Speeding Access to Specialty Health Care in NYC

New System Streamlines Process to See a Specialist

HEALTH- Appointments to see an outpatient specialist at NYC Health + Hospitals/Lincoln are expected to be a little quicker and easier to schedule, thanks to a program called eConsult—a system that streamlines the referral process from primary care providers to specialists.

The system also facilitates enhanced communication between the primary care provider and the specialist so sometimes the patient can avoid a visit to a specialist altogether.

At left, Milton Nunez, CEO of NYC Health + Hospitals/Lincoln congratulates Herman Ambris, MD, Chief of Service of Physical Medicine and Rehabilitation, and 30 year veteran of Lincoln, for the team’s stellar participation in the process.

The eConsult system has been expanding dramatically in recent months, as more outpatient clinics in the public health system sign on citywide. 

Just this month, Rehabilitation Medicine and Infectious Disease at NYC Health + Hospitals/Lincoln became the 100th and 101st specialty clinics in the city to participate. They join 12 other specialty clinics at Lincoln—including Ear/Nose/Throat, Gastroenterology, Neurology, and Urology—making the hospital one of the most aggressive adopters of eConsult in the public health system.

NYC Health + Hospitals/Jacobi and NYC Health + Hospitals/North Central Bronx are also participating in eConsult, demonstrating the unity of the Bronx hospitals in improving patient access to specialty care.

“Specialists like oncologists, orthopedic surgeons, and ophthalmologists often play a critical role in diagnosing and managing our patients’ illnesses,” said Dave Chokshi, MD, vice president and chief population health officer at NYC Health + Hospitals. “EConsult helps facilitate more rapid access to specialist expertise, which is a priority as we continuously work to improve patient care.”

How does it work?

When a primary care provider’s patient has a health concern that would typically be treated by a specialist, the primary care provider can send a message through the system and get a quick response from the specialist, who can then suggest next steps for the patient, as well as secure a timely appointment for the patient, if needed.

For example, one Bronx resident—we’ll call him Joe—saw his primary care doctor recently, who diagnosed acute pancreatitis. The primary care doctor exchanged messages through eConsult with a gastroenterologist about the best approach for Joe. 

The gastroenterologist gave instructions to the primary care doctor for the tests Joe needed, and an appointment for a visit was scheduled. When Joe went to the gastroenterologist, the diagnosis was already clear, and Joe and the gastroenterologist were able to focus on the plan of care—a much faster path from problem to solution than in the past. Joe couldn’t have been more pleased with the care.

Some lucky patients have it even easier. Depending on the diagnosis, sometimes the guidance from specialists can empower the primary care provider to treat the patient in the primary care setting, avoiding the visit to the specialist completely. 

For example, the specialist might recommend the primary care provider to prescribe a medication, and the patient can do all the follow-up with the primary care provider, always with the support of the specialist if additional guidance is needed.

Measuring success

“By having a significant number of patients managed in the primary care setting and by reducing the number of inefficient first visits to specialists, we have freed up valuable appointment time with our specialists, which makes a huge difference for patients,” said Hannah Byrnes-Enoch, MPH, director of specialty care transformation in the Office of Population Health.

Throughout the public health system, there have already been 79,370 referrals between a primary care provider and a specialist through eConsult, and nearly 8,000 new referrals take place each month. Is it working? When eConsult first started, only 14 specialty clinics participated, but wait times for new patient appointments dropped by 23 percent—a key reason why NYC Health + Hospitals is pushing to expand the program.

About NYC Health + Hospitals/Lincoln

NYC Health + Hospitals/Lincoln, located at 234 East 149th Street in the Bronx, is a 362-bed, Acute Care Level 1 Trauma Center with the busiest single site emergency department in the region. Recognized as a “2013 Top Performer on Key Quality Measures” by The Joint Commission, receiving top grades in Leapfrog Scores Safety in 2015 and 2017, and acknowledged with High Performing ranks in U.S. News & World Report in 2017 and 2018, the hospital emphasizes primary care and specialty medicine and uses the latest advances in medical science. It has designations as a Breast Center of Excellence, Breast Imaging Center of Excellence, Diabetes Education Center of Excellence, and others. Lincoln’s Primary Stroke Center has The Joint Commission’s Gold Seal of Approval and the American Heart Association/American Stroke Association’s Gold Plus and Target Plus Honor Elite awards. Its Hemodialysis, Palliative Care and Perinatal Care services are all The Joint Commission certified.


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