An electronic consult (eConsult) system allows primary care practitioners (PCPs) to request assistance from specialists electronically, potentially expediting access to specialty services among patients who need them. Despite its ability to improve access to care, a study in JAMA Internal Medicine finds that an eConsult system can increase work burden among PCPs.1

A total of 40 Los Angeles-based PCPs with varying practice types were interviewed about their use of the Los Angeles County Department of Health Services eConsult system. The eConsult system used by the PCPs was a separate platform from the electronic medical record system. Perceptions of clinical workflow, relationships and access to specialists, and referral decision making were all assessed in the qualitative interviews. Investigators de-identified interview data for review and analysis.

Approximately 60% (n=24) of PCPs in the study reported performing ≥5 eConsults each week. Among the PCPs, the perceived benefits associated with an eConsult system included improvements in expediting specialist input as well as greater clinical and educational discussion with specialists. In addition, some PCPs reported greater accountability in communicating patient needs to the specialist.

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Despite these advantages, the PCPs reported that some of the specialty care work had been shifted to their practice sphere, resulting in increased workload. Although some of the interviewed PCPs believe the benefits of the eConsult system offset the increased work burden, others reported frustration with the system’s increased administrative burden, the restructuring of the delivery of specialty care, and the greater clinical responsibility.

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The findings of this study are considered hypothesis generating because of the qualitative nature of the analysis. Additionally, the lack of interviews prior to eConsult system implementation limits the ability to determine a definite beneficial impact of the system on clinical care.

In an accompanying invited commentary, Nathaniel Gleason, MD, of the division of general internal medicine at the University of California, San Francisco, and colleagues noted that the study provided important insight into PCP experiences but caution that results should not be taken as “a verdict on the success or failure of eConsult.”2

“Rather, it raises important questions about how design features, implementation strategies, and contextual influences can lead a tool to be successfully adopted in one setting while encountering more resistance in another,” they concluded.


  1. Lee MS, Ray KN, Mehrotra A, Giboney P, Yee HF Jr, Barnett ML. Primary care practitioners’ perceptions of electronic consult systems: a qualitative analysis [published online April 12, 2018]. JAMA Intern Med. doi:10.1001/jamainternmed.2018.0738
  2. Gleason N, Ackerman S, Shipman SA. eConsult — transforming primary care or exacerbating clinician burnout? [published online April 12, 2018]. JAMA Intern Med. doi:10.1001/jamainternmed.2018.0762