Ottawa-made platform cuts wait time for consults
Service provides chance to ask questions and means shorter waits for patients
About a decade ago, two Ottawa doctors were puzzling over a common problem for family physicians trying to get answers for their patients: long waits for consultations with a specialist.
Patients sometimes waited up to nine months. Wouldn’t it be quicker if the family physician could ask the specialist a question? reasoned Dr. Clare Liddy, a family physician, and Dr. Erin Keely, an endocrinologist, who are both researchers. It could eliminate long waits and frustration for the patient. It might even reduce unnecessary trips for elderly or isolated patients.
Their made-in- Ottawa solution has become known as Champlain BASE (Building Access to Specialists through eConsultation), known as eConsult. It offers doctors and nurse practitioners the online version of grabbing a quick chat about a perplexing case with a knowledgeable colleague in a hospital hallway.
The web-based platform — a collaboration between the Bruyère Research Institute, The Ottawa Hospital and the Champlain LHIN — got off the ground in 2010 with five specialty areas. The system now has about 200 specialists in 59 specialty areas in its bank, including experts in pharmacy, transgender care and pediatric cardiology. There are 350 to 400 eConsults per week in Champlain LHIN alone.
The system is now available across Ontario through the Ontario Telemedicine Network and has expanded to other provinces. Federal corrections facilities in Ontario will have access to the service starting in August.
“Most specialists simply want to provide better care,” Liddy said. “It’s extremely reassuring for the family doctor and the patient.”
Emails were not secure enough, so the initiative developed secure portals. Physicians can include images and attachments, such as lab reports, diagnostic images and even photos of conditions such as skin rashes, along with their questions. But Liddy and Keely wanted to keep it as simple as possible to get more doctors on board.
“Doctors have to deal with so many forms,” Keely said. “This system is aimed at keeping the adoption rate high by keeping the technology simple.”
Dr. Claire Kendall, a family physician with the Bruyère Family Health Team, was an early adopter and now uses the service about five times a month. She has used eConsult to access specialists including a pediatric geneticist and experts in HIV treatment and addictions.
Where Kendall works, eConsult is integrated into the electronic medical records system. Answers usually come back within days, she said. “It has revolutionized the way we provide care in this region. I’m glad it has been adopted across the province.”
Even if eConsult doesn’t replace a face-to-face consult, it helps to get treatment started while the patient is waiting, Liddy said. About two-thirds of the queries can be answered without the need for a face-to-face appointment.
“I see a lot of patients I don’t need to see,” Keely said.
Liddy and Keely and fellow researchers had published numerous studies. In one study involving interviews with 34 patients, 87 per cent said the service was useful in their situation and 70 per cent thought it was an acceptable alternative to face-to-face visits.
“She took photos of both of my hands and sent them through the eConsult, and within 24 hours I was back at the office,” one patient said.
Legally, doctors have a duty of care: They are obliged to provide the best advice with the informa- tion given. The Canadian Medical Protective Association, which provides legal advice and support to physicians, was consulted about the platform and likes it because there is a record of the exchange, Keely said.
Specialists also like eConsult, she said.
“We’re really enjoying the direct communications with each other,” she said. “It might not be for everyone, but specialists know the burden of wait times. They also like to provide teaching to primary care providers. It has had tremendous education benefits.”
The platform also has a great potential for improving equity of access, especially for those in remote and rural areas, for seniors who find it difficult to travel, and especially for those in long-term care, Liddy said.
There are 76,000 older adults in long-term care, and 97 per cent of them have two or more chronic conditions, including heart disease and dementia. Electronic consultation has been especially helpful for physicians managing wound care in seniors — sometimes the doctors send a photo of the skin problem when they ask for advice — and doctors who are “de-prescribing ” or dialing down behaviour medication such as anti-psychotics in long-term care facilities.
That’s just the start, said Liddy, whose team has funding to test the service for patients living with chronic pain in Ontario, Quebec and Manitoba.
“There is so much expertise. Everyone I ask always says ‘yes.’”
For Kendall, one of the best things about eConsult is learning from specialists.
“I get to learn more and the patient gets better care,” she said. “There’s a richness that comes with that.”
Most specialists simply want to provide better care. It’s extremely reassuring for the family doctor and the patient.