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Health Aff (Millwood). 2017 Mar 1;36(3):492-499. doi: 10.1377/hlthaff.2016.1283.

Los Angeles Safety-Net Program eConsult System Was Rapidly Adopted And Decreased Wait Times To See Specialists.

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Michael L. Barnett ( is an assistant professor of health policy and management at the Harvard T. H. Chan School of Public Health and an instructor in the Division of General Medicine and Primary Care at Brigham and Women's Hospital, both in Boston, Massachusetts.
Hal F. Yee Jr. is chief medical officer at the Los Angeles County Department of Health Services, in Los Angeles, California.
Ateev Mehrotra is an associate professor of health care policy at Harvard Medical School, in Boston.
Paul Giboney is director of specialty care at the Los Angeles County Department of Health Services.


Lack of timely access to specialty care is a significant problem among disadvantaged populations, such as those served by the Los Angeles County Department of Health Services. In 2012 the department implemented an electronic system for the provision of specialty care called the eConsult system, in which all requests from primary care providers for specialty assistance were reviewed by specialists. In many cases, the specialist can address the primary care provider's question via an electronic dialogue, thereby eliminating the need for the patient to see a specialist in person. We observed rapid growth in the use of eConsult: By 2015 the system was in use by over 3,000 primary care providers, and 12,082 consultations were taking place per month, compared to 86 in the third quarter of 2012. The median time to an electronic response from a specialist was one day, and 25 percent of eConsults were resolved without a specialist visit. Three to four years after implementation, the median time to a specialist appointment decreased significantly, while the volume of visits remained stable. eConsult systems are a promising and sustainable intervention that could improve access to specialist care for underserved patients.


Access To Care; Information Technology; Minority Health; Organization and Delivery of Care; Safety-Net Systems

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