Table 1.

The Champlain Building Access to Specialists through eConsultation Service's Impact Viewed Through the Lens of the Quadruple Aim Framework

AimOutcomeMeasureeConsult Impact
Patient ExperienceWait timesUsage dataResponds to previously articulated patient dissatisfaction with wait times22
Patient satisfactionInterviewsPatients deem useful in 86% of visits, acceptable alternative to traditional referrals in 97%23
Response timeUsage dataMedian response time of 1.2 days (interquartile range, 0.2 to 4.2)
Referral avoidanceUsage data71% of cases resolved without need of a face-to-face specialist referral
Provider ExperiencePCP satisfactionCloseout surveyPCPs rank eConsult as high/very high value in 94% of cases25
Educational valueCloseout survey92% of cases ranked as high/very high educational value.
Specialist satisfactionSurveys94% of specialists report eConsult improves communication with PCPs26
CostsTotal system costsCost dataTotal system costs over 2014 to 2015 fiscal year were $207,68027
Per capita costCost dataWeighted average of $47.35/case versus $133.60/case for traditional referrals27
Direct and indirect savingsEstimate of resource utilization, patient costs, etc.Accounting for societal factors (eg, avoided referrals and patient expenses) yields additional savings of $11/case28
Population HealthHealth outcomes (eg, mortality, morbidity, and health status)Health administrative data, randomized controlled trialsUnable to assess
Provider adoptionUsage data1299 PCPs have enrolled with the service
Population servedUsage data28,838 cases completed, average monthly case volume increased from 13 in 2011 to 969 in 2017
Provider utilizationUsage data61% of enrolled PCPs have used the service in the last 12 months
Patient safetyUsage dataeConsult prompts a referral in 3.4% of cases, potentially improving patient safety31