L.A. E-Referral System Could Be a Model for Improving Access to Care

A Los Angeles County electronic referral system that has helped bolster communication and collaboration among primary care physicians and specialists could serve as a model for easing specialist shortages and reducing health care costs in other areas, Kaiser Health News reports.

According to KHN, physicians at county and community clinics have increasingly been sending patients to emergency departments amid long waits to see specialists, which can take weeks or months.

Details of Los Angeles County Program

To help patients bypass long waits and ease the burden on EDs, Los Angeles County in 2012 implemented an electronic referral system called eConsult. The system was modeled after a similar program at San Francisco General Hospital and aimed to streamline the referral process.

The eConsult program allows PCPs to consult with specialists via Web-based communications, which can include exchanging medical records or photos.

Under the program, clinics use guidelines for each specialty to determine priority for appointments. In the meantime, PCPs can continue treating patients while consulting electronically with specialists.

The eConsult program facilitates about 10,000 requests for 40 specialties monthly.

While the program has not solved all of the county's problems, PCPs and specialists have said things have gotten better in the three years since the program began, KHN reports.

According to KHN, about 30% of referred patients did not end up needing to see a specialist, largely because of improved communication between PCPs and specialists. For patients who did end up visiting specialists, more already had undergone necessary lab work and tests, making the visits more efficient.

Concerns, Implications

Some providers still have concerns about the program.

Nwando Olayiwola, associate director of UC-San Francisco's Center for Excellence in Primary Care, said the program "solves a huge part of the problem, but it doesn't solve all of it."

Meanwhile, other providers have expressed concern about how the program does not pay PCPs for any extra services a specialist might request.

Richard Seidman -- CMO of Northeast Valley Health, which operates several community clinics -- said, "Without any extra reimbursement, those costs are hitting the primary care providers."

However, Paul Giboney, Los Angeles County's specialty care director, said the eConsult program still could become a national model. He noted that he has received inquiries about how the system works from officials from various states (Gorman, Kaiser Health News, 5/13).