Electronic Consultations (eConsults): A Triple Win for Patients, Clinicians, and Payers

Focus Area:
State Health Policy Leadership
Telehealth The Center for Evidence-based Policy


To increase access to care, asynchronous electronic consultation (eConsult) has been developed to facilitate direct communication and coordination between clinicians over a secure electronic platform. During these consults, the requesting clinician and the specialist share and discuss patient-specific information.

This report reviews the evidence on the effectiveness and safety of the use of eConsults by primary care clinicians and clinicians from multiple specialties and draws on interviews with leaders of six eConsult programs, including those operated by the Los Angeles County Department of Health and a Connecticut nonprofit, Community Health Center, Inc. The findings from four systematic reviews and 36 individual studies indicate that eConsults, compared with the traditional referral process, appear to be safe and are associated with:

  • Improved access to specialty care,
  • More efficient use of health care resources,
  • High patient and clinician satisfaction, and
  • Lower total cost of care.

The findings also indicate that implementation within clinician practices and health care delivery systems can be long and complex and includes challenges such as integrating eConsults into electronic health records.

This report is intended to be used to support decision makers considering coverage and implementation of eConsults. State Medicaid agencies are initially implementing coverage of eConsults through fee-for-service. Moving forward, states could explore how eConsult services can be incorporated into managed care contracts or other value-based payment models that add incentives, while placing guardrails, for use.

This report was developed on the basis of a more detailed report developed for the Medicaid Evidence-based Decisions (MED) Project, a research collaboration of 22 state Medicaid programs administered by the Center for Evidence-based Policy at Oregon Health & Science University.

Read the report.

Read a companion blog post on policy implications.

Thielke A, King V. Electronic Consultations: A Triple Win for Patients, Clinicians, and Payers. Milbank Memorial Fund. June 2020.


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