UMMS Affiliation

Division of Health Informatics and Implementation Science, Department of Population and Quantitative Health Sciences

Publication Date


Document Type



Health and Medical Administration | Health Services Administration | Health Services Research | Telemedicine


OBJECTIVE: Electronic consultations (e-consults) are clinician-to-clinician communications that may obviate face-to-face specialist visits. E-consult programs have spread within the US and internationally despite limited data on outcomes. We conducted a systematic review of the recent peer-reviewed literature on the effect of e-consults on access, cost, quality, and patient and clinician experience and identified the gaps in existing research on these outcomes.

MATERIALS AND METHODS: We searched 4 databases for empirical studies published between 1/1/2015 and 2/28/2019 that reported on one or more outcomes of interest. Two investigators reviewed titles and abstracts. One investigator abstracted information from each relevant article, and another confirmed the abstraction. We applied the GRADE criteria for the strength of evidence for each outcome.

RESULTS: We found only modest empirical evidence for effectiveness of e-consults on important outcomes. Most studies are observational and within a single health care system, and comprehensive assessments are lacking. For those outcomes that have been reported, findings are generally positive, with mixed results for clinician experience. These findings reassure but also raise concern for publication bias.

CONCLUSION: Despite stakeholder enthusiasm and encouraging results in the literature to date, more rigorous study designs applied across all outcomes are needed. Policy makers need to know what benefits may be expected in what contexts, so they can define appropriate measures of success and determine how to achieve them. Informatics Association 2019. This work is written by US Government employees and is in the public domain in the US.


consultation, consultation and referral, remote consultation, systematic review, telemedicine

Rights and Permissions

Published by Oxford University Press on behalf of the American Medical Informatics Association 2019. This work is written by US Government employees and is in the public domain in the US.

DOI of Published Version



J Am Med Inform Assoc. 2019 Oct 17. pii: ocz185. doi: 10.1093/jamia/ocz185. [Epub ahead of print] Link to article on publisher's site

Journal/Book/Conference Title

Journal of the American Medical Informatics Association : JAMIA

PubMed ID


Related Resources

Link to Article in PubMed