UCSF Sustainability Stories


Deborah Fleischer, Green Impact, July 2013


UCSF eConsult program makes patients happy and delivers green benefits

computerThe UCSF Medical Center and the Department of Medicine’s electronic health record (EHR) has transformed the way UCSF delivers health care. Primary care and subspecialist physicians in medicine are engaged in eConsults, an innovation made possible by the new EHR system to improve the referral and communication process.  eConsults is a mechanism for primary care physicians to receive a subspecialty consultation within 72 hours for patients that do not require an in-person evaluation.

Dr. Ralph Gonzales, Professor of Medicine with UCSF’s Department of Medicine, took time out from his busy schedule to speak with us about the eConsult program, which makes it easier for UCSF patients to see a subspecialist, not only saving patients time and money and improving access to subspecialists, but helping UCSF reducing carbon emissions. 

Dr. Gonzales, along with Nat Gleason and Josh Adler among others, have been designing and implementing programs that allow more patients to get their follow-up care from home instead of trekking to the Medical Center. In addition to creating more access for new patients at UCSF, the patients absolutely love it.

“The most developed program is our eConsult program, which has saved up to 500 patient visits over the past six months in our initial pilot with medicine subspecialties.  We’ve calculated it saves patients approximately $50-$75 per person when you take into account visit co-payments, transportation and parking, not to mention time off work and child care,” explained Dr. Gonzales.

eConsults are also Green Consults

In addition to reducing office visits, the program helps UCSF reduce the carbon footprint of its clinical operations. 

Over a typical year, UCSF sees about 150,000 new patient referrals/consultations among the specialty practices.  If 5-10 percent of these referrals are managed as eConsults instead of office visits, UCSF would save about 15,000 trips to UCSF and over $1 million in savings for patients, who would not need to drive, park, pay a co-pay, miss work or pay for childcare (this assumes $50-$75 out of pocket costs for patients per consultation).

Assuming patients average 20 miles round trip, if the eConsult program is expanded across UCSF, annually it could reduce patient travel by 300,000 miles, reducing 125 metric tons of carbon, equal to taking 26 cars off the road.

Emerging Trend:  Telemedicine

Another emerging trend to keep an eye on is telemedicine, where UCSF is exploring a range of technologies, from iPhone apps and virtual tumor boards to remote dentistry and nutrition consultations to HIV patients.  These technologies can provide better care and improve how practitioners work together.

UCSF recently completed a study that calculated the cost/benefit of UCSF providing pharmacy and nutrition consultations via telemedicine to HIV-patients at SF clinics.  The study found that the benefits of telemedicine included providing high-tech and quality care, as well as reduced travel and associated green house gas emissions.  Insurance reimbursement issues continue to be a challenge.

If you want to learn more about how to launch a telemedicine program at UCSF, click HERE.