E-Consults in Pediatric Radiology: A Pilot Study of a Novel Electronic Consultation Service Connecting Pediatric Care Providers to Pediatric Radiologists 

E-Consults in Pediatric Radiology: A Pilot Study of a Novel Electronic Consultation Service Connecting Pediatric Care Providers to Pediatric Radiologists | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article E-Consults in Pediatric Radiology: A Pilot Study of a Novel Electronic Consultation Service Connecting Pediatric Care Providers to Pediatric Radiologists Navaira Shoaib, Natalie Egan, Sebastian Gallo, Tarik Alkasab, and 3 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8622468/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background Electronic consultations (eConsults) have gained widespread use across medical specialties; however, radiology, particularly pediatric radiology, has lagged in adoption. Pediatric care increasingly depends on timely subspecialty input, and traditional communication methods with radiologists can be fragmented. Objective To evaluate the feasibility, utility, and impact of a structured pediatric radiology eConsult platform implemented within a large academic quaternary pediatric care setting. Materials and Methods This IRB-approved, retrospective study evaluated an eConsult tool integrated into the Epic electronic health record (EHR) between April 2022 and June 2025. The tool facilitated asynchronous communication between pediatric care providers and pediatric radiologists. Data from 257 eConsults were extracted and categorized thematically. Provider and radiologist perceptions were assessed via REDCap surveys. Results Most eConsults originated from gastroenterology (57.2%) and primary care (24.9%). Thematic categories included diagnostic interpretation support (48.2%) and protocol planning (29.9%). Among pediatric care provider survey respondents (n = 26), 100% were satisfied, and 80.8% reported that eConsults altered their clinical decision-making. Radiologists found the system usable, with mixed views on workload impact and collaboration. Conclusion Structured eConsults in pediatric radiology are feasible, well-received, and may enhance access to imaging guidance and clinical decision-making. Their broader implementation can support efficient, scalable specialty communication. Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Introduction Once dismissed as a passing buzzword, eHealth has evolved into a transformative paradigm in healthcare. Introduced in the early 2000s, the term draws inspiration from e-commerce, representing a convergence of medical informatics and public health to enhance healthcare through digital technologies. [ 1 ] Among the innovations within eHealth, electronic consultations (eConsults) have emerged over the past two decades as a robust tool to improve access to specialty expertise. Broadly defined, eConsults enable asynchronous provider-to-provider communication within secure platforms, embedded in the electronic health record (EHR). Definitions vary across systems: some highlight text-based consultations for guidance, while others include formalized workflows for documentation and billing. [ 2 ][ 3 ] In the last two decades, eConsults have seen widespread adoption across multiple medical specialties. In internal medicine, eConsults have been integrated since 2009, offering structured specialty input in safety-net populations.² Furthermore, in 2014, national initiatives like the AAMC’s Project CORE® (Coordinating Optimal Referral Experiences), developed under Centers for Medicare & Medicaid Services (CMS), have advanced the integration of eConsults across more than 55 adult and pediatric health systems providing standardized tools between primary care and specialty communication and structured referral into EHR, emphasizing value-based collaboration, reduced referral burden, and improved care quality.[ 4 ] Within this realm, dermatology became a model of efficiency with referral avoidance rates ranging from 12% to 84% ³, while cardiology reported that eConsults were effective in outpatient referrals with a low conversion rate to traditional consults.[ 5 ] Despite this progress, radiology has lagged in adopting structured eConsult pathways. We believe that when appropriate, Radiology eConsults, in contrast to traditional in-person consults, have the potential to offer clear value by way of formal documentation in EHR, particularly when clarifying interpretation or determining imaging appropriateness for clinical workup and management. This is more pressing as verbal communication between radiologists and referring providers can often be fragmented. Furthermore, the shift to remote work and telehealth in the COVID-19 post-pandemic era has only widened the gap, with increased uncertainty about how to access the radiologist's input. At the same time, radiologists face increasing imaging volumes and workflow interruptions, making asynchronous consultation a more sustainable approach.[ 6 ] There is emerging evidence that supports the utility of radiology-based eConsults. Cameron and Schwartz demonstrated that reinterpretation of outside CT and MRI via eConsult reduced unnecessary repeat imaging and improved diagnostic accuracy.[ 7 ] In 2018, the American College of Radiology (ACR) emphasized radiology’s role in population health and virtual care delivery through eConsults, especially in supporting value-based care models. [ 6 ] Still, in the field of pediatric radiology, the potential of eConsults remains largely untapped. Pediatric radiologists often provide nuanced, cross-subspecialty expertise, but seldom through structured, scalable platforms. Therefore, we considered this as an opportunity to explore a new way of clinical collaboration and offer timely imaging query input for clinical decision-making. In this pilot study, we evaluate a pediatric radiology eConsult service that connected pediatric primary care providers and subspecialists with pediatric radiologists through a structured, electronic, asynchronous platform, assessing feasibility, clinical value, and impact on clinical workflow and communication within a quaternary care providing academic healthcare system. Methods Study Design and Institutional Approval This Institutional Review Board (IRB) approved study involved the development and evaluation of a non-billable e-Consult tool integrated within the Epic EHR as an order. The tool was