Experiences of specialist physicians with e-consultations

An e-consultation is a form of virtual asynchronous communication between a primary care provider (PCP) and specialist physician within a shared electronic health record (EHR), designed to improve communication and timely access to specialized care. Newfoundland and Labrador (NL) initiated a province wide e-consult service in 2018 which continues today, used by PCPs and specialists working in the provincial health care system. Objectives: The focus of this observational study is to explore the experiences of specialists who have utilized the NL e-consult system. Methods: The study method was a mixed method survey. An anonymous, web-based questionnaire was sent to specialist physicians working in NL who participated in the e-consult service between January 2018 and December 2022. Results: Thirty-six specialists completed the e-questionnaire, with a 55% response rate (36/66). The majority were internal medicine specialists (53%), followed by surgical subspecialities (16%), psychiatrists (11%), and other (19%). Most respondents agreed there was a role for e-consults in the health care system. However, almost all respondents (90%) indicated they had no protected clinical time for completing e-consults. Moreover, 92% indicated e-consults were answered outside of regular working hours at least some of the time. About half (47%) replied they spent 1 h or less per week answering e-consults, while 30% indicated it was 2–3 h per week. Only 44% of physicians were financially reimbursed for completing e-consults. Conclusion: The e-consult system has been successfully introduced within the provincial health care in NL. However, issues of dedicated time for e-consults and adequate financial compensation may limit its sustainability in the long term.