optimize telehealth and the development of a robust electronic consultation (e-consult) system for specialty care.

The Chief Quality Officer, Dr. Daren Anderson, stated, “Throughout my career as a health care provider I was impressed with the quality of work at HRSA-funded health centers. However, I kept seeing the lack of access to specialty care having a negative impact on patients in the community.” Obtaining referrals was often difficult and could result in wait times of up to 9 to 12 months for patients to be seen for specialty care in Connecticut. “We all felt this was impacting our patients. We were 10 miles away from a hospital but couldn’t get a patient seen,” continued Dr. Anderson.

Learning from other health centers that have implemented a similar process to address this care gap, CHCI set out to find a more effective solution. They developed an e-consult program that served as a triage mechanism for specialist care providers such as cardiologists, dermatologists, endocrinologists, orthopedists, and gastroenterologists, to eliminate unnecessary specialist patient visits. Many patients did not need to be seen in the office at all as the medical advice needed to care for the patient and address the consult question could be shared electronically. Dr. Anderson explained, “We had to create a decentralized model where we could efficiently connect specialists with patients.”

CHCI embedded electronic consultation and referrals into their clinical workflow. They developed a system on the backend where primary care providers (PCPs) submitted referral requests for their patients via their existing workflows; subsequently, the referrals were routed to the e-consult system by a referral coordinator using a standing referral order. PCPs were free to opt in or out of the e-consult system. The CHCI e-consult system is a physician-to-physician email consult system that allows primary care providers to initially consult with specialists before involving the patient. A cluster-randomized controlled trial was conducted with 36 PCPs across 12 CHCI delivery sites to test the efficacy and effectiveness of the innovative approach. The trial results revealed that 69% of the trial e-consults were resolved without a visit to the specialist thereby improving access to and timeliness of care, reducing specialty utilization, and streamlining specialty referrals without compromising patient care.

In response to CHCI’s research on e-consults, the Connecticut Medicaid program began reimbursing health providers for physician-to-physician email consults such the CHCI e-consult program. CHCI works with other health centers across the country to help them adapt this same process to connect patients to specialty care. Dr. Anderson clarified, “We take a broad view to implementation, tailoring the system to the client’s needs to meet them where they are. Our aim is to help primary care providers strengthen and expand their practice by providing them a tool to connect to specialists.” To learn more about implementing an e-consult system you can contact CHCI at 860-347-6971 or Dr. Anderson at 860-852-0831.

Date Last Reviewed:  June 2019