Champlain LHIN Improving People’s Access to Specialist Care
Jan 17, 2017 - The expanded use among doctors of an electronic medical tool created by the Champlain LHIN and its partners is positively impacting patient care. The tool, known as eConsult, recently reached a significant milestone: 20,000 completed cases since its inception. This milestone means thousands of patients in our region are receiving the care they need more efficiently and effectively.
eConsult was established in 2010 by the Champlain LHIN, in partnership with Bruyère Research Institute, Winchester District Memorial Hospital, and The Ottawa Hospital. The Champlain LHIN led the implementation, which was developed with family physician, Dr. Clare Liddy, and endocrinologist, Dr. Erin Keely. The program is formally known as Champlain BASE, which stands for Building Access to Specialist Care through eConsultation.
The service allows medical specialists to give patient-specific advice to family doctors and nurse practitioners in a secure, web-based setting. It means they can correspond quickly and effectively to address patient issues, often saving patients from long waits for specialists, and other inconveniences - while saving money and gaining efficiencies for the health system. The program has improved access to specialist care and decreased wait times in the Champlain region:
- More than 8,000 patients have benefitted from specialist advice that directly resulted in avoiding unnecessary specialist appointments.
- In roughly 11,500 eConsult cases, specialists provided family doctors and nurse practitioners with advice for a new or additional course of action they had not otherwise considered.
- Approximately 1,100 primary care providers (970 family doctors and 174 nurse practitioners) are using this tool to communicate with nearly 100 different specialty areas (including dermatology, obstetrics/gynecology, hematology and endocrinology).
- Specialists respond within seven days, with an average response time of two days.
Dr. Phyllis Hierlihy is one of the specialists who provides responses through eConsult. She is an endocrinologist in Ottawa who has worked for more than 20 years with people who have diabetes and other metabolic conditions. Dr. Hierlihy has been using eConsult for less than a year, and appreciates its benefits.
"The communication process is encrypted and amazingly user-friendly," Dr. Hierlihy said. "I’m very excited about eConsult - it is a major improvement in how health care providers can communicate, learn from each other, and deliver care," she said. "Moreover, the process respects everyone’s most precious commodity and that is time! And it is truly 'patient-centred care.'"
Jay Mercer is a family doctor and Lead Physician of the Bruyère Academic Family Health Team. The team cares for 17,000 patients, and has been using eConsult since 2013.
"We have 23 family doctors and 4 nurse practitioners that use eConsult, and we derive tremendous value from it," Dr. Mercer said. "The key for us was adding the tool to our existing electronic medical records (EMR) process. It is seamless for our doctors and nurse practitioners, since they are already working in the EMR when the patient is in their office. They don’t lose time or become frustrated trying to find logins or passwords to get into other systems."
Through the EMR, the family doctor or nurse practitioner asks a patient-specific, non-urgent question for the appropriate specialist. This notifies the centre’s referral clerks, Danielle Perras and Diane Desjardins, that they need to initiate and submit an eConsult case.
"Without the eConsult tool, and depending on the kind of medical specialty needed, one to twelve months may pass before patients have access to speciality care," said Ms Perras, explaining that with delays, patients become understandably anxious.
"Because eConsult response time is an average of only two days, it reduces patients’ uncertainty," Ms Desjardins added. "It’s a useful tool to quickly and securely communicate with specialists."
|Jay Mercer with referral clerks Diane Desjardins
(left) and Danielle Perras (right).
When the specialist replies through eConsult, Ms Perras or Ms Desjardins updates the patient’s EMR and lets the primary care provider know about the new information for the patient.
Thanks to the information exchange through the eConsult tool, the family doctor or nurse practitioner often meets their patients’ needs without a specialist appointment. eConsult is also a useful way for specialists to let the family doctor or nurse practitioner know which diagnostic tests or courses of treatment the patient requires before they go to the specialist appointment.
The Champlain LHIN’s eConsult service has won a number of awards, including a place on the Minister's Medal for Excellence in Health Quality and Safety Honour Roll, and it continues to grow. It is used by 421 clinics in 100 cities and towns.
As a means of improving care across Ontario, the Ministry of Health and Long-Term Care is evaluating the benefits of various eConsultation models. The Champlain tool was selected as one of the models, and has also been extended to the Mississauga Halton LHIN region for access by its providers.
Additionally, eConsult partners are sharing the tool and collaborating with health services in other provinces and territories, including Newfoundland and Labrador, British Columbia and Quebec.