Watch administrative director Barb Spurrier describe the eConsult project (YouTube version for slow connection).
As part of its first platform, Mayo Clinic Connection, the CFI experimented with electronic consultations to make physician-patient and physician-physician communication more flexible. There were two types of eConsults: synchronous, in which communication was in real time through video or phone with the patient present; and asynchronous, which was a phone call or email between physicians without the patient present.
The physician-to-patient eConsults made follow-up communication more convenient for some patients. Many medical treatments required a follow-up visit some weeks or months later, but those who came to Mayo Clinic from a long distance found it difficult to make a second trip to Rochester.
The CFI’s research showed that some of those doctor's appointments could be done through a video conference call. In partnership with Blue Cross Blue Shield, the CFI developed an eConsult system in which patients did their follow-up appointment over Skype with a video camera. As CFI outpatient lab manager Naomi Woychick explained,
…if the patient has been here for the course of their full work-up, and not all of their exams are done but they're going home, typically what would happen is that the doctor would end up doing a comprehensive letter to the patient, summarizing all of the care that they received from the sub-specialty consults and the lab tests and everything. In one case, there was a patient who had been here for a couple of weeks and left his family. Then he went back home to Colorado and we did a Skype summary visit with webcams. The patient was sitting in his own home, and the doctor had faxed him all of his medical information, so he could look at all the written information and have the conversation with the doctor. And it was interesting because Dr. Paat was sitting in the chair, and we could see the guy at the computer, with his wife in the background, and Dr. Paat said, "Oh, is that your wife?" And so she came over and got to meet Dr. Paat, and it was very cool to watch the interaction that they were able to have. And Dr. Paat still did a summary letter, but it wasn't as intense. And he said that when it's a complicated case, he can spend up to 45 minutes putting together a summary visit, but here it took 12 to 15 minutes to summarize everything.
One version of these eConsults was set up on a subscription model, with the insurer allowing the patient unlimited consults with their primary care physician.
The second type of eConsult helped physicians to communicate with each other more easily and to save time in record-keeping. The CFI set up a special email-style communication system that allowed primary care doctors to ask questions of specialists both inside and outside of Mayo Clinic and to have the consultation automatically recorded and billed.
The CFI engaged in an intensive PR effort through newsletters, posters, videos, and other media to encourage physicians to use eConsults among themselves and to present the option to their patients. In 2009 the CFI had 1200 eConsults in pilot, and for 2010 it anticipated doubling that number. However, in 2010 the CFI had not yet figured out a way to quantify the benefits of eConsults. As LaRusso explained, "So while we can show that patients like it, because it saves them time and doctors like it because it saves them time; we still have to figure out a way to financially convert the number of these eConsults that we're doing into a dollar figure."