eConsult Allows Doctors to Tap into Prompt Advice from Specialists
Dr. Sarah Newbery’s teenage patient was presenting with a shoulder issue that the Marathon family physician had never previously encountered.
“She had limited range of motion, and a scapular crepitus that I had not seen – or heard – previously,” remembers Dr. Newbery. The wait for the patient to see a pediatric orthopedic surgeon – a service that is not available locally and is limited in the region – could take months.
Fortunately, Dr. Newbery had recently enrolled in a program that allowed her to consult with specialists throughout the province, using a web-based tool. With her patient’s permission, Dr. Newbery took a 30-second video of the patient moving her arm. The video not only captured the abnormal shoulder movement, but the audio also picked up the crepitus.
“Within five minutes, I was able to create an eConsult note to a pediatric orthopedic surgeon and attach the video and ask my questions about appropriate imaging and management. The next day, I had a response that addressed all of my questions and allowed me to support the patient much more quickly than if she had had to wait for a face to face visit with an orthopedic surgeon, and without me ordering unnecessary or unhelpful tests,” said Dr. Newbery.
Dr. Newbery said she also appreciated the fact that her patient and her family did not have to travel unnecessarily. “The coordination of her care was quite seamless as it all happened in the context of her “medical home” in primary care.” she said.
That was not the only time that Dr. Newbery used eConsult to inform her clinical decision-making. She has used it regularly for dermatology cases, psychiatry cases and other musculoskeletal patient cases. “I live in a region of the province with limited specialist access and eConsult allows me to access specialists that are not available in my region. I value the flexibility of being able to add images and video as well.”
Since the launch of the Ontario eConsult Program in June 2018, the program has helped inform the clinical decision-making of thousands of health-care professionals like Dr. Newbery. More than 48,000 eConsults have been submitted since its launch.
Supported by the Ministry of Health and Long-Term Care, the program connects physicians and nurse practitioners to specialists via a secure, web-based tool. Through eConsult, physicians and nurse practitioners can receive prompt and secure advice from more than 90 specialties, including: addiction medicine, genetics, chronic pain, transgender care, cardiology, rheumatology, and neurology. Physicians and nurse practitioners receive a response within seven days, often eliminating the need for an in-person specialist visit. The eConsults are available at no cost to health-care professionals.
The response from health-care providers and patients has been overwhelmingly positive, said Dr. Clare Liddy, an Ottawa family physician who co-developed the program. Dr. Liddy said all specialties are now represented in the service as well as many subspecialties.
The program was borne of her frustration in trying to access care for her own patients. “As a family doctor, I was starting to notice the waiting times really increasing across multiple areas.”
She discussed the issue with her colleague Dr. Erin Keely, an endocrinologist, who had seen similar issues on the other side of the referral-consultation process. They decided that using technology to create a more timely dialogue between family doctor and specialist was the way to go. “We knew that creating that ability to have a conversation between doctors was going to translate into better care for patients,” says Dr. Liddy.
As the service has evolved, it has proven to be useful for even complex medical issues, such as chronic pain, and mental health. And it works especially well when lab reports are involved. “If a blood test comes back and there’s something that might be a bit concerning, you would normally send the patient to see a hematologist. With eConsult, you can send the lab result with your question, include some patient history, and ask what next steps need to be taken, if any,” she said.
An unexpected bonus of the service — and a benefit for the health-care system – is that it has proven to reduce the need for additional specialist visits. Dr. Liddy said that more than two-thirds of patients who had an eConsult didn’t need a referral based on the advice they received.
The College of Family Physicians of Canada and the Royal College of Physicians and Surgeons of Canada support eConsult as a standard of practice. Additionally, the Canadian Medical Protective Association has described the service as “an opportunity to improve efficiency, enhance patient care, expand access to specialists and provide a clear audit trail of the specialist’s advice.”
If you are not yet enrolled, contact the Ontario eConsult Centre of Excellence. The team will assist you in getting signed up. You may also visit its website at econsultontario.ca for more information. For information about how to make eConsult a regular part of your practice, please contact [email protected].