Date of Completion


Embargo Period



Jane Ungemack, Jun Lu, Joseph Burleson

Field of Study

Public Health


Master of Public Health

Open Access

Open Access


Importance: Medically underserved populations receiving care at community health centers lack access to specialty care.

Objective: To evaluate the impact of a dermatology electronic consultation (eConsult) program on a statewide scale focusing on access to care for medically underserved patients.

Design: Retrospective cohort study of 2385 dermatology referrals from June 2014 through November 2015.

Setting: Large, multi-site Federally Qualified Health Center in Connecticut.

Participants: Dermatology referrals pre-eConsult implementation from June to November 2014 (n=1258) and post-eConsult implementation from June to November 2015 (n=1127). All referrals came from primary care providers from twelve primary care sites in CT.

Intervention: Implementation of a dermatology eConsult program.

Main outcomes and measures: Outcome measures included appointment completion rates, eConsult utilization, PCP diagnoses, teledermatologist diagnoses, reasons for face-to-face (F2F) consultation recommendations, and biopsy results for those diagnosed with suspicious neoplasm.

Results: Prior to the eConsult program implementation there were 1258 dermatology referrals, with 514 patients (41%) never receiving an appointment. Among those who received an appointment only 139 patients (11%) were actually seen by a dermatologist, with a median appointment wait time of 77 days. Post eConsult implementation there were 1127 referrals to dermatology of which 499 were sent electronically. Of these, 78 (16%) required a face-to-face visit, with a median wait time of 28 days. The most common reason for a F2F recommendation was suspicious neoplasm (n=29). One in three (35%) patients with this clinical impression had biopsy-confirmed skin cancer.

Strengths and Limitations: Main strength of the study is the large scale implementation of eConsults across multiple community health centers. Main limitation is the narrow generalizability of the data to other medical settings.

Conclusions and Relevance: Implementation of an eConsult program at a statewide level increases access to dermatologic care and reduces wait times for underserved populations receiving medical care at community health centers. The system also appears to provide an effective mechanism for early detection of skin cancer in medically underserved populations.

Major Advisor

Jane Ungemack