Founded at the Abramson Cancer Center at the University of Pennsylvania

E-Consults: Reducing Wait Times for Patients with Blood Disorders

E-Consults are being used to reduce wait times for hematology patients


Wait times to see a physician, particularly a specialist, have steadily increased over the last several years. Recent data found the average wait time for an appointment was 26 days in 2022—up 8% from 2017 and 24% from 2004. Waiting periods for specialty physicians can stretch as long as six months. This is more than mere inconvenience, with study after study showing extended wait times negatively impact care outcomes, particularly for underserved people and communities.

Researchers at the Penn Center for Cancer Care Innovation (PC3I) are testing one alternative to face-to-face visits known as e-consults for non-malignant hematology, or non-cancerous blood disorders. E-consults are defined as communications, typically occurring through electronic health records, that allow specialty physicians to provide patient consultations based on chart review alone, rather than relying on face-to-visits. This observational study and innovation initiative, led by Mia Djulbegovic, MD, MHS and conducted in collaboration with the Penn Blood Disorders Center at the Perelman Center of Advanced Medicine, utilized innovative methods to create, optimize and test e-consults to dramatically improve access to specialty care.


E-consults have long shown promise, but minimal evidence existed demonstrating their impact on the clinical outcomes and experience until now. E-consults for patients with blood disorders led to a 13-fold reduction in “time to action” – from 90 days for face-to-face visits to seven days for e-consults. Time to action is a patient-centric measure of the time it takes from seeing a primary care doctor to receiving a medical intervention for a blood disorder informed by a specialist recommendation. Additionally, most care providers—including referring clinicians and hematologists—expressed high satisfaction with the e-consultation process, with net promoter scores above 84.


Mia Djulbegovic, MD, MHS; Justin Grischkan, MD; Ashna Aggarwal; Stephanie Wang; Allyson Pishko, MD; Ariela Marshall, MD; Adam Cuker, MD, MS; Joseph Teel, MD; Justin Bekelman, MD


Penn Medicine-OptumLabs


Clinical Transformation


By Scott Harris

Transforming Cancer Care

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