eConsults: How Ontario patients are skipping specialist waiting rooms and getting faster advice

Dr. Sarah NewberyWaiting. It seems Ontario patients wait a lot. It is unfortunately not uncommon for patients to experience the anxiety and frustration of having to wait weeks or months for a specialist appointment. What if we could leverage technology to connect family physicians with specialists for appropriately selected patient issues, and drastically cut wait times for patients no matter where they live in our vast province? That goal is well on its way to becoming a reality in Ontario with the Provincial eConsult Initiative, a partnership between OntarioMD, the Ontario Telemedicine Network (OTN) and Champlain BASE (Building Access to Specialists through eConsultation).There have been several efforts at developing an electronic consultation system for Ontario. Search for “eConsult” using a major search engine like Google and the results turn up local solutions and apps for your smartphone that deliver specialist advice. Fortunately, Ontario is focused on providing a flexible and scalable eConsult solution to family physicians and specialists all over the province – with two established eConsult solutions – OTN’s eConsult and the Champlain BASE service on behalf of the Ontario Ministry of Health and Long-Term Care through the Provincial eConsult Initiative. To date, nearly 9,000 physicians, both family physicians and specialists, have enrolled as part of the initiative. While family physicians currently enrolled in these initiatives access eConsultation services through the secure OTN portal (otnhub.ca) or the Champlain BASE platform (champlainbaseeconsult.com), they’ll soon be able to conduct electronic consults from their OntarioMD-certified electronic medical record (EMR) and be able to communicate with specialists anywhere in Ontario. This widens the network of specialists available to all family physicians and gives their patients timely access to specialist advice, delivered through the family physician in a way that supports coordination and continuity of care.The results of this initiative, thus far, have exceeded targets for usage. Family physicians report that eConsult has been a positive experience for patients. Patients in rural or remote areas, or with mobility issues, can often avoid travel, avoid the wait times, and receive high quality, timely care all coordinated and communicated through their family physician. Through OTN’s eConsult, as an example, the family physician can send a request for an eConsult, appending pertinent patient information, to an individual specialist or to a group of specialists within a specific therapeutic area. In many cases, the family physician gets a response the same day with response times ranging from a few minutes to a few days. Today, with OTN’s eConsult, the average response time is three days, which is a dramatic improvement over the current wait time for face-to-face consultations.I believe that the Provincial eConsult Initiative can support key directions in the healthcare system contributing to more timely access to care in a more equitable way, with good coordination through the patient’s family physician, and with good outcomes for appropriately selected patients. Family physicians can connect to any specialist in the province who is part of eConsult, not just the local specialists - an important opportunity for those family physicians in areas like mine that don’t have regional access to many specialist services. For example, as a physician in northern Ontario, I can ask a question of a dermatologist or rheumatologist anywhere in the province, from Thunder Bay to Windsor. This greater equity of access supports family physicians in settings like mine to help their patients make the right decisions about their health in a timely way and without the burden of travel and the costs of time off work to attend appointments in person. Getting specialist advice much sooner also protects them from potentially adverse events that may occur during a long wait time. Electronic consultation also protects our valuable health care resources by freeing up specialists’ time to treat the more complex patients who require a face-to-face visit sooner. That’s good news for the healthcare system, physicians and patients alike.eConsult is easy to use and is expanding across Ontario. Patients should ask their family physicians about using this technology to avoid waiting for a specialist. Family physicians can get more information on the initiative by visiting OntarioMD.ca or can contact econsult@ontariomd.com to sign up. OntarioMD Practice Advisors are also available to help physicians with advice on minor changes to their workflow when using eConsult. I strongly recommend eConsult and appreciate how it is complementing the care I can provide to my patients. Dr. Sarah-Lynn Newbery is a rural physician in comprehensive community practice in Marathon, Ontario. She is also the Chief of Staff at Wilson Memorial General Hospital, an active community teacher and faculty member at the Northern Ontario School of Medicine and the current President of the Ontario College of Family Physicians. Dr. Newbery is the eConsult Champion for the North West LHIN and is on the advisory council for the Provincial eConsult Initiative.

eConsults: How Ontario patients are skipping specialist waiting rooms and getting faster advice

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