Building Access to Specialists through eConsultation
Excessive wait times for accessing specialist care is one of the most significant problems facing many health care systems. In order to reduce specialist wait times, we developed and implemented the Champlain BASE (Building Access to Specialists through eConsultation) eConsult service. This secure, web-based platform enables primary care providers (PCPs) to submit a patient-specific question to one of 84 different specialty groups. Our objective is to understand the effectiveness, population impact, and cost savings associated with the service.
We implemented the eConsult service in the Champlain health region in Eastern Ontario, Canada. The region is home to 1.2 million people with one major urban referral center in Ottawa, with outlying rural communities up to two hours away by car. We used an integrated knowledge translation approach including a mixed methods design, guided by the RE-AIM framework. We utilized data routinely collected through the service with additional data collected through: (1) an exploratory qualitative study to examine patients’ perspectives, and (2) an online survey to explore specialists’ perspectives.
Reach: 11,461 eConsults have been processed with an average specialist response time of 2 days (as compared to several months). Over 60% of cases did not require a face-to-face specialist visit following an eConsult; in fact, in 40% of cases, an unnecessary referral was avoided.Efficacy: 86% of patients surveyed stated that eConsult was useful, citing such benefits as speed of response and avoidance of hassle. PCPs report the service as having high or very high value for themselves in 94% of cases. Specialists surveyed agreed the service is a feasible way to improve access to specialist care (94%), improves communication between providers (94%), and has educational value for PCPs (91%). Adoption: 937 PCPs have registered to use the service; this represents over half of all PCPs in our health region.Implementation: The service was developed using existing infrastructure based on Microsoft SharePoint. The weighted average cost per eConsult is $47.35 versus $133.60 for a traditional face-to-face referral (a cost reduction of 65%). Maintenance: While the service was originally funded with research dollars, it is now funded through our provincial health care system. Additionally, we have retained over 95% of our specialist providers since inception.
The Champlain BASE eConsult service is an innovative, effective, and low-cost way of improving access to specialists. The service has seen high adoption and utilization among users and has demonstrated high value for patients and providers.