Dr. Rajiv Dhamija

Dr. Rajiv Dhamija (RD), from the Department of Health Services-Los Angeles County, discusses his abstract for the National Kidney Foundation’s 2014 Spring Clinical Meetings (SCM14), Increasing Nephrology Specialty Care Efficiency with the Use of Electronic Consults, with Dr. Kenar Jhaveri (eAJKD), eAJKD Editor.

eAJKD: Why don’t you tell us a little about your research and abstract being presented at NKF 2014 Spring Meetings?

RD: Our work details the electronic consultation (e-consult) nephrology specialty outcomes from the Department of Health Systems (DHS) in Los Angeles County. Currently we provide nephrology services to not only our own DHS hospitals, clinics, and tertiary facilities but we also cover affiliate community clinics and health facilities outside of DHS. Due to the sheer numbers of nephrology specialty clinic requests we are unable to meet the ever increasing demand. Recently, DHS leadership implemented the e-consult portal for specialty care to help provide direct patient care recommendations to primary care providers. In addition the e-consult allows the nephrology specialty provider to triage those patients needing routine vs. urgent face to face visits. Primary care providers from both within DHS facilities as well as those in the community are able to get nephrology specialty care patient specific feedback from DHS Renal providers through the consult system. Written dialogue exchanges occur in a secure web based e -consult portal between the primary care provider and the renal consult specialist.

eAJKD: How do you account for payment for the physician providing for the E consult? In the current world of RVUs, can this model survive? What do you think of RubiconMD.com, a similar national endeavor?

RD: Currently the e-consult system is not reimbursed separately by DHS Los Angeles County. Each DHS nephrology division is assigned their own facility as well as a share of the community health facilities to provide e-consult nephrology specialty services. Volume of e consult dialogues and requests are monitored and distributed accordingly. The work done by the nephrology specialist consult provider is felt to be within the scope of practice for both the salaried and contract DHS e-consult health providers.

We are not able to access the Rubicon MD program within DHS. After reviewing their website I feel they are more of privatized company with national endeavor. Our format is focused on providing specialty care to our local Los Angeles county patient population with ever increasing needs for specialty clinic coverage.

I feel that treating patients remotely across state and international borders may have additional benefits as well as risks. Personally, I believe additional resources including malpractice implications as well as RVU type work compensation models will need to be further developed to meet the technological innovations in modern e consult web-based telemedicine.

eAJKD: Where do you and your group go from here?

RD: We continue to evolve the e-consults to be more efficient and transparent. Documentation of dialogue as well as streamlining the face to face Nephrology visits enable us to provide Nephrology specialty care to a variety of patient and primary care provider needs. Capacity issues, scope of practice and the mission statement of each DHS facility are taken into account. Those patients requiring urgent biopsy or immunosuppressive therapy can be sent to a particular DHS facility, whereas patients requiring transplant care or rehabilitation care in addition to their renal care may be sent to an alternate DHS facility. By doing so we hope to optimize patient care and provide efficient timely service.

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Click here for a full list of SCM14 abstracts of poster presentations.

Check out more eAJKD coverage of the NKF’s 2014 Spring Clinical Meetings!