PRACTICE PARTNER
Impact of eConsult on Access
Specialists responded to eConsult in a median of 1 day (Improved access)
71% of cases did not require a face-to-face specialist visit (efficient, coordinated care)
In 4% of cases, eConsult prompted a medical referral (patient safety)
4%
4% 1%
Referral was originally contemplated at this stage but now avoided (51%)
Referral was originally contemplated and is still needed (20%)
20%
20%
51%
Referral was not originally contemplated and is still not needed (20%)
Referral was not originally contemplated, but eConsult process resulted
in a referral being initiated (4%)
Other (4%)
There was no particular benefit to using eConsult in this case (1%)
* Based on Ontario eConsult Service survey data for April 1st, 2018 to March 4th, 2019
a response within seven days, often eliminating the need
for an in-person specialist visit. The eConsults are avail-
able at no cost to health-care professionals.
The response from health-care providers and patients
has been overwhelmingly positive, said Dr. Clare Liddy,
an Ottawa family physician who co-developed the pro-
gram. Dr. Liddy said all specialties are now represented
in the service as well as many subspecialties.
The program was borne of her frustration in trying to
access care for her own patients. “As a family doctor, I
was starting to notice the waiting times really increasing
across multiple areas.”
She discussed the issue with her colleague Dr. Erin
Keely, an endocrinologist, who had seen similar issues
on the other side of the referral-consultation process.
They decided that using technology to create a more
timely dialogue between family doctor and specialist
was the way to go. “We knew that creating that ability
to have a conversation between doctors was going to
translate into better care for patients,” says Dr. Liddy.
As the service has evolved, it has proven to be useful
for even complex medical issues, such as chronic pain,
and mental health. And it works especially well when
lab reports are involved. “If a blood test comes back and
48
DIALOGUE ISSUE 3, 2019
there’s something that might be a bit concerning, you
would normally send the patient to see a hematologist.
With eConsult, you can send the lab result with your
question, include some patient history, and ask what
next steps need to be taken, if any,” she said.
An unexpected bonus of the service – and a benefit for
the health-care system – is that it has proven to reduce the
need for additional specialist visits. Dr. Liddy said that
more than two-thirds of patients who had an eConsult
didn’t need a referral based on the advice they received.
The College of Family Physicians of Canada and the
Royal College of Physicians and Surgeons of Canada
support eConsult as a standard of practice. Addition-
ally, the Canadian Medical Protective Association has
described the service as “an opportunity to improve effi-
ciency, enhance patient care, expand access to specialists
and provide a clear audit trail of the specialist’s advice.”
If you are not yet enrolled, contact the Ontario
eConsult Centre of Excellence. The team will assist you
in getting signed up. You may also visit its website at
https://econsultontario.ca/ for more information.
For information about how to make eConsult a regu-
lar part of your practice, please contact eConsultCOE@
toh.ca.
MD