designed to facilitate asynchronous communication between pediatric providers and pediatric radiologists for specific non-urgent outpatient imaging-related questions. Tool Implementation and Workflow Integration The e-Consult tool was created in early 2022 and integrated with the radiology department’s Nuance Workflow Orchestrator, PowerScribe One, and Visage® 7 PACS. From April 2022 to June 2025, pediatric providers were trained and encouraged to use the tool through active engagement by Radiology Practice Support. The tool was intended exclusively for non-urgent outpatient imaging-related queries and low-acuity clinical questions. It was not available for use in emergency, inpatient, or urgent care settings, or pediatric interventional radiology. Additionally, reinterpretations of outside imaging studies and requests for addenda were excluded, as they were considered outside the scope of the e-Consult tool. The Epic e-Consult order included a free-text field for providers to describe the clinical question. Each e-Consult generated a unique radiology accession number, which appeared on the pediatric radiologist’s daily worklist. These e-Consults were managed using standard radiology workflows, with reports templated in Nuance and imaging history accessed via Visage PACS, when applicable. The expected turnaround time for the response was 48 hours. The tool bypassed the Epic In-Basket function to maintain workflow alignment with standard practice and pediatric radiology operations. Figure 1 demonstrates the process of handling queries through this system. Data Extraction and Categorization We surveyed our institutional database using the Nuance mPower Clinical Analytics platform (mPower for PowerScribe 360) to identify all pediatric e-Consults submitted since the tool’s inception. All consults placed between April 2022 and June 2025 were extracted, yielding a total of 257 e-Consults. Each entry was reviewed and categorized based on the stated reason for consultation as shown in Table 2 . Table 1 Pediatric e-Consults by Provider Type (n = 257) Type of Pediatric Care Provider Number of e-Consults Gastroenterology 147 Primary Care 64 Endocrine 18 Pulmonology 9 Rheumatology 8 Nephrology 3 Neurology 3 Orthopedics 2 Pediatric Surgery 1 Hematology and Oncology 1 Infectious Diseases 1 Grand Total 257 Table 2 Thematic Categorization of Pediatric e-Consults (n = 257) Purpose Grouped Subcategories Number of e-Consults Diagnostic Interpretation Support Clarification, differentiation, and diagnostic confirmation 124 Protocol and Modality Planning Imaging modality selection, tailored protocols 77 Follow-up and Surveillance Imaging-based monitoring or disease assessment 39 Operational / Workflow Support Scheduling, reporting, administrative queries 14 Risk and Safety Assessment Contrast precautions, imaging-related risk evaluation 3 Total 257 Survey Instrument: Two structured REDCap-based surveys, each using a five-point Likert scale, were administered separately to pediatric care providers and pediatric radiologists to assess ease of use, perceived impact on clinical decision-making, and communication preferences. Results PEDIATRIC CARE PROVIDERS: Of the 77 pediatric care providers invited to participate in the survey, 26 responded, yielding a response rate of 33.8%. Pediatric Gastroenterology accounted for the majority of eConsults (57.2%), followed by Primary Care (24.9%) and Pediatric Endocrinology (7.0%), with smaller contributions from other pediatric subspecialties (Table 1 ). User Satisfaction and Usability Figure 2 shows the graphical representation of User Satisfaction and Usability. All 26 respondents (100%) reported being either “very satisfied” (76.9%) or “satisfied” (23.1%) with their eConsult experience. The majority (88.5%) found the ordering process to be “very easy,” while 11.5% described it as “somewhat easy.” Frequency of Use Figure 3 shows the system's frequency of use. Half of the participants (50%) reported using pediatric eConsults approximately once per month, with 38.5% using the service every three months. Fewer respondents reported using it every six months (7.7%), and one participant used it infrequently. Prior Consultation Methods Before the implementation of eConsults, the most commonly used methods for consulting radiologists included visiting the reading room (42.3%), making a phone call (23.1%), and emailing (19.2%). Only 15.4% of respondents used “other” methods, and none reported having no prior communication method. Comparative Experience All respondents reported that their experience with the eConsult system was better than previous consultation methods, with 76.9% describing it as “much easier” and 23.1% as “somewhat easier.” Fig. 4 shows this trend. Impact on Clinical Decision-Making A significant majority (80.8%) indicated that the eConsult process changed their approach to patient care. Qualitative comments included: “Helped me order appropriate targeted imaging”, “Faster turnaround”, and “Able to decide on next steps in imaging”. Awareness of the eConsult Program Respondents first learned about the eConsult platform through the following channels: newsletter or email communication (46.2%), presentations or meetings (26.9%), and colleagues or word-of-mouth (19.2%). Figure 5 shows the graphical representation of this factor. Qualitative Feedback Open-ended comments reflected appreciation for the service’s efficiency and utility. Some providers noted variability in the clarity of responses, while others emphasized its usefulness for targeted imaging and triage. PEDIATRIC RADIOLOGIST: A total of 8 surveys were given to pediatric radiologists, with a response rate of 100% Survey responses indicated generally favorable attitudes toward the usability and perceived efficiency of the e-Consult system. Most respondents (75%) agreed or strongly agreed that the platform was more efficient than traditional communication methods such as phone calls. Similarly, six indicated that the system was easy to use and well-integrated into their daily workflow. However, perceptions regarding the impact of e-Consults on clinical workload were more nuanced. Notably, none of the respondents agreed or strongly agreed that handling e-Consults had significantly increased their workload. Instead, responses clustered around the neutral to strongly disagree end of the scale, with 38% (3/8) indicating strong disagreement and another 