1 in 10 “eConsults” shown to need f2f

Announcement/ Alert the National Center for Biotechnology Information (NCBI) at the U.S. National Library of Medicine (NLM).

For the purposes of this study of more than 5,000 encounters, eConsults were text based messages (presumably email). Just over 500 (10%) needed a face to face appointment. The reason given for those appointments was enlightening – 75% were because of diagnostic uncertainty and only 1% were because of urgency or physical examination.

It would be interesting to analyse the specialties that were included and some of the detailed characteristics might shed even more light; for example age, sex, ethnicity/ language, educational attainment, severity of illness, underlying co-morbidity/ long term condition and the previous clinical history between doctor-patient.


From their website:

J Telemed Telecare. 2015 Sep 22. pii: 1357633X15602634. [Epub ahead of print]

Early e-consultation face-to-face conversions.

Pecina JL1, North F2.

Author information:

·  1Department of Family Medicine, Mayo Clinic Rochester, USA pecina.jennifer@mayo.edu.

·  2Department of Primary Care Internal Medicine, Mayo Clinic Rochester, USA.



E-consultations are asynchronous, text-based consultations. The specialist e-consultant answers clinical questions in a similar way to a standard consultation but the questions and answers are sent electronically. The e-consultant has access to some or all of the medical record but does not have contact with the patient. Although e-consultations are meant to substitute for face-to-face (F2F) consultations, a significant proportion of e-consultations are converted to F2F consultations.


We examined e-consultation content from a sample of e-consultations that had subsequent F2F visits in the same specialty as the e-consultation within 28 days of the e-consultation.


Out of 5115 e-consultations, there were a total of 547 (10.7%) early F2F conversions. One hundred and fifty-one e-consultations with subsequent early F2F conversions were reviewed in eight specialties. In 64% of the F2F conversions, specialists recommended the F2F consultations. In 75% there were complex diagnostic or treatment considerations. In only 1% was there a sense of medical urgency or a stated need for physical examination.


E-consultations convert to F2F consultations primarily at the request of the specialist. Diagnostic and treatment complexity appear to be the main reasons. We found little evidence that patients decided independently to get a F2F visit or that specialists needed a F2F visit to perform a physical examination. Although e-consultations might not be a complete substitute for F2F consultations, they may serve as an entry level consultation that could be supplemented by a video consultation as needed for cases with more diagnostic and treatment complexity.

© The Author(s) 2015.

PMID: 26395892 [PubMed – as supplied by publisher]

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