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Tapping the Benefits of Targeted Automatic Electronic Consultations

By Christopher Cheney  
   August 13, 2019

Information drawn from a patient's electronic health record triggers virtual consultation with a specialist.

A new model for electronic consultations has the potential to improve care quality, reduce length of stay, and decrease hospital costs, according to a new journal article.

No single physician can know everything, which requires specialist consultation to effectively manage many conditions. But traditional consults—with chart review, patient history, physical exam, and recommendations—are time consuming and resource intensive. Targeted automatic electronic consultation (TACo) offers an efficient electronic health record-driven approach to specialty consultations.

Under the TACo approach, the EHR identifies patients who meet the criteria for automatic consultation and displays a customized view of patient information to a designated specialist for virtual review, the authors of the new Journal of the American Medical Association article wrote.  

"The consultant can choose to provide targeted advice, suggest formal consultation, or neither. Like e-consults, this model allows the specialist to review pertinent information in the EHR and offer a rapid response. Unlike regular e-consults, these targeted automatic consults are triggered by patients' EHR data rather than a consultation request. Unlike automatic formal consults, the TACo model enables efficient virtual consultation," they wrote.

Previous research has shown patient access benefits from e-consult programs such as a Veterans Affairs study that found e-consults reduced response time by 92% to 95%, slashing consultation access time from 34.4 days to 2.4 days.

TACo approach to diabetes consults

The University of California San Francisco Diabetes Service has adopted the TACo model for inpatient screening:

  • On a daily basis, the EHR screens inpatients for four criteria—Type 1 diabetes, insulin pump use, and hyperglycemia or hypoglycemia in the previous day
  • For targeted patients, the EHR presents pertinent data for diabetes specialists such as glucose trends, insulin dose, fluid and nutritional information, and lab tests
  • After reviewing targeted cases virtually, specialists can make management recommendations in a brief consult note

The UC San Francisco TACo approach has generated significant benefits, including a 39% decrease in the proportion of patients with hyperglycemia and a 36% decrease in hypoglycemic events.

TACo opportunities

Five factors are likely to drive future adoption of the TACo model, the JAMA article says:

1. Consultations that are commonly requested

2. Patients that primary care teams find difficult to manage or challenging to connect with timely consultations

3. Patients that do not require detailed chart review

4. Patients that do not require visits with consulting clinicians

5. Triggering consultations with objective data such as a clinical test result that is conducive to EHR-based screening

"Because this model would likely increase the total number of consults, any investment in consultant time would have to be offset by improvements in care and decreased costs. If this approach results in improved quality, reduced lengths of stay, and decreased hospital costs, the business case for health system support could be strong, particularly when payments to the system are capitated or bundled," the JAMA article says.

Christopher Cheney is the senior clinical care​ editor at HealthLeaders.


In the targeted automatic electronic consultation (TACo) approach, the electronic health record identifies patients who meet the criteria for automatic consults.

TACo consultation opportunities include patients who do not require a detailed chart review or physical examination.

The University of California San Francisco Diabetes Service's TACo approach to inpatient screening has improved control of hypoglycemia and hyperglycemia.

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