How to put health-care in­no­va­tion into prac­tice

Waterloo Region Record - - Insight - CLARE LIDDY AND ERIN KEELY

It all started when the two of us sat down over a cup of cof­fee.

As a fam­ily physi­cian and en­docri­nol­o­gist, we stand on op­po­site sides of a large chasm called Pa­tient Wait Times, and we both started see­ing more and more of our pa­tients swal­lowed up by this abyss.

In her role as a fam­ily doc­tor, Clare no­ticed how long some pa­tients had to wait for an ap­pointment with a spe­cial­ist.

In Erin’s case, pa­tients were wait­ing months for ap­point­ments with her as an en­docri­nol­o­gist, of­ten for prob­lems their fam­ily doc­tors could have ad­dressed with just a lit­tle guid­ance.

Surely, we thought, there was a bet­ter way, a quicker path that could save pa­tients the me­an­der­ing months-long waits they too of­ten face?

From this con­ver­sa­tion, we came up with an in­no­va­tive so­lu­tion: what if, in­stead of a fam­ily doc­tor mak­ing a re­fer­ral every time they faced a ques­tion about a pa­tient’s care, they could reach out to a knowl­edge­able spe­cial­ist di­rectly?

Per­haps, in some cases, the spe­cial­ist could guide the fam­ily doc­tor, sav­ing the pa­tient a long wait for an in-per­son ap­pointment.

And this could save the be­lea­guered pub­lic health sys­tem im­por­tant re­sources.

With pub­lic grant fund­ing and the sup­port of re­gional part­ners — in­clud­ing On­tario’s Cham­plain Lo­cal Health In­te­gra­tion Net­work and the Winch­ester Dis­trict Memo­rial Hos­pi­tal — we cre­ated the Cham­plain BASE eCon­sult ser­vice.

It’s a se­cure on­line plat­form that al­lows pri­mary care providers to ask spe­cial­ists ques­tions about a pa­tient’s care. Spe­cial­ists re­spond within a week — two days on av­er­age — with ad­vice on the pa­tient’s care, rec­om­men­da­tions for re­fer­ral or re­quests for more in­for­ma­tion.

Eight years since its found­ing, the eCon­sult ser­vice has com­pleted over 30,000 cases, en­rolled more than 1,300 pri­ma­rycare providers and al­lowed thou­sands of pa­tients to re­ceive high-qual­ity care with­out need­ing a face-to-face spe­cial­ist visit.

Other in­no­va­tors in sev­eral prov­inces have part­nered with us to bring the BASE eCon­sult model to their ju­ris­dic­tions. And the govern­ment of On­tario re­cently com­mit­ted to ex­pand­ing the ser­vice across the prov­ince.

The eCon­sult ser­vice made the leap from pi­lot into prac­tice — no easy feat in the of­ten-in­tractable and rigid Cana­dian health sys­tem.

Over the years, we’ve learned a num­ber of im­por­tant lessons about cre­at­ing and im­ple­ment­ing health-care in­no­va­tions, which too of­ten fail to sus­tain them­selves be­yond an ini­tial pi­lot phase.

Suc­cess­ful in­no­va­tions are built on a foun­da­tion of sound ev­i­dence and that ev­i­dence comes from solid re­search. But re­search alone can’t launch a ser­vice and many promis­ing in­no­va­tions have re­mained clois­tered in aca­demic jour­nals — valu­able plat­forms, but ones that rarely res­onate out­side their im­me­di­ate cir­cles.

In or­der to get some­thing im­ple­mented, you need to reach the peo­ple who do the ac­tual im­ple­ment­ing: Clin­i­cians, pol­i­cy­mak­ers and es­pe­cially pa­tients, whose voices must be heard.

We cre­ated eCon­sult first and fore­most to solve a prob­lem: Poor ac­cess to spe­cial­ist care.

Our so­lu­tion em­braced tech­nol­ogy but when choos­ing this path, we re­mained set on our desti­na­tion, which was al­ways im­prov­ing ac­cess for pa­tients.

By re­main­ing ag­nos­tic to the par­tic­u­lar tech­nol­ogy we used, we en­sured that the plat­form we ul­ti­mately chose was the best one for the job and avoided be­ing hemmed in by the lim­i­ta­tions of a par­tic­u­lar pro­gram or ven­dor.

Im­ple­men­ta­tion is an on­go­ing process and adapt­ing to new facts or chang­ing needs is vi­tal.

For in­stance, in the early days of eCon­sult, we con­sid­ered build­ing the ser­vice around an email client.

How­ever, On­tario’s pri­vacy leg­is­la­tion doesn’t al­low trans­mis­sion of pa­tient data through email be­cause it’s too in­se­cure, so we switched to a plat­form with more ro­bust se­cu­rity mea­sures.

While such ad­just­ments are in­evitable and must be taken in stride, the over­all goal of the in­no­va­tion should re­main at the fore­front of its im­ple­men­ta­tion.

Many pro­grams suf­fer from a grad­ual broad­en­ing of their scope, which can di­lute their im­pact on the ob­jec­tive they orig­i­nally meant to achieve. Mis­takes are in­evitable.

The best way to learn from them is to seek con­tin­u­ous feed­back from the providers and pa­tients who use or ben­e­fit from the ser­vice.

We have seen first-hand the pos­i­tive im­pact eCon­sult can have on pa­tient care.

And we hope that one day every Cana­dian can avoid the pit­falls of ex­ces­sive wait times — which range from in­con­ve­nience to se­ri­ous de­te­ri­o­ra­tion of health — and ben­e­fit from im­proved ac­cess to spe­cial­ist care.

• Dr. Clare Liddy is a clin­i­cal in­ves­ti­ga­tor at the C.T. La­mont Pri­mary Health Care Re­search Cen­tre of the Bruyère Re­search In­sti­tute, a tier 2 chair and as­so­ciate pro­fes­sor at the Univer­sity of Ot­tawa’s De­part­ment of Fam­ily Medicine, and a prac­tis­ing fam­ily physi­cian and an ex­pert ad­viser with Ev­i­denceNet­

• Dr. Erin Keely is an en­docri­nol­o­gist with the Ot­tawa Hos­pi­tal, a pro­fes­sor at the Univer­sity of Ot­tawa’s De­part­ment of Medicine, and a clin­i­cian re­searcher with the Ot­tawa Hos­pi­tal Re­search In­sti­tute. Dis­trib­uted by Troy Me­dia


A hear­ing spe­cial­ist at work: Au­thors Clare Liddy and Erin Keely ask what if, in­stead of a fam­ily doc­tor mak­ing a re­fer­ral every time they faced a ques­tion about a pa­tient’s care, they could reach out to a knowl­edge­able spe­cial­ist di­rectly?

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