Ontario’s eConsult service fills digital healthcare gap, particularly with COVID’s arrival

While COVID-19 amplified the gaps in Ontario’s digital healthcare network, the province’s eConsult service has provided clinicians with a necessary resource, notably at the start of the pandemic.

A pair of studies published in the Annals of Family Medicine by researchers at the University of Ottawa’s Faculty of Medicine and the Bruyère Research Institute demonstrate the established success of the provincial electronic consultation (eConsult) from its launch in June 2018. eConsult provides physicians and nurse practitioners with immediate electronic access to specialist advice for their patients, across a wide range of disciplines.

Case volumes grew by 180% over the first two years of the eConsult service, which swiftly launched a sub-specialty COVID-19 group when the province declared a state of emergency over the disease in March 2020. For clinicians, this meant having real time data advice from infectious disease specialists on the novel coronavirus through a no-cost service.

“Our team is very proud to have demonstrated the successful scale up of the eConsult service in Ontario and, despite the increasing numbers of people served, we have maintained our service quality in particular the rapid response time. In addition to further expanding general specialty access during the pandemic through eConsult, we also quickly added our Covid-19 specialties to address issues such as self-isolation, return to work, and chronic symptoms post Covid-19.” – Dr. Clare Liddy, Chair of the Department of Family Medicine and uOttawa Research Chair in eConsult and Primary Healthcare Delivery; and Senior Researcher, Bruyère Research Institute.

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Electronic Consultations Improve Primary Care Physicians’ Access to Subspecialty Advice and Reduces Costly, Inconvenient Patient Referrals
A new study in the Annals of Family Medicine examines usage data from a provincial electronic consultation (eConsult) service in Ontario, Canada, which facilitates rapid and secure communications between primary care physicians and subspecialists. The research team sought to analyze eConsult’s impact on primary care physicians’ access to subspecialty advice, health system costs, and whether there was a decreased need for in-person visits. They also identified barriers to access and uptake over a two-year period. Study participants submitted 60,474 eConsult records during the study period. Uptake in eConsult usage increased significantly month over month, from 1,487 eConsults in July 2018 to 4,179 in June 2020. The median subspecialist response time was one day, with a billed median of 15 minutes per case, which resulted in a median cost of $50. Requesting physicians received advice for a new or additional course of action in 55% of cases, and received confirmation on their original course of action in 40%. In 51% of cases, a referral was avoided as a result of the eConsult. The researchers state these findings are comparable to the average subspecialist response time of other eConsult services across Canada, suggesting that eConsult is highly generalizable and can be scaled up without sacrificing effectiveness. The findings suggest that eConsult can also reduce unnecessary specialty referrals, saving the patient and health system time and money. 

The Provincial Spread and Scale of the Ontario eConsult Service: Evaluation of the First 2 Years: Clare Liddy, MD, MSc, CCFP, FCFP, et al. C.T. Lamont Primary Health Care Research Center, Bruyère Research Institute, Ottawa, Ontario, Canada

Canadian eConsult Services Provided Much-Needed COVID-19 Information, Specialty Consults for Primary Care Doctors 
Researchers in Ontario, Canada, conducted a study to assess the impact of utilizing an electronic consultation (eConsult) service to provide timely access to COVID-19 specialist advice for primary care practitioners. The study examined eConsult cases submitted to a COVID-19 specialist group in order to assess usage patterns, impact on response times and referrals, and the content of clinical questions being asked.  They analyzed 289 eConsults submitted to the Champlain BASE(™) and Ontario eConsult services between March and September 2020. Fifty-one eConsult requests were submitted to the Champlain BASE(™)  and 238 to the Ontario eConsult service. The median specialist response time was 0.6 days (range: three minutes to 15 days) and the average time spent by specialists per eConsult was 16 minutes (range: five to 59 minutes). In 24% of cases, eConsults resulted in an avoided face-to-face referral, saving patients and the health care system time and money. Five major themes were identified relating to clinical questions: (1) precautions for high-risk populations; (2) guidance on self isolation and return to work; (3) diagnostic clarification and/or need for COVID-19 testing; (4) guidance on personal protective equipment; and (5) management of chronic symptoms. Researchers assert that their study demonstrates the significant potential of eConsults during a pandemic as the protocol was quickly implemented across Ontario and resulted in rapid and improved access to specialist care.

Evaluation of an Electronic Consultation Service for COVID-19 Care: Jatinderpreet Singh, MD, CCFP, MSc, MASc, et al. Department of Family Medicine, University of Ottawa and C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, Ontario, Canada