• Ekaterina Anderson, Ariella Krones, Varsha G Vimalananda, Sarah L Cutrona, Jay D Orlander, Judith L Strymish, and Seppo T Rinne.
• Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, 200 Springs Rd, Bedford, MA 01730. Email: ekaterina.anderson@va.gov.
• Am J Manag Care. 2023 Dec 1; 29 (12): e378e385e378-e385.

ObjectivesElectronic consultations, or e-consults, which are requests for specialist advice without direct patient interaction, are becoming increasingly common across health systems. We sought to identify clinicians' perspectives on the quality of e-consult requests that they send and receive.Study DesignA qualitative research study at the US Department of Veterans Affairs (VA) New England Healthcare System.MethodsWe interviewed a total of 73 clinicians, including 38 specialists across 3 specialties (cardiology, neurology, pulmonology) and 35 primary care clinicians (PCCs), between March and June 2019. The interviews were analyzed using thematic analysis.ResultsVA specialists and PCCs generally agreed that e-consult requests should be focused and precise, not require lengthy chart review, and include adequate preliminary workup results. At the same time, specialists expressed frustration with what they perceived as suboptimal e-consult requests. Interviewees attributed this gap to 3 factors: limitations of the electronic health record user interface, divergence between PCCs and specialists in the areas of expertise, and organizational pressures on the 2 groups.ConclusionsVA clinicians' perspectives on suboptimal requests contain lessons that are broadly applicable to other health systems that seek to maximize the potential of e-consults to facilitate clinician collaboration and care coordination.

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