With provider shortages and long wait times for appointments, demand continues to outpace the safety net’s ability to provide high-quality, timely care for all patients.

Electronic consultation (E-Consult) is a delivery system innovation that allows primary care providers and specialists to more easily communicate, consult one another, and refer patients. E-Consult can help reduce unnecessary in-person visits and expedite necessary visits with specialists. It’s also improving care coordination among providers by allowing for secure dialogue, faster transfer of patient information and test results, and the development of shared treatment plans.

This tool is transforming how providers communicate and is generating a more collaborative approach to care for the patients most in need.

Advancing the use and implementation of E-Consult has been a complex endeavor that required working with multiple partners and providers committed to improving the way that we deliver care to low-income and underserved Californians. While there is still much work to be done, important tools and lessons have emerged and are beginning to take root.

With promising programs first underway in Los Angeles and San Francisco, the Foundation sought to spread and scale the use of E-Consult across the state and safety net. Through evaluation and learning along the way, we identified four guiding principles that enable this unique innovation to succeed:

Relationships - E-Consult requires the engagement of several diverse partners with unique expertise and differing levels of leadership, as well as a collective willingness to pursue new ways of operating and communicating.

Technology - Providers and organizations need to understand the types of electronic health record systems and technologies that either facilitate or impede existing referral processes, and determine a shared platform or new solution to functionality integrate E-Consult.

Shared Metrics - Standardized data collection and measurement tools are critical to capturing success and identifying challenges related to E-Consult.

Policy - Changes in policy and reimbursement incentives are needed to ensure the long-term viability of E-Consult. A policy workgroup representing diverse stakeholders has helped to build consensus around the innovation, determine its impact, and outline the policy changes needed to make it sustainable.