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PAPER SPOTLIGHT
Can a Virtual Benign Hematology Consult
Improve Access to and Quality of Care?
A multidisciplinary team of researchers
developed a virtual benign hematology con-
sultative service that can potentially reduce
the time it takes a specialist to examine
patient charts and improve access to care for
individuals in remote areas. The researchers
published the findings of their pilot program
in Blood.
“The idea for this program came from the
belief that there was a better way to practice
benign hematology,” lead author Ashok Pai,
MD, from Kaiser Permanente Oakland Medical
Center in California, told ASH Clinical News.
“Our goal was to provide high-quality care for
patients, more timely service for our col-
leagues, and develop expertise and capacity
within this aspect of hematology.”
The program was designed to leverage a
small number of physicians to provide expert
consults to a large patient population, the
authors explained. In October 2017, a pilot
project was initiated at two participating
medical centers after receiving buy-in from
the departments of adult and family medi-
cine. By March 2018, the program expanded
to a total of five medical centers.
Under the project’s protocol, practitio-
ners electronically submitted all non-urgent
benign hematology consultation requests
through an e-consult portal. The portal’s
landing page included evidence-based work-
ups for discrete common hematologic condi-
tions that were developed by members of 15
hematology departments.
Evidence-based workups assessed
consultation requests for common causes,
while urgent health questions and in-patient
consults were called in directly to an on-call
physician. Through the e-consult service,
hematologists reviewed the patient’s chart
and provided advice to the primary-care
physician or conducted an in-person visit with
the patient when deemed appropriate.
One hematology physician from each
medical center rotated weekly in triaging
consults for other hematologists at his or her
respective center. The e-consult program also
included other factors to increase efficiency
and streamline care, such as prepopulated
templates that answered frequently asked
questions and use of established order sets
for the workup of common hematologic is-
sues. Also, the authors wrote, “this allowed
the referring providers to choose the tests
they ordered more wisely.”
During the first seven months of the
20
ASH Clinical News
program, practitioners
at the participating
FIGURE. Patterns for the Benign Hematology
medical centers sub-
mitted a total of 2,013
E-Consult Service
requests through
the e-consult portal.
1,000
These fell under the
900
categories of “Ask the
800
Specialist” (n=1,107)
700
or a specific diagnosis
600
code (n=906).
500
Eighty-five per-
400
cent of the requests
300
submitted under
200
the generic “Ask the
100
Specialist” code were
0
handled electronically,
(n=1,107)
(n=906)
and the remaining
were triaged to an
in-person consult.
Most of the requests
resulted in advice,
rather than in-person appointments ( FIGURE ).
“The time needed for hematology expert
The most common triaged diagnoses for in-
virtual electronic medical record (EMR)
person appointments were thrombocytosis
case review and clinical recommendation is
(60.8%), leukopenia (50.0%), and thrombo-
likely one-quarter of the time needed for a
cytopenia (47.6%).
traditional in-person consultation,” Dr. Pai
Of those with a designated diagnosis
explained. “With the virtual consultation
code, the most frequently submitted queries
service, experts’ time can be used more effi-
included:
ciently, and the service can be made available
anytime and anywhere.”
• anemia (11.9%)
The authors also surveyed hematologists
about their perceptions of the program, with
• abnormal serum protein electrophoresis
most reporting that the workup algorithms
test results (10.3%)
were concise, relevant, and helpful.
Based on the experiences with this pilot
program (which still allowed for in-person
• anticoagulation (7.1%)
consultations when desired), Dr. Pai said,
“The future of hematology is in virtual,
• thrombocytopenia (5.1%)
expert-based consultative services available
to support patients and frontline physicians
• leukocytosis (3.6%)
everywhere.”
However, he cited limitations of the pro-
• thrombocytosis (2.8%)
gram, including the single-center experience
and the program’s reliance on EMR data ac-
• erythrocytosis (2.2%)
curacy and accessibility. “Work will need to be
done so the future EMR are mostly focused
• leukopenia (2.0%)
on clinical needs,” he concluded.
The authors report no relevant conflicts of
Approximately 90 percent of the consulta-
interest.
tion requests were addressed within 24
hours. Data on the time to completion of
REFERENCE
an e-consult was available from seven of
Pai A, Kotak D, Facher N, et al. Development of a virtual benign hematology
the participating hematologists; the aver-
consultation service: results of a pilot project involving 5 medical centers. Blood.
2019;133:993-5.
age time necessary to complete a consult
was 14.47 minutes (range = 14.02-14.91
minutes).
April 2019