The End of the Consult Letter as We Know It

The End of the Consult Letter as We Know ItThe end is in sight for the consult letter as we know it today. This has the potential to be a significant benefit delivered by meaningful use standards—physicians will get the clinical information they want and need from other physicians, and they will get it faster and more efficiently. Gone will be the days of lengthy, unstructured notes sent by fax or mail from one provider to another.

In today’s world, specialists report to referring physicians (i.e., primary-care providers) via a dictated consult letter or transcribed exam notes. These tend to be text heavy and contain no discrete or importable data. Others send EHR-generated narratives—lengthy notes that most physicians find difficult to read, if not useless. Finding the impression and care plan buried in massive amounts of verbiage is frequently a frustrating and time-consuming process. Meaningful use addresses this challenge by requiring a discrete data-rich summary of care for transitions from provider to provider. A menu measure in Stage 1, these summaries become a core measure in Stage 2, with more robust and structured content and the requirement that at least some of them be transmitted electronically.

The required Summary of Care provides better-quality information to the receiving provider and is created with less manual effort by the sending physician. The receiving EHR assimilates all of the data, presenting it in a cogent manner. The Summary of Care will contain structured data and a concise, accessible impression and care plan that tells the referring physician exactly what he/she needs to know. The receiving physician will filter the data as desired and the data can then be incorporated into the patient’s chart in his/her EHR, since all certified EHRs will use standard vocabularies.

Ease and speed of communication, along with cost reduction, are significant benefits, too. The Summary of Care can be transmitted as quickly as the data is entered into the patient’s chart. An automated batch process sends the summaries from the specialist’s EHR directly to the PCP’s, eliminating the cost of printing, faxing, or mailing letters. Meaningful use Stage 2 provides for the exchange either directly from provider to provider via secure e-mail (the “Direct” messaging protocol) or through Health Information Exchanges (HIEs).

Meaningful use will mark an end to the transmission of consult letters devoid of discrete data and to the exchange of hard to read exam notes. The impact on physician and practice productivity is undeniable.