VA-Specific Primary Care Clinicians Say E-Consultations Are Valuable, But May Increase Workload

In this interview with Veterans Health Today, Joseph Simonetti, MD, MPH, assistant professor of medicine in the Division of Hospital Medicine, University of Colorado School of Medicine, discusses his recent study examining the pros and cons of e-consultations among clinicians treating veterans.

A team of researchers recently sought to understand and identify perceptions of e-consultation and workload among primary care clinicians in the US Veterans Health Administration system. According to the findings published online in JAMA Network Open, although primary care physicians feel that e-consultation is a valuable tool to increase access to specialty care for veterans, it may also increase their workload.

“E-consultation is increasingly being adopted to expand access to specialty care and reduce health care costs, the study authors wrote. “Little is known about clinicians’ perceptions of using e-consultations, which may be associated with program adoption.” 

Although further research is needed to better understand the increased workload and clinician burnout linked with use of e-consultations, we spoke with study author Joseph Simonetti, MD, MPH, assistant professor of medicine, Division of Hospital Medicine, University of Colorado School of Medicine,
who suggests that e-consultation adds additional burden to clinical day-to-day work, which may lead to worsening burnout and provider turnover. However, Dr Simonetti does note that some clinicians in the VA felt the use of e-consultations helped avoid unnecessary face-to-face visits. 

What existing data led you and your co-investigators to conduct this research?

The VA started expanding it’s e-consultation program around 2011. Since then, there has been a substantial increase in use of e-consultation among VA providers. To date, there has been very little work done to improve our understanding of how providers feel about using this mechanism of care.

Please briefly describe your study and its findings. Were any of the outcomes particularly surprising?

Overall, primary care physicians seemed to feel that e-consultation is a valuable tool to increase access to specialty care for veterans, and that avoiding unnecessary face-to-face visits eased the burden of attending in-person appointments for patients. However, physicians also reported that relying on e-consultation, rather than asking patients to see specialists in-person, resulted in more work for the primary care physician. In some cases, their roles expanded to ordering and interpreting testing, or making diagnostic decisions, that were not within their typical scope of practice.

What are the possible real-world applications of these findings in clinical practice?

Our prior work has shown that at least one-third of VA primary care providers suffer from burnout. If the current findings are validated, it suggests that e-consultation adds additional burden to their clinical day which may lead to worsening burnout and provider turnover. Additionally, if e-consulation is adding time to the workday, something else has to be sacrificed to make room for it.  

Do you and your co-investigators intend to expand upon this research?

Future work will need to validate and quantify these findings, explore additional potential unanticipated outcomes related to e-consultation, and develop programs to address this issue.ν

About Joseph Simonetti, MD, MPH

Dr. Simonetti is an Assistant Professor of Medicine in the Division of Hospital Medicine at the University of Colorado School of Medicine. He is a board-certified internist who serves as a teaching attending in the Hospital Medicine Group at the Rocky Mountain Regional VA Medical Center. He is a researcher within the Denver-Seattle Center of Innovation for Veteran-Centered and Value-Driven Care and the Rocky Mountain Mental Illness Research, Education and Clinical Center for Suicide Prevention. His research focuses on improving Veterans’ access to services within the VHA system, and reducing the burden of firearm-related suicide among Veterans.

Reference:
Lee M, Leonard C, Greene P, et al. Perspectives of VA Primary Care Clinicians Toward Electronic Consultation-Related Workload Burden: A Qualitative Analysis. JAMA Netw Open. 2020;3(10):e2018104. Published 2020 Oct 1. doi:10.1001/jamanetworkopen.2020.18104