Dawn of a New and Improved Consult Letter

Dawn of a New and Improved Consult LetterMy last blog clearly touched a nerve, as evidenced by the number of comments (14 in 5 days) and their spirited tone. Clearly—and we agree on this—the consult letter is a key part of patient care. The issue is how to get useful information efficiently transferred from the specialist to the primary-care physician without compromising the nuanced content and without reducing the patient encounter to a series of data points—the fear voiced by many of those who commented.

The question at the heart of this matter is what constitutes a consult letter in today’s medical practice and what it should be in the future. Currently, it may be a well-worded letter that ideally is concise and to the point; however, at the other end of the spectrum, an EHR-generated exam note is increasingly serving as the consult letter. My previous blog was really an indictment of the templated notes that more and more physicians are sending in lieu of consult letters. These are often bloated, undecipherable multipage notes that physicians find useless in communicating or identifying the impression and care plan. (This is the fundamental objection expressed in the comments from Drs. Dugger, Franc, Werner, Raulston, Kuhl, and others.)

The new Summary of Care document—a creation of the meaningful use program—replaces the EHR-generated exam note. While its emphasis is on transmitting discrete data, there is nothing that precludes physicians from incorporating narratives that convey the desired nuance. The Summary of Care can accommodate a long list of data, but it does not have to be a “data dump”—data that the sending physician feels is not relevant can be omitted. What physicians typically find most valuable in the summary is a limited set of data—diagnosis, medications, procedures, lab test results, and immunizations, along with a care plan. Descriptive text can be inserted/appended if the physician feels it would add value.

The value of the Summary of Care format is its simplicity, consistency, and data-rich content, which together enable the receiving physician to easily identify the information that is important to him or her (typically, the impression and care plan), and to incorporate that information into the patient’s chart. The data is subsequently available to the physician and can be retrieved and/or reported as needed. This stands in stark contrast to the templated exam note that currently functions as a consult letter.

Designed correctly, the Summary of Care will serve as a new and improved consult letter, delivering system-wide efficiencies while preserving the personal “art of diagnosis” (to quote Christian Wertenbaker’s comment). Nothing prevents a physician who crafts well-constructed consult letters from continuing to send them along with the Summary of Care. But it is my prediction that as EHR software continues to evolve and to develop more content-rich Summaries of Care, fewer and fewer physicians will find it necessary to supplement them in this manner. And given how overburdened and harried so many doctors already are, that will be a good thing.