38% selecting “neutral.” This distribution suggests that while e-Consults were not widely viewed as burdensome, their impact on workflow efficiency may not have been consistently experienced across users. Similarly, views on whether the platform enhanced collaboration with referring providers were divided. Half of the respondents selected “neutral,” while the remaining responses were split evenly between agreement and disagreement. These findings suggest that while the platform was not perceived as disruptive to collaboration, it may not have significantly enhanced it either, particularly in settings where interdisciplinary communication was already well-established through other means. Overall satisfaction with the system and willingness to continue its use were modestly positive. Most respondents (5 of 8) either agreed or strongly agreed that they were satisfied with the platform and supported its continued implementation. Qualitative Insights Thematic analysis of open-ended responses revealed a few concerns. A common theme was communication fragmentation. Rather than streamlining clinical interactions, e-Consults were occasionally perceived as an additional communication layer, supplementing rather than replacing existing modes such as reading room visits, phone calls, and emails. One radiologist noted, “It’s just another place to check, and the other three are still being used.” A few participants also raised concerns about redundancy, reporting that clinicians often followed up e-Consults with verbal discussions, undermining the time-saving intent of the system. Others expressed unease regarding the permanence of written consult responses, with one respondent explaining, “Sometimes you need to convey subtleties that don’t come across well in a written e-Consult. And once documented, it feels legally binding.” Despite these concerns, several radiologists viewed the platform as a promising model for structured, auditable, and asynchronous communication and a line of essential non-billable services in pediatric imaging. Discussion The results of this pilot study demonstrate high levels of satisfaction, usability, and clinical utility associated with a pediatric radiology eConsult platform. As healthcare systems increasingly rely on asynchronous models for specialty access, our findings suggest that structured, EMR-integrated eConsults may play a significant role in troubleshooting and streamlining pediatric imaging workflows. All respondents found eConsults easier to use than prior communication methods, such as informal reading room visits or phone calls, reflecting improved workflow efficiency. Most pediatric providers reported using the platform regularly and indicated that it had a direct impact on clinical decision-making. These findings align with national trends observed across multiple specialties, in which eConsults improved access to expert input and reduced unnecessary services. However, our findings also highlighted a perceived shift in workload between referring and consulting clinicians. While referring clinicians may find eConsults helpful, specialists can experience increased burden. This tension has also been described by Kirsh and Au. [ 8 ] Building on this observation, we suggest that targeted clinical decision support, such as Epic Best Practice Advisories (BPAs), may help pediatric providers in deciding on appropriate imaging tests to order and support more balanced workload distribution. Beyond improving individual encounters, we believe that eConsults may offer value at the population level. Patterns in consult submissions, such as frequent questions regarding incidental findings or imaging selection, can inform targeted radiology educational initiatives, institutional guidelines, and clinical decision support. This position views eConsults as more than a communication tool; rather, it serves as a driver for improving pediatric radiology operations by identifying gaps in service, institutional learning, and quality improvement. Traditional methods, such as reading room visits, phone calls, or emails to reach pediatric radiologists, can disrupt workflow and lack formal documentation. While often expedient, “curbside consults” carry uncertain medicolegal risk due to the absence of formal records and unclear liability boundaries. [ 9 ] The eConsult system replaces these informal channels with a secure, auditable, and structured communication mechanism, aligning with best practices in contemporary clinical and legal governance. Looking ahead, with the inescapable integration of artificial intelligence into the pediatric health system, eConsult workflows may further enhance clinical decision-making, reduce diagnostic delays, and promote efficient patient-centered imaging pathways. Limitations This study is limited by its small sample size, modest response rate, and the feedback reflects the views of early adopters. Conclusion For pediatric care providers, this pilot study demonstrates that the eConsult program is both feasible and highly valuable in enhancing access to pediatric radiology expertise while supporting efficient and high-quality pediatric care. The platform facilitated timely, well-documented communication between pediatric care providers and radiologists, frequently resolving clinical questions without the need for in-person referrals or unnecessary imaging. Radiologists found the system usable and well-integrated, though some noted concerns about redundancy and communication fragmentation. Consistent with national frameworks and expert commentary, the success of eConsult depends not only on technological deployment but also on intentional design. Structured templates, shared expectations, and clear roles across referring and consulting providers are essential to reduce ambiguity, optimize workload distribution, and ensure legal and clinical clarity. Declarations Funding: No external funding. Conflicts of interest: None declared. Ethics approval: This study was approved by the Institutional Review Board. A waiver of informed consent and HIPAA authorization was granted due to the retrospective nature of the study. The research involves no more than minimal risk and does not affect the standard of care for patients. All identifiable data were stored in password-protected files within the institutional firewall, and access was restricted to study personnel. De-identification procedures were followed, and