Risk Reduction Resources

Curbside and eConsults

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Introduction

Curbside consultations—informal clinician-to-clinician discussions regarding a patient’s condition—are common in clinical practice. While convenient, they also pose legal, clinical, documentation, and operational risks.

With the increasing use of digital communication platforms, eConsults provide a more structured alternative but also introduce unique considerations. This practice tip outlines how to minimize risk, maintain compliance, and ensure patient safety by applying structured decision-making processes.

Definitions

Curbside Consultation

An informal, clinician-to-clinician discussion that:

• Provides general insight or education guidance.
• Does not involve patient-identifiable information.
• Does not create a formal consultant–patient relationship.
• Is not documented by the consultant.

eConsult

A structured, documented, asynchronous clinical consultation conducted through a secure electronic platform that:

• Includes review of relevant patient information.
• Creates a formal medical recommendation.
• Establishes accountability for the consultant’s input.
• May be billable.

Risks Associated with Curbside Consultations

Clinical Risk

• Incomplete clinical information may lead to inaccurate or unsafe advice.
• The consulting clinician may unintentionally provide recommendations that are interpreted as medical advice rather than general information.
• Lack of direct examination risks misdiagnosis or delayed diagnosis.
• Potential for delayed patient evaluation.

Legal & Liability Risk

• If the consultant’s opinion influences treatment and results in harm, both clinicians may face liability—even if the consultant never saw the patient.
• Absence of documentation makes defense difficult if litigation arises.
• Blurred lines around whether a physician–patient relationship was established.

Ethical & Professional Risk

• Risk of bias due to limited context.
• Boundary issues when senior clinicians feel pressured to provide advice.
• Potential for inappropriate reliance on informal consultations.

Compliance/Privacy Risk

• HIPAA violations may occur if identifiable information is shared through an unsecured channel or with someone not involved in the patient’s care.
• Risk of discussions occurring in public or non-private areas.

Operational Risk

• Reliance on informal processes instead of structured referral workflows.
• Potential for inconsistent advice across clinicians.

Recommended Guidelines for Curbside Consultations

When Curbside Consults Are Appropriate

• Diagnostic brainstorming without identifiable patient details.
• Questions requiring specialty insight that do not require chart review or patient-specific advice.
• Education or mentorship interactions.
• General guidance on best practices or typical management pathways.

When Curbside Consults Are Not Appropriate

Curbside consults should not be used when:

• A medical decision will rely on the consultant’s input.
• The consultant would normally need to review images, labs, or the chart.
• There is diagnostic uncertainty requiring formal evaluation.
• The interaction would create or could be construed as a patient–specialist relationship.
• The requesting clinician expects written guidance or recommendations.
• When the advice will guide specific patient treatment.
• When the case is complex, high-risk, or requires specialist expertise.
• When an eConsult or in-person referral is clearly indicated.

Documentation Guidelines

For curbside consults:

• Do not document the consultant’s name unless there is a formal consultation.
• Document that the clinician “discussed the case with a colleague for general clinical insight; no formal consultation was initiated.”
• Avoid attributing specific guidance to the consultant.

Privacy Protection

• Avoid sharing patient identifiers (name, DOB, MRN).
• Keep discussions on secure, HIPAA-compliant systems whenever possible.
• Refrain from discussing cases in public or semi-public spaces.

Role Clarification

Consultants should clarify:

• “I can provide general thoughts, but this is not a formal consultation.”
• “Based on limited information, you may wish to consider a formal referral.”

This protects both clinicians and aligns expectations.

Guidance for eConsults

What is an eConsult?

A structured, documented, asynchronous medical consultation designed to:

• Support timely access to specialty input.
• Enhance primary–specialty collaboration.
• Provide billable services when appropriate.
• Maintain a clear audit trail.

Benefits of eConsults

• Improved timeliness of specialty input.
• Lower cost compared to in-person visits.
• Reduced need for patient travel.
• Efficient triaging for cases needing in-person referral.
• Provides structured specialist input.
• Reduces unnecessary referrals.
• Creates a defensible documentation trail.
• Improves communication between primary and specialty care.
• Allows asynchronous review without disrupting workflows.

Risks of eConsults

• Incomplete or unclear clinical questions.
• Overreliance on specialty input without proper follow-up.
• Potential delays if the consult is inappropriate for an eConsult format.
• Liability associated with incomplete data review.
• Documentation errors or unclear attribution of responsibility.

Appropriate Use Cases for eConsults

• Non-urgent clinical questions.
• Medication management adjustments where specialist input is needed.
• Review of imaging/labs when uploaded or part of EHR.
• Differential diagnosis assistance.
• Post-procedure clarification (non-urgent).

When eConsults Are Not Appropriate

• Emergency or time-sensitive cases (stroke, chest pain, acute abdomen).
• Complex conditions needing physical examination.
• Consent-dependent situations or when contraindicated by specific regulations or policies.
• Situations requiring prolonged discussion or multidisciplinary input.
• Cases where the patient wants direct access to the specialist.

Documentation Requirements

• Responsibility for follow-up care clearly assigned.
• A note that the patient was informed (if required by local policy).

Requesting Provider Must Provide

• A focused clinical question.
• Relevant medical history and exam findings.
• Key labs, imaging, and medication data.
• Clarity on the clinical context and goals.

Consultant Responsibilities

• Review all materials provided.
• Document recommendations with clear disclaimers where appropriate.
• Flag cases that require in-person referral.
• Avoid treating outside scope of provided information.
• Provide response within established turnaround time guidelines.

Recommended Workflows

Decision Tree

Before seeking specialist input:

1. Is this a simple general question?
   → Use curbside (no PHI disclosed).
2. Will recommendations influence medical management?
   → Use eConsult or formal referral.
3. Is the situation urgent?
   → Direct phone call or formal emergent referral.
4. Does the query require chart review, imaging, or labs?
   → Use eConsult or formal referral.
5. Does the specialist need to examine the patient?
   → Formal in-person referral.

Standardized Messaging Templates

Can include:

• Required data checklist for eConsults.
• Expected turnaround times.
• Disclaimer language for curbside conversations.

Training & Compliance Recommendations

• Annual education on curbside risk and documentation.
• Clear institutional policy defining curbside vs. eConsult.
• Training for new clinicians on digital communication risks.
• Establish audit processes to ensure consistency and compliance.
• Reinforcement of HIPAA-safe communication channels.

Summary

Curbside consultations and eConsults are valuable tools when used appropriately. Clinicians should use curbside consults only for general guidance and rely on eConsults or formal referrals when clinical decision-making requires comprehensive review or documentation.

References

American College of Physicians. (2019). ACP ethics manual (7th ed.). Annals of Internal Medicine, 170(2, Suppl.), S1–S32.

Vimalananda, V. G., Gupte, G., Seraj, S. M., Orlander, J., Berlowitz, D., & Fincke, B. G. (2018). A systematic review of asynchronous provider-to-provider electronic consultation services. Telemedicine and e-Health, 24(12), 1011–1020.

Thielke, A., & King, V. (2020). Electronic consultations (eConsults): A triple win for patients, clinicians, and payers. Milbank Memorial Fund.

https://pmc.ncbi.nlm.nih.gov/articles/PMC2882285/#:~:text=Giving%20a%20curbside%20consult.,accurate%2C%20well%2Dfounded%20diagnosis

https://www.medcentral.com/biz-policy/physician-curbside-consult-evolution-and-risks

https://www.aristamd.com/thought-leadership/articles/econsult-as-alternative-to-curbside-consults

Updated on: 11/2025