The 10 Steps to Establishing an

eConsultation Service

to Improve Access to Specialist Care

Dr. Clare Liddy, Amir Afkham, Dr. Erin Keelyccelerating Change

• “Timely feedback Excellent information that I can relay to my patient for excellent quality of care. I really appreciate this service!  and so do my patients”

Champlain BASE Service: Building Access to Specialists through eConsultation

A collaboration between:The Ottawa Hospital (TOH)

The Bruyère Research Institute (BRI) Winchester District Memorial Hospital (WDMH)

Champlain Local Health Integration Network (LHIN)

Funding: TOHAMO AFP Innovation Fund

Champlain LHINe-Health Ontario

The eConsultation Team

What is eConsult?

• A web-based service for primary care providers to access specialist care for their patients

• Leverages existing secure regional collaboration space.

• Primary Care Provider uses a simple template

Prompted for key information

May attach additional information (test results, images, EMR-generated consult letter)

Answering an e-Consultation• Assigned to appropriate specialist

• Specialist receives an email notification

• Expected to answer within one week

• Can give one of three replies:

1. A reply to the question

2. A request for additional information

3. A recommendation for referral (along with any tests etc. to be completed beforehand)

• Initiator can then provide additional information, submit follow-up questions/clarification, or close the case (and respond to a brief survey)

Widely available in Champlain region…

244 PCP’s registered (MDs, NPs, and delegates) from 50 clinics in 24 different geographical areas

Current status – 25 specialty services

Cardiology Dermatology Nephrology Neurology Endocrinolog

y Pain

Medicine PainConnect

“Re-Consult” Psychiatry

Internal Medicine Thrombosis Hematology Radiology:

• Abdominal

• Musculoskeletal

• NeuroRadiology

• Thoracic Urology

ENT & Head/Neck Surgery Diabetes Education General Pediatrics OB/GYN Pediatric Hematology/Oncology Rheumatology Palliative Care Infectious Disease Clinical Pharmacy

As of May 15th 2013: 1163 cases in total

Value of eConsults for patients[from PCP survey responses completed for each case]

• Eliminate travel to specialist• Dramatically reduce wait time• Appropriate treatment starts

quickly, avoids deterioration• Reduced anxiety

Overall value of the eConsult service in this case for patient(1083 Completed Cases) AVG.: 4.56/5

91% of PCP’s rate as

high or very high value

for their p

atients

Impact of eConsultation on Need for Face-to-Face Referral[from PCP survey responses completed for each case]

N=1083 cases40% of cases led to a referral

being avoided

10 Steps to eConsultation1. Partners• Form your project team

Establish the key working partnerships

Clinical champions

Regional support

Technology partner

10 Steps to e-Consultation1. Partners• Form your project team

2. Platform• Leverage what’s already

deployed

• Choose a platform for the e-Consultation system

• Should be based on local existing infrastructure

Facilitated by ensuring that key partners are part of initial project team

System should be user-friendly, simple, and to the point – easy to learn and re-learn

10 Steps to e-Consultation1. Partners• Form your project team

2. Platform• Leverage what’s already

deployed

• Start small and build

• Facilitates the engagement of all users

• Allows you to identify obstacles early

3. Pilot• Start small and grow

10 Steps to e-Consultation1. Partners• Form your project team

2. Platform• Leverage what’s already

deployed

3. Pilot• Start small and grow

4. Product• Practical form & workflow

design

• Design the e-Consultation form ONE FORM for all specialties

• Three formats were explored: Free text Directed form (mandatory fields) Existing EMR forms

• Consult with users to match form to workflow

• Use common tools for development to keep modifications quick and easy

10 Steps to e-Consultation1. Partners• Form your project team

2. Platform• Leverage what’s already

deployed

3. Pilot• Start small and grow

4. Product• Practical form & workflow

design

• Privacy impact, and threat risk

assessments were performed

• Most health regions/health care orgs.