identifying information was removed after data collection and analysis. Consent to participate: Not applicable due to IRB-approved waiver of consent. Consent to publish: Not applicable. Data availability: Available upon request. Author Contribution N.S. conceptualized the study, developed the methodology, performed formal analysis, conducted the investigation, curated the data, wrote the original draft, and prepared the figures.N.E. contributed to software integration, data curation, and resource management.S.G. participated in the investigation and contributed to manuscript review and editing.T.A. and M.G. contributed to manuscript review and editing.T.V. and M.G. supervised the project and reviewed the manuscript.P.S. conceptualized the study, supervised the project, and provided critical manuscript revisions and project administration.All authors reviewed and approved the final manuscript. Data Availability De-identified data from REDCap surveys used in this study are available from the corresponding author upon request. References Eysenbach G (2001) What is e-health? J Med Internet Res 3(2):e20. https://doi.org/10.2196/jmir.3.2.e20 Vimalananda VG, Gupte G, Seraj SM, Orlander J, Berlowitz D, Fincke BG et al (2015) Electronic consultations (e-consults) to improve access to specialty care: a systematic review and narrative synthesis. J Telemed Telecare 21(6):323–330. https://doi.org/10.1177/1357633X15582108 Liddy C, Drosinis P, Keely E (2016) Electronic consultation systems: worldwide prevalence and their impact on patient care—a systematic review. Fam Pract 33(3):274–285. https://doi.org/10.1093/fampra/cmw024 Association of American Medical Colleges. Project CORE®: Coordinating Optimal Referral Experiences. Washington (DC): AAMC (2014) Available from: https://www.aamc.org/about-us/mission-areas/health-care/project-core Liddy C, Drosinis P, Keely E (2016) Electronic consultation systems: worldwide prevalence and their impact on patient care—a systematic review. Fam Pract 33(3):274–285. https://doi.org/10.1093/fampra/cmw024 American College of Radiology. E-Consults and Radiology’s Role in Virtual Care Delivery, ACR Bulletin (2018) May Available from: https://www.acr.org Cameron SF, Schwartz RK (2024) Radiology e-Consults: reinterpretation of outside CT and MRI exams to improve quality, reduce unneeded imaging, and lower costs. Curr Probl Diagn Radiol 53(1):40–47. https://doi.org/10.1067/j.cpradiol.2023.08.004 Kirsh SR, Au DH (2023) Enhancing the e-consult: empowering efficient and collaborative care. Am J Manag Care 29(12):648–649. https://doi.org/10.37765/ajmc.2023.89465 Cotton VR (2010) Legal risks of curbside consults. Am J Cardiol 106(1):135–138. https://doi.org/10.1016/j.amjcard.2010.02.024 Additional Declarations No competing interests reported. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8622468","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":582003498,"identity":"4996fbf9-520a-41db-828a-2a1c80d14b5c","order_by":0,"name":"Navaira 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Introduced in the early 2000s, the term draws inspiration from e-commerce, representing a convergence of medical informatics and public health to enhance healthcare through digital technologies. [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]\u003c/p\u003e \u003cp\u003eAmong the innovations within eHealth, electronic consultations (eConsults) have emerged over the past two decades as a robust tool to improve access to specialty expertise. Broadly defined, eConsults enable asynchronous provider-to-provider communication within secure platforms, embedded in the electronic health record (EHR). Definitions vary across systems: some highlight text-based consultations for guidance, while others include formalized workflows for documentation and billing. [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e][\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]\u003c/p\u003e \u003cp\u003eIn the last two decades, eConsults have seen widespread adoption across multiple medical specialties. In internal medicine, eConsults have been integrated since 2009, offering structured specialty input in safety-net populations.\u0026sup2; Furthermore, in 2014, national initiatives like the AAMC\u0026rsquo;s Project CORE\u0026reg; (Coordinating Optimal Referral Experiences), developed under Centers for Medicare \u0026amp; Medicaid Services (CMS), have advanced the integration of eConsults across more than 55 adult and pediatric health systems providing standardized tools between primary care and specialty communication and structured referral into EHR, emphasizing value-based collaboration, reduced referral burden, and improved care quality.[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]\u003c/p\u003e \u003cp\u003eWithin this realm, dermatology became a model of efficiency with referral avoidance rates ranging from 12% to 84% \u0026sup3;, while cardiology reported that eConsults were effective in outpatient referrals with a low conversion rate to traditional consults.[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]\u003c/p\u003e \u003cp\u003eDespite this progress, radiology has lagged in adopting structured eConsult pathways. We believe that when appropriate, Radiology eConsults, in contrast to traditional in-person consults, have the potential to offer clear value by way of formal documentation in EHR, particularly when clarifying interpretation or determining imaging appropriateness for clinical workup and management.\u003c/p\u003e \u003cp\u003eThis is more pressing as verbal communication between radiologists and referring providers can often be fragmented. Furthermore, the shift to remote work and telehealth in the COVID-19 post-pandemic era has only widened the gap, with increased uncertainty about how to access the radiologist's input. At the same time, radiologists face increasing imaging volumes and workflow interruptions, making asynchronous consultation a more sustainable approach.[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]\u003c/p\u003e \u003cp\u003eThere is emerging evidence that supports the utility of radiology-based eConsults. Cameron and Schwartz demonstrated that reinterpretation of outside CT and MRI via eConsult reduced unnecessary repeat imaging and improved diagnostic accuracy.