Table 2

Themes Related to Acceptability, Decision Making, and Communication

Access to Specialty Care	Deciding to Use the eConsult Service
Most participants agreed that eConsult would improve access to care for both eConsult and standard referral patients Convenience Since eConsults do not require payment, appointment scheduling, or travel, they were anticipated to reduce financial and time burdens on patients eConsults were expected to make in-person specialty visits more efficient Reliance on primary care An established, trusting relationship with a primary care clinician, and with the medical center more generally, appeared to enhance the acceptability of eConsult Digital literacy Most participants used the patient portal to communicate with their clinicians and to view personal health information; high digital literacy appeared to enhance acceptability of eConsult Fears and concerns Participants wanted reassurance that eConsult would be used appropriately and that patients would continue to have direct access to specialists when needed or preferred	No consensus about the extent to which patients should be involved in eConsult decision making Preference for involvement increased when a hypothetical copay was introduced Communicating the specialist’s response Preferred medium of communication depended on level of urgency of specialist’s recommendations Some participants wanted to see the specialist’s response verbatim; others felt that the primary care clinician’s summary would be sufficient Would a copay for eConsult be acceptable? A copay would be acceptable to some participants, but a majority said that they would rather see the specialist in person if a copay was levied for eConsult.

Access to Specialty Care

Deciding to Use the eConsult Service

Most participants agreed that eConsult would improve access to care for both eConsult and standard referral patients
Convenience
Since eConsults do not require payment, appointment scheduling, or travel, they were anticipated to reduce financial and time burdens on patients
eConsults were expected to make in-person specialty visits more efficient
Reliance on primary care
An established, trusting relationship with a primary care clinician, and with the medical center more generally, appeared to enhance the acceptability of eConsult
Digital literacy
Most participants used the patient portal to communicate with their clinicians and to view personal health information; high digital literacy appeared to enhance acceptability of eConsult
Fears and concerns
Participants wanted reassurance that eConsult would be used appropriately and that patients would continue to have direct access to specialists when needed or preferred

No consensus about the extent to which patients should be involved in eConsult decision making
Preference for involvement increased when a hypothetical copay was introduced
Communicating the specialist’s response
Preferred medium of communication depended on level of urgency of specialist’s recommendations
Some participants wanted to see the specialist’s response verbatim; others felt that the primary care clinician’s summary would be sufficient
Would a copay for eConsult be acceptable?
A copay would be acceptable to some participants, but a majority said that they would rather see the specialist in person if a copay was levied for eConsult.

eConsult = electronic consultation