Research ArticleOriginal ResearchA

Sustainability of a Primary Care–Driven eConsult Service

Clare Liddy, Isabella Moroz, Amir Afkham and Erin Keely
The Annals of Family Medicine March 2018, 16 (2) 120-126; DOI: https://doi.org/10.1370/afm.2177

Article Figures & Data

Figures

  • Figure 1a
    Figure 1a

    Average number of eConsults completed per primary care clinician for users of the Champlain BASE eConsult service as function of their registration year.

    BASE = Building Access to Specialists through eConsultation.

    Note: User denotes an individual who used the service at least once in the year indicated.

  • Figure 1b
    Figure 1b

    Number of primary care clinician users of the Champlain BASE eConsult service in relation to all primary care clinicians who registered for the service each year.

    BASE = Building Access to Specialists through eConsultation.

    Note: User denotes an individual who used the service at least once in the year indicated.

  • Figure 2a
    Figure 2a

    Impact of the Champlain BASE eConsult service on primary care clinician’s course of action by specialty service for the 10 specialites most frequently referred to.

    BASE = Building Access to Specialists through eConsultation; OB/GYN = obstetrics and gynecology.

  • Figure 2b
    Figure 2b

    Impact of the Champlain BASE eConsult service on the need for a face-to-face referral by specialty service for the 10 specialties most frequently referred to.

    BASE = Building Access to Specialists through eConsultation; OB/GYN = obstetrics and gynecology.

Tables

  • Table 1

    Primary Care Clinician, Specialist, Patient, and Utilization Characteristics of the Champlain BASE eConsult Service

    CharacteristicsDistribution
    Primary care clinicians (n = 1,020)
    Type, No. (%)
     Nurse practitioner160 (16)
     Family physician860 (84)
    Sex, female, No. (%)701 (69)
    Practice location, rural107 (69)
    Specialists (n=106)
    Sex, female, No. (%)47 (44)
    Patients (n=14,105)
    Age group, No. (%)
     <18 y2,249 (16)
     18–64 y8,824 (63)
     ≥65 y3,032 (21)
    Sex, female, No. (%)8,750 (62)
    Response time
    eConsult creation to specialist response, median (75th percentile), h20.75 (80.98)
    eConsult creation to primary care clinician close out, median (75th percentile), d5.09 (10.98)
    Self-reported specialist response time, No. (%) (n=14,105)
     <10 min6,796 (48)
     10–15 min4,566 (32)
     15–20 min2,127 (15)
     >20 min616 (4)

    • BASE = Building Access to Specialists through eConsultation.

Additional Files

  • Supplemental Appendix

    Supplemental appendix 1

    Files in this Data Supplement:

  • The Article in Brief

    Sustainability of a Primary Care-Driven eConsult Service

    Clare Liddy , and colleagues

    Background Excessive wait times for specialist appointments pose a significant barrier to patient care. To improve access to specialist care and reduce wait times, the Champlain BASE (Building Access to Specialists through eConsultation) eConsult service was launched in Ontario, Canada in April 2011. This study reports on the impact of the service during its first five years.

    What This Study Found The Champlain BASE eConsult service experienced exponential growth during its first five years. The electronic consultation system was created to provide primary care clinicians in Ontario, Canada with a range of high quality and timely (up to one week) specialty input. Electronic consultation is an alternate, complimentary approach to usual face-to-face referrals. The primary care clinician can submit a patient-specific question (usually for a patient who would have otherwise needed an in-person referral) to a specialty service via a secure web-based portal. The system, created in 2010, had four completed eConsult cases in April, 2011 compared to 769 cases in April, 2016, with primary care clinicians submitting 14,105 cases to 56 specialties during the 5-year period. Specialties receiving the highest number of eConsults were dermatology (17 percent); endocrinology, obstetrics/gynecology, and hematology (7 percent each); cardiology (6 percent); and neurology (6 percent). Specialists responded in a median of 21 hours; in 75 percent of cases they responded within three days. Self-reported billing time for specialists ranged from less than 10 minutes (in 48 percent of cases) to more than 20 minutes (4 percent of cases). By the end of the study period, approximately 80 percent of primary care clinicians in the region had adopted the eConsult service, which is poised for expansion across Canada.

    Implications

    • The study demonstrates that, once integrated into a practice's specialty referral workflow, the eConsult service has the potential to reduce wait times for specialty care.

  • Annals Journal Club

    Mar/Apr 2018: A Primary Care-Driven eConsult Service


    Kelsey R. Murray, MD, MHA, Grant Family Medicine, OhioHealth and Michael E. Johansen, MD, MS, Associate Editor

    The Annals of Family Medicine encourages readers to develop a learning community to improve health care and health through enhanced primary care. Participate by conducting a RADICAL journal club. RADICAL stands for Read, Ask, Discuss, Inquire, Collaborate, Act, and Learn. We encourage diverse participants to think critically about important issues affecting primary care and act on those discussions.1

    HOW IT WORKS

    In each issue, the Annals selects an article and provides discussion tips and questions. Take a RADICAL approach to these materials and post a summary of your conversation in our online discussion. (Open the article and click on "TRACK Discussion/ Submit a comment.") Discussion questions and information are online at: http://www.AnnFamMed.org/site/AJC/.

    CURRENT SELECTION

    Liddy C, Moroz I, Afkham A, Keely E. Sustainability of a primary care-driven eConsult service. Ann Fam Med. 2018;16(2):120-126.

    Discussion Tips

    This article explores the growth in use of an eConsult service in Eastern Canada during its first 5 years. Think about a patient you saw in the office and referred to a specialist or about whom you "curbsided" a specialist. Consider how this eConsult service could affect your practice and management of patients.

    Discussion Questions

    • What question does this study ask? Why does it matter?
    • How does this study expand upon previous research and clinical practice on this topic?
    • What study design is used in this article? What are some of the strengths and weaknesses of this study design?
    • How do eConsult services differ from regular consult services or telemedicine services? How are they similar?
    • How does the eConsult service in the article differ from other eConsult services?2
    • What are the main study findings?
    • What context is important in interpreting the findings?
    • How generalizable are the findings?
    • How has the eConsult service described in the article changed over time?
    • Who is affected by these findings, and how might they interpret or use these findings?
    • What are potential positive and negative outcomes of an eConsult service?
    • What are the next steps in applying the findings?
    • How might this study change your practice? What would be the advantages and disadvantages of using an eConsult service in your practice?
    • How might this change health policy? Physician education? Research?
    • How can further research expand upon this topic?

    References

    1. Stange KC, Miller WL, McLellan LA, et al. Annals Journal Club: It's time to get RADICAL. Ann Fam Med. 2006;4(3):196-197. http://annfammed.org/content/4/3/196.full.
    2. Barnett ML, Yee HF, Mehrotra A, Giboney P. Los Angeles safety-net program eConsult system was rapidly adopted and decreased wait times to see specialists. Health Aff (Millwood). 2017;36(3):492-499.

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