Growth of a sustainable service
Several years ago, primary care physician and clinical scholar Dr. Clare Liddy, with endocrinologist and researcher Dr. Erin Keely, asked a profound question: “How can our patients get specialist care and advice sooner?” Together, the two embarked on a remarkable journey of exploration, research, and evaluation leading to an innovative answer to their question.
Patients, primary care providers (PCPs) and specialists express high levels of frustration about poor access to specialist care and too-long wait lists. PCPs complain that they “refer and then wait and do not even know if the fax was received.” Specialists are often frustrated by their too-long wait lists: “I am frustrated by my wait list. I can’t ever seem to catch up…” Patients often wait months to see specialists, facing frustration and sometimes worsening conditions, only to learn that all they needed was a change in their medication. For this advice, many patients spend hours of their time, often losing work time, having family members or caregivers attend the appointment with them (causing additional economic burdens), paying for parking, meals and transportation – all for a five minute appointment that could have been resolved with a better communication system in place.
Drs. Liddy and Keely felt there had to be a better way. They began by talking to colleagues and policy makers to identify their needs. They conducted literature reviews and found several ideas on which to build. They applied to The Ottawa Hospital’s internal innovation grant competition and were successful. They first considered using email, but quickly discarded this idea because of privacy concerns. Instead, they partnered with the Champlain Local Health Integration Network (LHIN) and the Winchester Memorial District Hospital’s information technology team, taking advantage of their existing, secure and privacy-compliant collaboration space (using Microsoft SharePoint). In 2009, they held their first focus group with PCPs to develop the user forms, and had completed the privacy, impact and threat risk assessments. They launched a proof-of-concept study in January 2010, providing PCPs with access to five specialty groups. Using the ongoing feedback and evaluation from users, they completed the proof-of-concept study and re-designed the service into what it is today. A pilot study was launched in April 2011, with the Champlain LHIN providing funding to pay their specialists (outside of the province of Ontario’s public health insurance system due to multiple funding complexities). At the conclusion of the pilot study, the Champlain LHIN agreed that this service was important and now offers eConsult as a regular service.
In our region of 1.2 million people located in Eastern Ontario, Canada (the Champlain LHIN), the eConsult service has reduced wait times for accessing specialist care for non-urgent cases from months to days. Forty percent of cases resulted in avoidance of an unnecessary face-to-face referral, meaning that over 8,000 patients are no longer waiting to see a specialist, but have received specialist care within an average of two days. Furthermore, the service is highly rated by providers and their patients. As one patient said: “I hate having to ask my son to take time off work for appointments and this eConsult saved me a visit. I think what you are doing with this service is very good for patients like me.”
Over 50% of PCPs in the Champlain LHIN are registered users, and we offer access to more than 90 specialty services, by far the largest number offered in similar services world-wide. Our recent cost analysis estimates that patients located in rural areas save, on average, $254.30 each time they avoid a face-to-face specialist visit in terms of lost wages and travel/associated costs.