The Story of Champlain eConsult BASE™
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 1.3 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 76% of PCPs in the Champlain LHIN are registered users, and we offer access to more than 150 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.
Meet the Founders
Dr. Clare Liddy, Chair, Full Professor and University of Ottawa Research Chair in eConsult and Primary Health Care Delivery, leads the seminal body of work in the field of eConsult, which has had a marked impact on health services delivery locally and nationally. She currently holds multiple research grants examining the impact of eConsult on the care of patients with dementia, frailty, and chronic pain. She is the Primary Care Lead for the award-winning Champlain eConsult BASE™ service (ChamplainBaseeConsult.com) and the Co-Executive Director of the Ontario eConsult Centre of Excellence (OntarioeConsult.ca), which is managing the expansion of eConsult across Ontario. Across platforms, Ontario eConsult has processed over 300,000 cases on behalf of patients, the majority of whom don’t require a face-to-face visit after an eConsult. She has received over $37 million of peer-reviewed grant funding (including $12.1 million as a Principal/Nominated Principal Investigator), presented findings at over 450 international, national, and provincial conferences, and published more than 200 articles in peer-reviewed journals.
Dr. Erin Keely is an endocrinologist with The Ottawa Hospital, a Professor at the University of Ottawa’s Department of Medicine, and a clinician researcher with the Ottawa Hospital Research Institute. She is the co-founder of the Champlain BASE eConsult service which has served as the model for eConsult services across Canada. As specialist lead of the Ontario eConsult Centre of Excellence and Co-Executive Director of the Ontario eServices Program she is improving equitable access to specialist advice and reducing wait times through the integration of eConsult and eReferral services. Her clinical interests include medical complications of pregnancy, diabetes and pituitary disorders. Her research interests include obstetric medicine with a focus on the postpartum management of women with gestational diabetes and in health service delivery, specifically the implementation and evaluation eConsultation. She has received research funding from CIHR, Diabetes Canada, Royal College of Physicians and Surgeons of Canada, and has over 200 peer reviewed publications.
Amir Afkham is a Digital Health Manager in Ontario Health – East Region – and leads a team responsible for the implementation and adoption of eConsult and eReferral. His primary focus is on local and regional initiatives leveraging new technologies/solutions to improve efficiency and effectiveness of processes, as well as overall collaboration amongst healthcare providers. Amir’s work on eConsult began in 2009 where he worked as a senior project manager at the Champlain Local Health Integration Network (LHIN) in Ottawa. Prior to joining the LHIN, Amir spent over 20 years in the telecommunications sector, with leadership roles in product and solutions management. Amir holds a Bachelor of Electrical Engineering (Hnrs) and Minors in Computer Science and Business Administration from McGill University.