[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e] In 2018, the American College of Radiology (ACR) emphasized radiology\u0026rsquo;s role in population health and virtual care delivery through eConsults, especially in supporting value-based care models. [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]\u003c/p\u003e \u003cp\u003eStill, in the field of pediatric radiology, the potential of eConsults remains largely untapped. Pediatric radiologists often provide nuanced, cross-subspecialty expertise, but seldom through structured, scalable platforms. Therefore, we considered this as an opportunity to explore a new way of clinical collaboration and offer timely imaging query input for clinical decision-making.\u003c/p\u003e \u003cp\u003eIn this pilot study, we evaluate a pediatric radiology eConsult service that connected pediatric primary care providers and subspecialists with pediatric radiologists through a structured, electronic, asynchronous platform, assessing feasibility, clinical value, and impact on clinical workflow and communication within a quaternary care providing academic healthcare system.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eStudy Design and Institutional Approval\u003c/p\u003e \u003cp\u003eThis Institutional Review Board (IRB) approved study involved the development and evaluation of a non-billable e-Consult tool integrated within the Epic EHR as an order. The tool was designed to facilitate asynchronous communication between pediatric providers and pediatric radiologists for specific non-urgent outpatient imaging-related questions.\u003c/p\u003e \u003cp\u003eTool Implementation and Workflow Integration\u003c/p\u003e \u003cp\u003eThe e-Consult tool was created in early 2022 and integrated with the radiology department\u0026rsquo;s Nuance Workflow Orchestrator, PowerScribe One, and Visage\u0026reg; 7 PACS. From April 2022 to June 2025, pediatric providers were trained and encouraged to use the tool through active engagement by Radiology Practice Support.\u003c/p\u003e \u003cp\u003eThe tool was intended exclusively for non-urgent outpatient imaging-related queries and low-acuity clinical questions. It was not available for use in emergency, inpatient, or urgent care settings, or pediatric interventional radiology. Additionally, reinterpretations of outside imaging studies and requests for addenda were excluded, as they were considered outside the scope of the e-Consult tool.\u003c/p\u003e \u003cp\u003eThe Epic e-Consult order included a free-text field for providers to describe the clinical question. Each e-Consult generated a unique radiology accession number, which appeared on the pediatric radiologist\u0026rsquo;s daily worklist. These e-Consults were managed using standard radiology workflows, with reports templated in Nuance and imaging history accessed via Visage PACS, when applicable. The expected turnaround time for the response was 48 hours. The tool bypassed the Epic In-Basket function to maintain workflow alignment with standard practice and pediatric radiology operations. Figure\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e demonstrates the process of handling queries through this system.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eData Extraction and Categorization\u003c/p\u003e \u003cp\u003eWe surveyed our institutional database using the Nuance mPower Clinical Analytics platform (mPower for PowerScribe 360) to identify all pediatric e-Consults submitted since the tool\u0026rsquo;s inception. All consults placed between April 2022 and June 2025 were extracted, yielding a total of 257 e-Consults. Each entry was reviewed and categorized based on the stated reason for consultation as shown in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003ePediatric e-Consults by Provider Type (n\u0026thinsp;=\u0026thinsp;257)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"2\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eType of Pediatric Care Provider\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNumber of e-Consults\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGastroenterology\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e147\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePrimary Care\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e64\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEndocrine\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e18\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePulmonology\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRheumatology\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNephrology\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNeurology\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOrthopedics\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePediatric Surgery\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHematology and Oncology\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eInfectious Diseases\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eGrand Total\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e257\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eThematic Categorization of Pediatric e-Consults (n\u0026thinsp;=\u0026thinsp;257)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePurpose\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGrouped Subcategories\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNumber of e-Consults\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDiagnostic Interpretation Support\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eClarification, differentiation, and diagnostic confirmation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e124\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eProtocol and Modality Planning\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eImaging modality selection, tailored protocols\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e77\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFollow-up and Surveillance\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eImaging-based monitoring or disease assessment\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e39\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOperational / Workflow Support\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eScheduling, reporting, administrative queries\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRisk and Safety Assessment\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eContrast precautions, imaging-related risk evaluation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eTotal\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e257\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eSurvey Instrument:\u003c/p\u003e \u003cp\u003eTwo structured REDCap-based surveys, each using a five-point Likert scale, were administered separately to pediatric care providers and pediatric radiologists to assess ease of use, perceived impact on clinical decision-making, and communication preferences.