Physician-to-Physician eConsultations to Ophthalmologists at an Academic Medical Center.

ABSTRACT

Purpose: Physician-to-physician electronic consultation (eConsults) are used across specialties; however, their effectiveness in ophthalmology has not been reported. This study evaluated the feasibility and diagnostic accuracy of a physician-to-physician ophthalmology eConsult program, assessed the timeliness of in-person evaluation, and characterized the clinical questions of non-ophthalmology providers. Methods: Retrospective review of patients for whom an ophthalmology eConsult was placed to Massachusetts Eye and Ear from February 2019-August 2021. The eConsults were reviewed to identify submission-to-response time, primary diagnoses by eConsultant, and referral outcomes. The eConsults were categorized based on clinical question, urgency, and ophthalmic condition addressed. Demographic data on patients and referring providers were collected. Results: One hundred ophthalmology eConsults were placed, and 100% were responded to by an ophthalmologist. An average of 1.6 ± 1.9 days elapsed from the time of eConsult to completion. Of the 30 patients who presented for in-person evaluation at an ophthalmology clinic, diagnostic concordance between eConsultant and in-person ophthalmologist was observed in 93% of cases (n = 28 of 30). An average of 28.9 ± 27.4 days from eConsult response to in-person follow-up was observed. The most common clinical inquiries were about appropriate triage/referral (24.4%), management (22%), and diagnosis (19.7%). All eConsults were non-urgent. The most common ophthalmic condition addressed was chalazia/hordeola (14%). Only 5% of patients presented to an emergency department for the same ophthalmic concern addressed by eConsult. Conclusions: Ophthalmology eConsults provide timely access to nonurgent ocular diagnosis, triage, and management and in our study seem to provide high rates of diagnostic accuracy for nonurgent ophthalmic conditions. Translational Relevance Using ophthalmic eConsults can facilitate timely access to specialty care and reduce patient and provider burden.