Leveraging an Electronic Consultation Program for a High-Volume Hepatology Clinic.

INTRODUCTION: The prevalence of chronic liver disease is increasing in the United States, and a concurrent national shortage of hepatologists has resulted in long wait times for specialty care. Electronic consultations (E-consults) have emerged as a strategy to expand access by enabling asynchronous communication between referring providers and specialists. Limited data exist on hepatology-specific E-consults, particularly in the post-coronavirus disease 2019 era. This study aimed to characterize contemporary hepatology E-consult use and evaluate their impact on subsequent healthcare utilization within a health system. METHODS: We conducted a retrospective cohort study of all hepatology E-consults completed at a large academic health system between January 1, 2021, and December 31, 2024, with follow-up through June 30, 2025. Patient demographics, referring provider characteristics, clinical questions, and outcomes were extracted from the electronic health record. The primary outcome was the proportion of E-consults addressed without an in-person hepatology clinic visit within 6 months. RESULTS: A total of 3,011 hepatology E-consults were requested by 663 unique providers across 39 specialties, most commonly family medicine 36.8% and internal medicine 21.9%. The most common clinical concerns were abnormal liver tests (68.9%), abnormal imaging (18.5%), and metabolic-associated steatotic liver disease (12.4%). Median completion time was 0 days, compared with 46 days for traditional referrals. Overall, 63.6% of E-consults addressed clinical questions without a subsequent hepatology visit, avoiding nearly 137,000 miles of patient travel. DISCUSSION: Hepatology E-consults can effectively manage many low-complexity cases within primary care, preserve specialty clinic capacity, and reduce patient travel burden. These findings highlight the role of E-consults in addressing the growing demand for hepatology expertise.

Duke Scholars

Author Andrew Joseph Muir Medicine, Gastroenterology

Author Julius Middleton Wilder Medicine, Gastroenterology

Author Jacqueline Boykin Henson Medicine, Gastroenterology

Author Amreen Dinani Medicine, Gastroenterology