Speed it up! There's a platform linking primary care docs to specialists—and it's really working

A study of the first two years of an electronic consultation service that connects primary care physicians with specialists showed the platform sped up the exchange of information between the two groups and significantly reduced the number of unnecessary referrals to specialists. The study, looking at usage of Ontario’s eConsult service from the time it was launched in July 2018 through to June 2020, found specialists provided an initial response within two days on average to requests from primary care practitioners, which included family physicians and nurse practitioners. About 96% of initial responses were turned around in seven days or less and close to 99% came in 30 days or less. In just over half the cases, the primary care practitioner originally considered a referral but did not go ahead with it as a result of electronic consultation with a specialist, according to the study, which was authored by researchers at University of Ottawa's departments of medicine and family medicine, the Bruyère Research Institute in Ottawa, and the Ottawa Hospital. “This has exceeded our expectations,” said Dr. Clare Liddy, co-author of the study—entitled 'The Provincial Spread and Scale of the Ontario eConsult Service: Evaluation of the First 2 Years'—and one of the two doctors who created the eConsult platform, which is now used across Ontario, Alberta, Quebec, Manitoba and Newfoundland. Read: Frustration over Ont.'s outdated referral processes The study also found that in 55% of cases, primary care physicians received advice with a new or additional course of action. In 40% of cases, the specialist confirmed the primary care physician’s original course of action. The eConsult Service platform offers a way for primary care providers to communicate asynchronously with specialists. Requests are sent in writing and can be accompanied with supporting material such as photographs. “So for example, for a dermatology issue I can take a picture and describe the problem, and I can ask if the specialist thinks we need to do a biopsy,” explained Dr. Liddy, who holds no commercial interests or proprietary rights to the service. “For a cardiology case, the inquiry might be about the kind of testing a patient needs to get done. So instead of going to the cardiologist and being told during that visit what tests are needed—and then having to get another appointment after the tests are done—the patient can get the necessary tests done sooner and have the test results ready when they see the cardiologist.” Specialists on the eConsult platform billed a median of 15 minutes per case, with a median cost of $50. By comparison, said Dr. Liddy, face-to-face specialist visits can cost between $75 to $150 per visit depending on the doctor’s area of expertise. Read: It's high time to simplify our mental health referral system “Overall the huge value is the ability of physicians to get specialist advice for their patient within days, instead of the months it usually takes to get in to see a specialist,” said Dr. Liddy. “Every family physician has a waitlist of patients waiting for a specialist, so getting fast access to advice has a real clinical value.” For specialists, eConsult can ease the stress of knowing “there are so many people trying to see you and can’t get in,” said Dr. Liddy. Read: The Medical Post’s Referral Etiquette Guide Uptake at eConsult has been growing rapidly. In the first two years of implementation, case volumes grew by 180%. Over the period analyzed by the study, close to 4,500 practitioners—of whom 90% were primary care clinicians—submitted a total of 60,474 eConsult requests. Just over 1,480 specialists across Ontario were registered with eConsult, an increase of almost 890 since the launch of the service. The most commonly accessed specialties were dermatology, hematology, endocrinology, obstetrics and gynecology, and neurology. A sub-group made up of COVID specialists was launched shortly after Ontario declared a state of emergency in March 2020. “It’s been very successful,” said Liddy. “A key question we asked was: when you go big can you maintain the service quality? If you look at the ability of people to get response quickly, I think we can safely say that yes, we maintained the service quality.” Read: I'm fed up, and I can't take it anymore!

Speed it up! There's a platform linking primary care docs to specialists—and it's really working

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