Demand for ambulatory specialty services has grown at rates that have overwhelmed health systems’ capacity, resulting in impaired access and long wait times for patients. This drives down patient and provider satisfaction and leads to decreased quality of care.
Based on a model initially piloted at the University of California, San Francisco, the AAMC launched Project CORE®: Coordinating Optimal Referral Experiences in 2014 to help health systems improve the referral experience for both clinicians and patients. Through the Project CORE program, the AAMC has partnered with more than 55 adult and pediatric health systems to successfully implement eConsults and enhanced referrals, tools that can be built into the electronic health record (EHR). Through this innovative model, CORE health systems are improving efficiency and effectiveness at the interface between primary care and specialty care, thereby improving quality of care and access and promoting patient-centered care.
The CORE Model
The CORE model uses tools embedded in the EHR system, known as eConsults and enhanced referrals, that provide point-of-care decision support. Along with a robust implementation strategy, these decision-support tools enhance clinical workflows, improve communication and coordination of care at the interface of primary care and specialty care, and enhance quality and efficiency of care.
What are eConsults?
In the CORE model, eConsults are asynchronous exchanges typically initiated by a primary care physician (PCP) to a specialist colleague. In lieu of an in-person visit, a specialist responds through the EHR to a PCP’s inquiry within 72 hours. These exchanges use structured condition-specific templates within the EHR to create a seamless, point-of-care pathway that facilitates high-quality coordination and communication between providers. For appropriate questions (typically about straightforward, low-acuity issues), eConsults allow for significantly more efficient specialist input and more cost-effective care delivery. If a question is too complex or the patient needs to be seen, a specialist can convert an eConsult to a referral. Patients also have the option to request an in-person visit rather than an eConsult at any time.
What are enhanced referrals?
An enhanced referral provides point-of-care decision support for the referring health care provider through the use of condition- and specialty-specific templates within the EHR. These templates convey pre-consultation guidance from specialists at the point of referral, which streamlines the transmission of the clinical question and key diagnostic data. The templates prompt referring providers to clearly list their expectations about duration of care and delegation of responsibility. Furthermore, enhanced referrals help the PCP decide whether a referral is necessary (ultimately preventing some referrals) and initiate the appropriate specialty evaluation plan. This process maximizes the effectiveness of the first specialty visit, thus preventing unnecessary follow-up visits for reviewing diagnostic tests.
Learn more about (PDF) CORE eConsults, enhanced referrals, and implementation.
Why Join the Project CORE Program?
By joining the Project CORE program, health systems have access to one-on-one consultation, collaborative activities, implementation resources, and a network of other CORE health system leaders to support implementation of eConsults and enhanced referrals across primary and specialty care. By the end of the engagement, health systems will have developed the local expertise to continue to scale and sustain the CORE model at their organization.
Resources include sample specialty- and condition-specific templates for over 40 adult and pediatric specialties, 11 modules detailing strategies for all aspects of implementation, including how to engage PCPs and specialists with this new model of care delivery, specialty-specific data and customized benchmarking reports, guidance on the EHR build, eConsult in Action books with high quality eConsult exchanges for adult and pediatric specialties, and collaborative webinars and on-demand videos with CORE health system leaders.
Discover the many benefits and services (PDF) associated with joining the Project CORE program!
CORE Testimonials
“The AAMC CORE Network has been a valued partner to Yale, providing guidance, wisdom, and support throughout all stages of implementation and expansion.”
Yale Medicine Project CORE Team
"The implementation of eConsults led to a host of benefits at our health system. It is one of those rare programs that improves things for us at every level: improved clinical care, enhanced education between specialists and primary doctors, decreased costs of overall care for everyone while at the same time improving the work satisfaction of our clinical providers of care.”
Health System, Chief Clinical Officer