will have a privacy office/officer who

can help

5. Privacy• Ensure security &

privacy requirements met

10 Steps to e-Consultation1. Partners• Form your project team

2. Platform• Leverage what’s already

deployed

3. Pilot• Start small and grow

4. Product• Practical form & workflow

design

5. Privacy• Ensure security &

privacy requirements met

6. Process• Fit into clinics’

workflows

• Determine the workflow

Must fit as seamlessly as possible into physician’s

usual workflow to ensure participation

• Important to minimize system usage time

10 Steps to e-Consultation1. Partners• Form your project team

2. Platform• Leverage what’s already

deployed

3. Pilot• Start small and grow

4. Product• Practical form & workflow

design

5. Privacy• Ensure security &

privacy requirements met

6. Process• Fit into clinics’

workflows

10 Steps to e-Consultation1. Partners• Form your project team

2. Platform• Leverage what’s already

deployed

3. Pilot• Start small and grow

4. Product• Practical form & workflow

design

5. Privacy• Ensure security &

privacy requirements met

6. Process• Fit into clinics’

workflows

7. Participants• Sustained engagement

• Solidifying clinical champions is the first important step in recruitment

• Physician participation will determine the success of e-Consultation-focus on motivated/enthusiastic participants

• Keep physician engagement aspects (joining, training, ongoing support) simple

10 Steps to e-Consultation1. Partners• Form your project team

2. Platform• Leverage what’s already

deployed

3. Pilot• Start small and grow

4. Product• Practical form & workflow

design

5. Privacy• Ensure security &

privacy requirements met

6. Process• Fit into clinics’

workflows

7. Participants• Sustained engagement

• Determine payment and liability aspects

• Specialist billing rate of $200/hr was established

Avg. of 11.7 min per case was observed

• Consultation with CMPA ensured that no novel litigation risks were created

8. Payment• Remuneration and

duty of care

10 Steps to e-Consultation1. Partners• Form your project team

2. Platform• Leverage what’s already

deployed

3. Pilot• Start small and grow

4. Product• Practical form & workflow

design

5. Privacy• Ensure security &

privacy requirements met

6. Process• Fit into clinics’

workflows

7. Participants• Sustained engagement

• Build in continuous quality feedback

• System usage and outcomes continuously evaluated

• Usage and outcome data fed back to users to encourage ongoing participation

8. Payment• Remuneration and

duty of care

9. Provide Feedback• Evolve based on regular

feedback

10 Steps to e-Consultation1. Partners• Form your project team

2. Platform• Leverage what’s already

deployed

3. Pilot• Start small and grow

4. Product• Practical form & workflow

design

5. Privacy• Ensure security &

privacy requirements met

6. Process• Fit into clinics’

workflows

7. Participants• Sustained engagement

8. Payment• Remuneration and

duty of care

9. Provide Feedback• Evolve based on regular

feedback

10. Plan the Transition• Prepare for

sustainability

• Plan your transition from pilot to sustainable program

• Three key elements are needed to ensure sustainability:

1. Maintaining the benefit of the service

2. Funded infrastructure

3. HR support

10 Steps to e-Consultation1. Partners• Form your project team

2. Platform• Leverage what’s already

deployed

3. Pilot• Start small and grow

4. Product• Practical form & workflow

design

5. Privacy• Ensure security &

privacy requirements met

6. Process• Fit into clinics’

workflows

7. Participants• Sustained engagement

8. Payment• Remuneration and

duty of care

9. Provide Feedback• Evolve based on regular

feedback

10. Plan the Transition• Prepare for

sustainability

“I love

this

service”

"Fast, easy to use service. very user friendly. The advice I received was thorough and helpful. I am very grateful!"

• “Invaluable

service for GPs”

"This eConsult saved an in-person referral and months of wait. This is such an excellent service. Also, as a Nurse Practitioner, I really value this service ... I get direct, timely access - this is improving care for my clients.“

On the Right Track![Direct quotes from PCP Surveys] “Excellent collaboration,

very quick response – so glad to have

access to this service!”