E-consults offer rapid pediatric allergy guidance for primary care providers

Allergy and asthma specialists can use e-consults to reduce the number of unnecessary referrals by providing access to advice within the electronic health record, according to a letter published in Annals of Allergy, Asthma & Immunology.

Prepared templates and open-ended options both were useful in submitting e-consult requests as well, Matthew R. McCulloch, MD, a fellow in allergy and immunology at Children’s Hospital Colorado at the time of the study and current assistant professor of allergy and immunology at the University of California, San Francisco, and colleagues wrote in the letter.

The researchers defined e-consults as asynchronous encounters that typically are conducted between a specialist and a primary care physician completely through the EHR to obtain clinical guidance about questions that may not need a referral or to help in deciding whether a referral is necessary.

Also, the researchers said, e-consults are meant to improve access to specialty care and to improve communication between specialists and PCPs.

In January 2020, the Children’s Hospital of Colorado began offering ambulatory e-consults in pediatric allergy and immunology. Providers within its network submitted requests through the EHR. Select private practice groups in the hospital’s pediatric care network also were eligible to participate in the program.

A single member of the pediatric allergy faculty at the hospital receives all the e-consult requests and consults with a clinical immunologist as needed for complex immunology cases.

Referring providers can choose from six prebuilt templates that request specific information such as immune concern, penicillin allergy, early food introduction, eczema, IgE deficiency or urticaria. An open-ended option is available as well.

The researchers reviewed 73 e-consults filed between January 2020 and March 2022, with an average of 2.7 per month. None of the requests were declined. The patients had a mean age of 4.9 years at the time the requests were submitted.

According to the researchers, 53 (72%) of the e-consults were completed within 24 hours of the request, with 40 (55%) of them requiring less than 10 minutes to complete. E-consults were requested by 55 (75%) physicians and 18 (25%) advanced practice providers.

Additionally, 42 (58%) of the e-consults resulted in advice only, 25 (34%) led to a recommendation to refer for an in-person consult and six (8%) were followed by a recommendation to refer to another specialty, including two for rheumatology, two for dermatology and two for gastroenterology.

The allergy and immunology team at the hospital ultimately saw 15 (60%) of the e-consult patients who were recommended for in-person consultations, and 21 (16%) of the e-consults included recommendations for laboratory evaluations.

With 33 (45%) e-consults completed using the open-ended template, the most commonly used prebuilt templates included food allergy (37%), immune concern (29%), urticaria (19%), drug allergy (12%) and allergic rhinitis (< 2%). None of the e-consults used the eczema template.

Considering the number of e-consults that used the open-ended option, providers seemed to prefer to describe what they felt were the most important aspects of the case, the researchers wrote.

Finally, 41 (56%) of the requests were from 11 private practices that are members of the hospital’s pediatric care network, and 32 (44%) were internal. The private practices most often sought e-consults for immune concerns (31%), and the internal e-consults were most often for food allergy (44%). Requests came from 51 unique providers overall.

With more than half of all requests sent by providers in private practice, the researchers wrote, there appears to be a strong interest in the service outside of the Children’s Hospital of Colorado system.

Noting the quick turnaround time, ease of completion and manageable request frequency, the researchers concluded that e-consults are an easily manageable service for pediatric allergy and immunology systems to offer.