UMMS Affiliation

Department of Population and Quantitative Health Sciences, Division of Health Informatics and Implementation Science; Department of Population and Quantitative Health Sciences, Division of Preventive and Behavioral Medicine

Publication Date


Document Type



Health Communication | Health Information Technology | Health Services Administration | Health Services Research | Telemedicine


BACKGROUND: Strong relationships and effective communication between clinicians support care coordination and contribute to care quality. As a new mechanism of clinician communication, electronic consultations (e-consults) may have downstream effects on care provision and coordination.

OBJECTIVE: The objective of this study was to understand primary care providers' and specialists' perspectives on how e-consults affect communication and relationships between clinicians.

RESEARCH DESIGN: Qualitative study using thematic analysis of semistructured interviews.

SUBJECTS: Six of 8 sites in the VISN 1 (Veterans Integrated Service Network) in New England were chosen, based on variation in organization and received e-consult volume. Seventy-three respondents, including 60 clinicians in primary care and 3 high-volume specialties (cardiology, pulmonology, and neurology) and 13 clinical leaders at the site and VISN level, were recruited.

MEASURES: Participants' perspectives on the role and impact of e-consults on communication and relationships between clinicians.

RESULTS: Clinicians identified 3 types of e-consults' social affordances: (1) e-consults were praised for allowing specialist advice to be more grounded in patient data and well-documented, but concerns about potential legal liability and increased transparency of communication to patients and others were also noted; (2) e-consults were perceived as an imperfect modality for iterative communication, especially for complex conversations requiring shared deliberation; (3) e-consults were understood as a factor influencing clinician relationships, but clinicians disagreed on whether e-consults promote or undermine relationship building.

CONCLUSIONS: Clinicians have diverse concerns about the implications of e-consults for communication and relationships. Our findings may inform efforts to expand and improve the use of e-consults in diverse health care settings.


communication, computerized order systems, coordinated care, qualitative research

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Written work prepared by employees of the Federal Government as part of their official duties is, under the U.S. Copyright Act, a “work of the United States Government” for which copyright protection under Title 17 of the United States Code is not available. As such, copyright does not extend to the contributions of employees of the Federal Government.

DOI of Published Version



Anderson E, Vimalananda VG, Orlander JD, Cutrona SL, Strymish JL, Bokhour BG, Rinne ST. Implications of Electronic Consultations for Clinician Communication and Relationships: A Qualitative Study. Med Care. 2021 Sep 1;59(9):808-815. doi: 10.1097/MLR.0000000000001575. PMID: 34116530; PMCID: PMC8360667. Link to article on publisher's site

Journal/Book/Conference Title

Medical care

PubMed ID


Related Resources

Link to Article in PubMed