Endocrinology Auto-Triggered e-Consults

Diabetes currently affects 25.8 million people in the U.S. Patients with diabetes are
generally managed, at least initially, by a primary care practitioner (PCP). As the
prevalence of diabetes continues to rise, PCPs are under increased pressure to achieve
recommended glycemic targets. Failure to achieve these targets has been shown to increase
clinical complications and cost of care.

Endocrinology referral is common for those patients not meeting A1c goals. Unfortunately,
access to specialty endocrinology care is limited and patients routinely wait weeks or months
before being seen. Electronic consultation (e-consult) is a new and innovative delivery model
that has the potential to provide greater access to specialty care. The current system at
Massachusetts General Hospital (MGH) allows PCPs to electively place an e-consult to solicit
specialist input. Specialists in turn review the patients chart, relevant data and the
clinical question and respond within the electronic medical record. E-consults have been well
received by both patients and physicians, not only at MGH, but also across many centers in
the US. With that said, the e-consult system remains in its infancy and current literature
largely focuses on process metrics without hard clinical end-points.

One way to optimize care for patients with diabetes is to automatically trigger an
endocrinology e-consult for those not meeting A1c targets. The goal of this project will be
to conduct a rigorous scientific evaluation of auto-triggered e-consults across Massachusetts
General Hospitals affiliated primary care practices. The e-consults will be unsolicited and
triggered based on inclusion criteria that include a1c and date of last PCP visit. This
project will leverage an existing diabetes population health registry that is being used
currently for ongoing diabetes care initiatives.