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003ePEDIATRIC CARE PROVIDERS: Of the 77 pediatric care providers invited to participate in the survey, 26 responded, yielding a response rate of 33.8%.\u003c/p\u003e \u003cp\u003ePediatric Gastroenterology accounted for the majority of eConsults (57.2%), followed by Primary Care (24.9%) and Pediatric Endocrinology (7.0%), with smaller contributions from other pediatric subspecialties (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eUser Satisfaction and Usability\u003c/p\u003e \u003cp\u003eFigure \u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e shows the graphical representation of User Satisfaction and Usability. All 26 respondents (100%) reported being either \u0026ldquo;very satisfied\u0026rdquo; (76.9%) or \u0026ldquo;satisfied\u0026rdquo; (23.1%) with their eConsult experience. The majority (88.5%) found the ordering process to be \u0026ldquo;very easy,\u0026rdquo; while 11.5% described it as \u0026ldquo;somewhat easy.\u0026rdquo;\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eFrequency of Use\u003c/p\u003e \u003cp\u003eFigure \u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e shows the system's frequency of use. Half of the participants (50%) reported using pediatric eConsults approximately once per month, with 38.5% using the service every three months. Fewer respondents reported using it every six months (7.7%), and one participant used it infrequently.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003ePrior Consultation Methods\u003c/p\u003e \u003cp\u003eBefore the implementation of eConsults, the most commonly used methods for consulting radiologists included visiting the reading room (42.3%), making a phone call (23.1%), and emailing (19.2%). Only 15.4% of respondents used \u0026ldquo;other\u0026rdquo; methods, and none reported having no prior communication method.\u003c/p\u003e \u003cp\u003eComparative Experience\u003c/p\u003e \u003cp\u003eAll respondents reported that their experience with the eConsult system was better than previous consultation methods, with 76.9% describing it as \u0026ldquo;much easier\u0026rdquo; and 23.1% as \u0026ldquo;somewhat easier.\u0026rdquo; Fig.\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e4\u003c/span\u003e shows this trend.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eImpact on Clinical Decision-Making\u003c/p\u003e \u003cp\u003eA significant majority (80.8%) indicated that the eConsult process changed their approach to patient care. Qualitative comments included: \u0026ldquo;Helped me order appropriate targeted imaging\u0026rdquo;, \u0026ldquo;Faster turnaround\u0026rdquo;, and \u0026ldquo;Able to decide on next steps in imaging\u0026rdquo;.\u003c/p\u003e \u003cp\u003eAwareness of the eConsult Program\u003c/p\u003e \u003cp\u003eRespondents first learned about the eConsult platform through the following channels: newsletter or email communication (46.2%), presentations or meetings (26.9%), and colleagues or word-of-mouth (19.2%). Figure\u0026nbsp;\u003cspan refid=\"Fig5\" class=\"InternalRef\"\u003e5\u003c/span\u003e shows the graphical representation of this factor.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eQualitative Feedback\u003c/p\u003e \u003cp\u003eOpen-ended comments reflected appreciation for the service\u0026rsquo;s efficiency and utility. Some providers noted variability in the clarity of responses, while others emphasized its usefulness for targeted imaging and triage.\u003c/p\u003e \u003cp\u003ePEDIATRIC RADIOLOGIST: A total of 8 surveys were given to pediatric radiologists, with a response rate of 100%\u003c/p\u003e \u003cp\u003eSurvey responses indicated generally favorable attitudes toward the usability and perceived efficiency of the e-Consult system. Most respondents (75%) agreed or strongly agreed that the platform was more efficient than traditional communication methods such as phone calls. Similarly, six indicated that the system was easy to use and well-integrated into their daily workflow.\u003c/p\u003e \u003cp\u003eHowever, perceptions regarding the impact of e-Consults on clinical workload were more nuanced. Notably, none of the respondents agreed or strongly agreed that handling e-Consults had significantly increased their workload. Instead, responses clustered around the neutral to strongly disagree end of the scale, with 38% (3/8) indicating strong disagreement and another 38% selecting \u0026ldquo;neutral.\u0026rdquo; This distribution suggests that while e-Consults were not widely viewed as burdensome, their impact on workflow efficiency may not have been consistently experienced across users.\u003c/p\u003e \u003cp\u003eSimilarly, views on whether the platform enhanced collaboration with referring providers were divided. Half of the respondents selected \u0026ldquo;neutral,\u0026rdquo; while the remaining responses were split evenly between agreement and disagreement. These findings suggest that while the platform was not perceived as disruptive to collaboration, it may not have significantly enhanced it either, particularly in settings where interdisciplinary communication was already well-established through other means.\u003c/p\u003e \u003cp\u003eOverall satisfaction with the system and willingness to continue its use were modestly positive. Most respondents (5 of 8) either agreed or strongly agreed that they were satisfied with the platform and supported its continued implementation.\u003c/p\u003e \u003cp\u003eQualitative Insights\u003c/p\u003e \u003cp\u003eThematic analysis of open-ended responses revealed a few concerns. A common theme was communication fragmentation. Rather than streamlining clinical interactions, e-Consults were occasionally perceived as an additional communication layer, supplementing rather than replacing existing modes such as reading room visits, phone calls, and emails. One radiologist noted, \u0026ldquo;It\u0026rsquo;s just another place to check, and the other three are still being used.