Implications of Electronic Consultations for Clinician Communication and Relationships: A Qualitative Study

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.