At Dartmouth-Hitchcock (D-H), we are always looking for innovative solutions that use technology to improve patient care.

Since its implementation in 2015, our eConsults program has enabled our primary care providers to seamlessly request specialty consultations on individual patient cases through our electronic medical record (EMR) system, which is called eD-H. Not only has the program significantly reduced unnecessary specialty referrals and visits, but it has cut down on healthcare and travel costs for patients, fostered better relationships between D-H health care providers and resulted in more efficient patient care.

Susan Hanlon
Director, Knowledge Map

About eConsults

In 2014, Dartmouth-Hitchcock was selected as a pilot site for the Association of American Medical Colleges’ Project CORE (coordinating optimal referral experiences) initiative, which was funded by a grant from the Centers for Medicare & Medicaid Innovation (CMMI). As part of Project CORE, D-H implemented a tool called eConsults that is based in the electronic medical record (EMR) and streamlines and improves communication and coordination between primary care providers (PCPs) and specialists.

The eConsults program allows PCPs to request a consultation from a specialist within the Dartmouth-Hitchcock system through a patient’s EMR, which is housed within the eD-H system. eConsults are typically used for patients who have low-complexity medical conditions.

Fantastic … quick answers to anything [my PCP] was considering doing.

D-H patient

Participating D-H providers from 42 specialty areas — including endocrinology, nephrology, pediatrics, psychiatry, radiology and more — can electronically review eConsults requests, access patient medical records and respond to PCPs, all within a few business days. PCPs are then able to use the information received from the specialist to provide expert care and determine the next steps in the patient’s treatment.

eConsults is currently available only for PCPs and specialty providers within the D-H system. However, to improve medical care throughout the entire region, D-H hopes to expand its eConsults program to include external providers that are not affiliated with the D-H system.

Benefits of eConsults

Patients, PCPs and specialists at D-H are realizing the benefits of eConsults. Benefits for patients include:

  • Faster access to specialty physician expertise.
  • Lower health care and travel costs due to avoiding unnecessary specialist referrals and visits.
  • Improved access to specialty care for patients with high-complexity health conditions.
  • Improved coordination of care between specialists and PCPs.

Benefits for PCPs include:

  • Efficient access to specialty physician expertise and advice.
  • Streamlined electronic communication with specialty physicians through convenient EMR-based interface.
  • Improved relationships with specialty physicians.

Benefits for specialty physicians include:

  • Easy access to patient information, records and images within EMR.
  • Streamlined electronic communication with PCPs through existing EMR-based interface.
  • Improved relationships with PCPs.
  • Fewer unnecessary specialist referrals and visits.
  • Increased availability to see patients with high-complexity health conditions promptly.

I find that eConsults help me feel I have a relationship with specialists!


eConsults program goals

  • Improve coordination and communication between PCPs and specialists.
  • Reduce unnecessary specialist referrals and visits.
  • Improve access to specialty physician expertise for patients with low-complexity health conditions.
  • Improve access to in-person specialty care for patients with high-complexity health conditions.

By the numbers

4 - Number of years since the eConsults program was implemented at D-H

95 percent - Percentage of PCPs who are satisfied with the response provided by the specialty physician through eConsults

80 percent - The approximate number of patients who were able to avoid a specialist referral after using eConsults

42 - Number of D-H specialties that are using eConsults