Prison e-Consultation System Yields Cost Savings from Avoided Unnecessary Referrals: Oklahoma

Rationale / Objectives

A lack of incentives for specialists caused problems in the quality of information and timeliness of their replies in respond of referral from primary care. It was discussed that there would be more patients to be referred for specialist visits that could be treated within primary care.

Project/Program Description & Major Achievements

Dr. David Kendrick, who is a practicing physician associate professor the University of Oklahoma School of Community Medicine developed a e-consultation system To simulate the doctor’s lounge culture where providers gathered, developed relationships and discussed patient cases together. Dr. Kendrick also wanted to provide a technological fix that would reduce the number of unnecessary referrals.

Lessons Learned

To date, there is cost saving value using an e-consultation platform for primary care, resulting in reduction in the unnecessary specialist referral.

Further Description

When Dr. Kendrick first built his e-consultation prototype, dubbed “Doc2Doc,” almost 120 primary care practioners who predominately practiced in rural settings signed up quickly. Specialists from the University of Oklahoma also agreed to review and respond to the incoming queue of consultation requests. Dr. Kendrick also approached the Oklahoma Department of Corrections (DOC) and, having learned about the necessity of reimbursing specialist time, told the prison system upfront that they would need to pay $50 to the specialist for every completed consultation. The prison e-consultation system was implemented.

Major Achievements




Implementation of e-consultation system to Oklahoma Department of Corrections Approximately 50 % reduction in utilization of specialty care Almost 100,000 e-consultations have taken place and the system has spread to Louisiana and Kentucky from Oklahoma