Immune hematology

The study find that the allergy and immunology can simplify the process of providing the most appropriate care, often reducing the need for in-person specialist visits. Therefore The paper; which has been published online in the Journal of Allergy and Clinical Immunology: In Practice; but reports on the first two years of the MGH program and ;finds a significant reduction in the time needed to access specialist guidance.

The allergy and immunology

Electronic; clinician-to-clinician consultations based on data in the electronic health record do not require real-time communication and are designed to address non-urgent questions specific to the care of an individual patient. The MGH began offering e-consults in Cardiology and Dermatology ;in late 2013 and extended the program to Allergy/Immunology in August 2016. As of January 2019; the MGH e-consult program involves 47 specialty areas, and almost 10,000 e-consults were provided during 2018.

The current study, led by first author Neelam Phadke, MD, MGH Division of Rheumatology; Allergy and Immunology; looked at data regarding allergy/immunology e-consults provided from August 2016 through July 2018, as well as in-person consults beginning in August 2014. Of approximately 300 e-consults completed during the study period; around 60% led to recommendations for in-person specialty visits; while 27% provided only advice and education to the referring practitioner.

When the e-consult led to a recommendation for an in-person specialty visit, information from the e-consult made visits more productive by allowing the allergist to be better prepared. Educational information provided via e-consults benefited both referring physicians and the patients; often providing reassurance on the appropriateness of a planned course of action.

The referring practitioner

Two-thirds of e-consults related to patients with histories of potentially allergic reactions to drugs, primarily antibiotics like penicillin; many in conjunction with a program to evaluate pregnant patients with a history of penicillin allergy. Immunology e-consults could result from patient or provider concerns about frequent infections or abnormal antibody levels.

While the average wait time for an in-person allergist visit before institution of the e-consult program was 22.5 days; the wait time reduced to 21.0 days after the program began. Allergists completed e-consults in an average of 11 minutes; and the average turnaround time for the referring provider to receive allergy specialist guidance was less than 24 hours.

Lead author Phadke notes that a key limitation to broader use of e-consults is the reliance on electronic medical records systems that may not be shared between specialists and referring physicians; a problem that could disproportionately affect smaller hospitals that already lack access to sub specialists like allergists.

Allergists completed e-consults

But when the required systems are in place, she says; “E-consults can allow primary care physicians to receive guidance from one or more subspecialists, synthesize messages that may have been conveyed from multiple providers; and delivery neatly packaged recommendations to the patient.”