\u0026rdquo;\u003c/p\u003e \u003cp\u003eA few participants also raised concerns about redundancy, reporting that clinicians often followed up e-Consults with verbal discussions, undermining the time-saving intent of the system. Others expressed unease regarding the permanence of written consult responses, with one respondent explaining, \u0026ldquo;Sometimes you need to convey subtleties that don\u0026rsquo;t come across well in a written e-Consult. And once documented, it feels legally binding.\u0026rdquo;\u003c/p\u003e \u003cp\u003eDespite these concerns, several radiologists viewed the platform as a promising model for structured, auditable, and asynchronous communication and a line of essential non-billable services in pediatric imaging.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe results of this pilot study demonstrate high levels of satisfaction, usability, and clinical utility associated with a pediatric radiology eConsult platform. As healthcare systems increasingly rely on asynchronous models for specialty access, our findings suggest that structured, EMR-integrated eConsults may play a significant role in troubleshooting and streamlining pediatric imaging workflows.\u003c/p\u003e \u003cp\u003eAll respondents found eConsults easier to use than prior communication methods, such as informal reading room visits or phone calls, reflecting improved workflow efficiency. Most pediatric providers reported using the platform regularly and indicated that it had a direct impact on clinical decision-making. These findings align with national trends observed across multiple specialties, in which eConsults improved access to expert input and reduced unnecessary services.\u003c/p\u003e \u003cp\u003eHowever, our findings also highlighted a perceived shift in workload between referring and consulting clinicians. While referring clinicians may find eConsults helpful, specialists can experience increased burden. This tension has also been described by Kirsh and Au. [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e] Building on this observation, we suggest that targeted clinical decision support, such as Epic Best Practice Advisories (BPAs), may help pediatric providers in deciding on appropriate imaging tests to order and support more balanced workload distribution.\u003c/p\u003e \u003cp\u003eBeyond improving individual encounters, we believe that eConsults may offer value at the population level. Patterns in consult submissions, such as frequent questions regarding incidental findings or imaging selection, can inform targeted radiology educational initiatives, institutional guidelines, and clinical decision support. This position views eConsults as more than a communication tool; rather, it serves as a driver for improving pediatric radiology operations by identifying gaps in service, institutional learning, and quality improvement.\u003c/p\u003e \u003cp\u003eTraditional methods, such as reading room visits, phone calls, or emails to reach pediatric radiologists, can disrupt workflow and lack formal documentation. While often expedient, \u0026ldquo;curbside consults\u0026rdquo; carry uncertain medicolegal risk due to the absence of formal records and unclear liability boundaries. [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e] The eConsult system replaces these informal channels with a secure, auditable, and structured communication mechanism, aligning with best practices in contemporary clinical and legal governance.\u003c/p\u003e \u003cp\u003eLooking ahead, with the inescapable integration of artificial intelligence into the pediatric health system, eConsult workflows may further enhance clinical decision-making, reduce diagnostic delays, and promote efficient patient-centered imaging pathways.\u003c/p\u003e \u003cp\u003eLimitations\u003c/p\u003e \u003cp\u003eThis study is limited by its small sample size, modest response rate, and the feedback reflects the views of early adopters.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eFor pediatric care providers, this pilot study demonstrates that the eConsult program is both feasible and highly valuable in enhancing access to pediatric radiology expertise while supporting efficient and high-quality pediatric care. The platform facilitated timely, well-documented communication between pediatric care providers and radiologists, frequently resolving clinical questions without the need for in-person referrals or unnecessary imaging. Radiologists found the system usable and well-integrated, though some noted concerns about redundancy and communication fragmentation.\u003c/p\u003e \u003cp\u003eConsistent with national frameworks and expert commentary, the success of eConsult depends not only on technological deployment but also on intentional design. Structured templates, shared expectations, and clear roles across referring and consulting providers are essential to reduce ambiguity, optimize workload distribution, and ensure legal and clinical clarity.\u003c/p\u003e"},{"header":"Declarations","content":"\u003ch2\u003eFunding:\u003c/h2\u003e \u003cp\u003eNo external funding.\u003c/p\u003e \u003cp\u003eConflicts of interest: None declared.\u003c/p\u003e \u003cp\u003eEthics approval: This study was approved by the Institutional Review Board. A waiver of informed consent and HIPAA authorization was granted due to the retrospective nature of the study. The research involves no more than minimal risk and does not affect the standard of care for patients. All identifiable data were stored in password-protected files within the institutional firewall, and access was restricted to study personnel. De-identification procedures were followed, and identifying information was removed after data collection and analysis.\u003c/p\u003e \u003cp\u003eConsent to participate: Not applicable due to IRB-approved waiver of consent.\u003c/p\u003e \u003cp\u003eConsent to publish: Not applicable.\u003c/p\u003e \u003cp\u003eData availability: Available upon request.\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eN.S. conceptualized the study, developed the methodology, performed formal analysis, conducted the investigation, curated the data, wrote the original draft, and prepared the figures.N.E. contributed to software integration, data curation, and resource management.S.G. participated in the investigation and contributed to manuscript review and editing.T.A. and M.G. contributed to manuscript review and editing.T.V. and M.G. supervised the project and reviewed the manuscript.P.S. conceptualized the study, supervised the project, and provided critical manuscript revisions and project administration.All authors reviewed and approved the final manuscript.