Electronic Consultations to Hepatologists Reduce Wait Time for Visits, Improve Communication, and Result in Cost Savings

The burden of chronic liver disease in the United States is likely underestimated.(1) Studies have demonstrated increasing complications of hepatitis C cirrhosis, increasing prevalence of nonalcoholic fatty liver disease, and the rising incidence of liver cancer.(2-4) Nonalcoholic fatty liver disease has an estimated prevalence of approximately 20%-35% in the United States and is expected to increase commensurate with the current obesity epidemic.(5,6) Hepatocellular carcinoma is expected to surpass breast, colorectal, and prostate cancers to become the third leading cause of cancer-related death by 2030.(7) Despite this increasing burden of disease, there remains a shortage of specialists to care for these patients. In fact, the American Association of Medical Colleges has predicted a shortage of more than 40,000 specialty physicians by 2020 and more than 65,000 by the year 2025.(8,9) With just over 1,000 fully trained hepatologists practicing in the United States, an increasingly growing coverage gap will emerge without clear solutions. It is widely acknowledged that access to specialty care is a common problem in the United States’ health care system with demand for specialists far surpassing supply in most tertiary care referral centers.(10) There has been an observed trend upward in the number of ambulatory clinic visits and the percentage of those visits that result in a referral to a specialty provider.(11) In fact, referral rates have more than doubled in the past decade, leading to more than a 3.5-fold increase in referral-generating visits for all Medicare patients.(12) Furthermore, a survey of safety-net hospitals in the United States revealed an average wait time of between 6 and 12 months for an initial visit with a specialist.(13) Ultimately, traditional workflow for ambulatory referrals to specialists has led to higher costs and more fragmented care, as communication breakdowns occur commonly in the outpatient referral process.(14) Electronic consultations (eConsults) offer one potential solution to improving access to specialty care