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eConsult rolls out across Canada: electronic solution decreases specialist wait times

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(computer with stethoscope

Drs. Clare Liddy and Erin Keely came up with a solution to referral wait times with eConsult, an online tool that family doctors can use to ask specialists information to see if their patient should be referred.

When Dr. Clare Liddy shared with Dr. Erin Keely that one of her patients had to wait for more than nine months for an appointment with a specialist, they agreed this was too long. Together, they set about solving the problem of extensive wait times to see specialists – a problem that seems to plague health-care systems.

That was in 2009. Now, their electronic eConsult solution is rolling out across Canada, and other countries are interested in it as well.

“Our goal is to have eConsult available across Canada for all Canadian patients,” said Dr. Keely. “The primary care doctors and patients see the value right away, so it is solving a problem.”

When they began, wait times to see specialists were long.

Dr. Clare Liddy

Dr. Clare Liddy has established a research program around eConsult and has published more than 40 articles about the experience.

“It was becoming increasingly common that I’d do a referral for patients and they would be waiting months and months to get that appointment with the specialist,” said Dr. Liddy, a family doctor.

The two realized they could improve access for patients by making it easier for family doctors and specialists to communicate. They looked at a variety of options – including telephone, video and email – but found another solution.

At the time, the region’s Champlain Local Health Integration Network (LHIN), was starting to use SharePoint, an online collaboration tool. So, with the assistance of Amir Afkham, senior project manager with the LHIN, Drs. Liddy and Keely launched an electronic consultation service, using the LHIN’s computer system housed at the Winchester District Memorial Hospital.

“Actually, it was a good starting point,” said Dr. Keely. “Because we started with family physicians in Winchester who were the ones that were piloting SharePoint. And given that they were in a rural-based community, it made sense for those patients not to have to travel for unnecessary specialist visits.”

Doctors and nurse practitioners can send questions and information about a particular patient’s case to a specialist through a private and secure web page. The specialist then reviews the information and gives feedback about the patient without having to see the patient in person. Because the specialists provide their comments and advice quickly, turn-around time is less than a week, often only days.

This system, known as the Champlain BASE eConsult (short for Building Access to Specialists through eConsultation), started with just five specialty groups. By reaching out to their networks and informing other specialists about the system, that number grew to 109 specialty groups by 2018. The majority of specialists are from The Ottawa Hospital, but many are experts from other health centres throughout the region.

“The specialists who register for eConsult are the ones really interested in innovative patient care. They want to do things differently because they recognize the problem of wait times, and are happy to be part of the solution,” said Dr. Keely. “They like working with family doctors and nurse practitioners and value that communication and interaction. Most importantly, they know it is better for their patients.”

“The idea of evaluating patients without seeing them face to face, dealing with very long wait lists for consultations, and finally frustrations about the limited amount of information you get when a patient is referred was what got me interested in eConsult,” said Dr. Doug Smith, a rheumatology specialist at The Ottawa Hospital who has been involved with eConsult since the beginning.

“I think it is hugely useful to patients because it allows referring doctors to receive answers in less than a week, as opposed to months for a referral visit. So, they get a quick answer. If there are further things needed, the doctors are guided in what they have to do,” said Dr. Smith.

The benefits to doctors and primary care providers in the community are obvious.

“It helps me get answers quickly, which helps my patients, and also helps me make decisions about whether I need to send this person to see a specialist or not,” said Dr. Kristina Whitehead, a family doctor. “Or sometimes I get information about an investigation or treatment that I hadn’t considered that I can implement immediately. It really helps me, which means my patients get the care they need, fast.”

In many instances, the information received from the specialist means that the patient does not have to physically see the specialist. If they do need to see the specialist, they can get tests done before the visit or start on medication while waiting.

“I often have patients who are disabled or chronically ill, or they may be elderly, or have barriers to transportation in the winter. Instead of having to go to an appointment and see a specialist, I get an answer for them, and they often don’t have to go anywhere,” said Dr. Whitehead.

Dr. Erin Keely

“Our goal is to have eConsult available across Canada for all Canadian patients,” said Dr. Erin Keely.

Since 2011, the service has completed more than 35,000 cases and enrolled more than 1,300 primary care providers. Each month, about 1,000 patients in the Champlain region have an eConsult sent on their behalf. In two-thirds of cases, the specialist’s advice allows the primary care provider to treat the patient without sending them for a face-to-face specialist referral. Conversely, in about four percent of cases, the primary care provider initially had no intention to refer but ended up choosing to do so on the specialist’s recommendation. This means about 1,200 patients received treatment for issues that may have been overlooked.

The convenience and efficiency of eConsult has been recognized by doctors, nurse practitioners, and specialists in Ontario who have adopted the system. In study after study, satisfaction among providers exceeded 90 percent. Patients found the eConsult service to be very useful and an acceptable way to receive access to specialist advice.

The eConsult success has started to spread across the province and the country. In its 2017 budget, the Ontario government committed to investing $245 million over three years to improve patient access to specialists, including rolling out eConsult across the province. Drs. Liddy and Keely have established the Ontario eConsult Centre of Excellence at The Ottawa Hospital in partnership with the Bruyère Research Institute and are leading the provincial government’s initiative to expand eConsult across Ontario.

Quebec, Manitoba, Alberta, Newfoundland, and New Brunswick have now implemented eConsult. Primary care providers in Nunavut are also using the system, which is ideal for the north where the cost to transport patients is so high. It helps identify patients who don’t need to leave their community to see a specialist in the south.

Dr. Liddy has established a research program around eConsult and has published more than 40 articles about the experience. The Ottawa Hospital team is committed to spreading knowledge and information about eConsult, which is not only being picked up nationally but also around the world. The system is unique to Canada, and The Ottawa Hospital is recognized globally as a leader in using this system to cut referral wait times for patients.

Innovation is at the core of what we do at The Ottawa Hospital – finding ways to improve treatments and provide unparalleled patient care. We are raising funds to support innovation, such as eConsult, that improves health care.

Dr. Liddy with part of Dr. Keely

 
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