\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eDe-identified data from REDCap surveys used in this study are available from the corresponding author upon request.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eEysenbach G (2001) What is e-health? J Med Internet Res 3(2):e20. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.2196/jmir.3.2.e20\u003c/span\u003e\u003cspan address=\"10.2196/jmir.3.2.e20\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eVimalananda VG, Gupte G, Seraj SM, Orlander J, Berlowitz D, Fincke BG et al (2015) Electronic consultations (e-consults) to improve access to specialty care: a systematic review and narrative synthesis. J Telemed Telecare 21(6):323\u0026ndash;330. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1177/1357633X15582108\u003c/span\u003e\u003cspan address=\"10.1177/1357633X15582108\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLiddy C, Drosinis P, Keely E (2016) Electronic consultation systems: worldwide prevalence and their impact on patient care\u0026mdash;a systematic review. Fam Pract 33(3):274\u0026ndash;285. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1093/fampra/cmw024\u003c/span\u003e\u003cspan address=\"10.1093/fampra/cmw024\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAssociation of American Medical Colleges. Project CORE\u0026reg;: Coordinating Optimal Referral Experiences. Washington (DC): AAMC (2014) Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.aamc.org/about-us/mission-areas/health-care/project-core\u003c/span\u003e\u003cspan address=\"https://www.aamc.org/about-us/mission-areas/health-care/project-core\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLiddy C, Drosinis P, Keely E (2016) Electronic consultation systems: worldwide prevalence and their impact on patient care\u0026mdash;a systematic review. Fam Pract 33(3):274\u0026ndash;285. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1093/fampra/cmw024\u003c/span\u003e\u003cspan address=\"10.1093/fampra/cmw024\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAmerican College of Radiology. E-Consults and Radiology\u0026rsquo;s Role in Virtual Care Delivery, ACR Bulletin (2018) May Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.acr.org\u003c/span\u003e\u003cspan address=\"https://www.acr.org\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCameron SF, Schwartz RK (2024) Radiology e-Consults: reinterpretation of outside CT and MRI exams to improve quality, reduce unneeded imaging, and lower costs. Curr Probl Diagn Radiol 53(1):40\u0026ndash;47. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1067/j.cpradiol.2023.08.004\u003c/span\u003e\u003cspan address=\"10.1067/j.cpradiol.2023.08.004\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKirsh SR, Au DH (2023) Enhancing the e-consult: empowering efficient and collaborative care. Am J Manag Care 29(12):648\u0026ndash;649. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.37765/ajmc.2023.89465\u003c/span\u003e\u003cspan address=\"10.37765/ajmc.2023.89465\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCotton VR (2010) Legal risks of curbside consults. Am J Cardiol 106(1):135\u0026ndash;138. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.amjcard.2010.02.024\u003c/span\u003e\u003cspan address=\"10.1016/j.amjcard.2010.02.024\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"","lastPublishedDoi":"10.21203/rs.3.rs-8622468/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8622468/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eElectronic consultations (eConsults) have gained widespread use across medical specialties; however, radiology, particularly pediatric radiology, has lagged in adoption. Pediatric care increasingly depends on timely subspecialty input, and traditional communication methods with radiologists can be fragmented.\u003c/p\u003e\u003ch2\u003eObjective\u003c/h2\u003e \u003cp\u003eTo evaluate the feasibility, utility, and impact of a structured pediatric radiology eConsult platform implemented within a large academic quaternary pediatric care setting.\u003c/p\u003e\u003ch2\u003eMaterials and Methods\u003c/h2\u003e \u003cp\u003eThis IRB-approved, retrospective study evaluated an eConsult tool integrated into the Epic electronic health record (EHR) between April 2022 and June 2025. The tool facilitated asynchronous communication between pediatric care providers and pediatric radiologists. Data from 257 eConsults were extracted and categorized thematically. Provider and radiologist perceptions were assessed via REDCap surveys.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eMost eConsults originated from gastroenterology (57.2%) and primary care (24.9%). Thematic categories included diagnostic interpretation support (48.2%) and protocol planning (29.9%). Among pediatric care provider survey respondents (n\u0026thinsp;=\u0026thinsp;26), 100% were satisfied, and 80.8% reported that eConsults altered their clinical decision-making. Radiologists found the system usable, with mixed views on workload impact and collaboration.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eStructured eConsults in pediatric radiology are feasible, well-received, and may enhance access to imaging guidance and clinical decision-making. Their broader implementation can support efficient, scalable specialty communication.\u003c/p\u003e","manuscriptTitle":"E-Consults in Pediatric Radiology: A Pilot Study of a Novel Electronic Consultation Service Connecting Pediatric Care Providers to Pediatric Radiologists ","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-01-29 16:38:17","doi":"10.21203/rs.3.rs-8622468/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"989ac23a-2562-40a4-a965-144a9dbb1009","owner":[],"postedDate":"January 29th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-02-17T17:10:14+00:00","versionOfRecord":[],"versionCreatedAt":"2026-01-29 16:38:17","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8622468","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8622468","identity":"rs-8622468","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}