The American journal of managed care
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Electronic consultation, or e-consult, systems improve specialty care access by conveying specialist expertise to primary care clinicians (PCCs) without requiring specialist visits. Our study evaluates organizational factors for e-consult implementation across 5 publicly financed, county-based health systems in California. Each system serves 40,000 to 180,000 culturally and linguistically diverse patients across 4 to 19 primary care locations. ⋯ Successful e-consult implementations in public delivery systems leveraged (1) prior primary care and specialty care clinician relationships and (2) integrated EHR and e-consult platforms. This contrasts with common expectations that new technology will overcome care delivery gaps. Findings add to existing e-consult implementation literature that emphasizes reimbursement and leadership champions.
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Editorial
The health IT special issue: enduring barriers to adoption and innovative predictive methods.
Electronic health record systems have the potential to significantly improve care coordination and, ultimately, clinical care delivery. Still, it is clear that these systems are not silver bullets that will automatically result in better coordination of care and quality.
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Telemedicine offers a promising solution to the growing physician shortage, but state-based medical licensing poses a significant barrier to the widespread adoption of telemedicine services. We thus recommend a mutual recognition scheme whereby states honor each other's medical licenses. Successfully implementing mutual recognition requires policy, technological, and administrative changes, including a federal mandate for states to participate in mutual recognition, consistent standards for using and regulating telemedicine, a mechanism to enable interstate data sharing, financial support for states, and a "state of principal license" requirement for physicians. Reforming the United States' outdated system of state-based medical licensure can help meet patient demand for virtual care services and improve access to care in rural and medically underserved areas.
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Implementation of retail health consumer tactics in primary care poses challenges for primary care doctors that must be recognized and addressed.
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To mark the 25th anniversary of the journal, each issue in 2020 will include an interview with a healthcare thought leader. Because January is our annual health information technology issue, we turned to Eric Topol, MD, of Scripps Research.