Focus on eConsult: One Physician’s Experience

Contributed by Dr. Anil Maheshwari, Grandview Medical Centre Family Health Team

It’s no secret that wait times for specialists are an issue throughout Ontario. Depending on the area of the province and type of specialist sought, wait times can range from a few weeks to more than a year. Sometimes family physicians will even need to recreate a consult request during the wait for a specialist because it’s been so long since the initial request was made! This is frustrating for both the physician and the patient, and it’s certainly not considered good patient care.

Fortunately, the Provincial eConsult Initiative is helping to shorten specialist wait times by connecting primary care providers and specialists to one of the two eConsult services available. You may be thinking “That’s awesome! But, what exactly is an eConsult?” An eConsult allows a primary care provider to send a secure electronic request for advice to a specialist, including any files needed to support the request. The requesting clinician can select a specific specialist listed in the eConsult database, or simply select one of over 100 specialties and be connected with a specialist.

eConsults have been available in Ontario since 2009. The service offers primary care providers access to more than 500 specialists in over 100 specialties, and an average response time of about two days. Our clinic has been using eConsult since last year and find it to be a huge time-saver. Several of our FHT doctors have used eConsult, and together, have sent over 20 eConsult requests, mostly for advice on dermatological issues (it’s very easy to send a picture) and to specialists such as psychiatrists and gastroenterologists who often have long wait times for face-to-face patient visits.

So, what types of consults make for good eConsults? In my experience, interactions that don’t need to be face-to-face are best suited for an eConsult. For example, primary care providers will often have a quick question for a specialist. While some of these can be handled through phone calls or ‘hallway consults.’ the specialist does not get paid for his or her time and these consults are often not properly documented. eConsults allow the same questions to be sent securely via a web portal, and soon directly through your EMR, and responses can be sent back securely to be attached to the patient’s chart in the primary care provider’s EMR. The family doctor gets a nominal fee for taking the time to create the eConsult, the specialist gets adequately reimbursed for writing out an opinion, and the information is recorded in an electronic format for easy filing.

When I gave a presentation at the OntarioMD EMR: Every Step Conference in Toronto last fall, an attendee asked how the Canadian Medical Protective Association (CMPA) feels about eConsults. The organization has summarized its position in an FAQ document, which was recently updated to clarify physician and specialist responsibilities during an eConsult. In summary, the CMPA supports eConsult as a method to improve efficiency, reduce wait times and ensure a clear audit trail of requests and advice given.

Perhaps most importantly, eConsult holds many benefits for patients. Sometimes, while a patient’s family doctor may be confident in their opinion on a medical issue, the patient would like reassurance and a second opinion from a specialist. Often, these patients are satisfied with getting that specialist opinion in writing rather than having to personally visit their office. In this way, eConsults can help put patients at ease, while decreasing the need for face-to-face specialist visits and associated wait times. Access is increased for those patients who absolutely need to be seen in person.

In my experience, eConsults have been a win-win for everyone involved. If you need more advice, ask some of your colleagues – many have probably tried eConsults. Then, if you’d like to give it a try, get in touch with your OntarioMD Practice Advisor or OntarioMD’s eConsult team at eConsult@ontariomd.com to start the process.

I will be presenting at the upcoming EMR: Every Step Conference in London on April 12 on Overcoming wait times for Specialists using e-Consult. Register today at https://www.ontariomd.ca/about-us/events/emr-every-step-conference-london-2018

Shared Experiences in Digital Health: Visit by the Norwegian Minister of Health and Care Services and Delegation to OntarioMD

Contributed by Sarah Hutchison

On January 24, OntarioMD had the honour of welcoming Norway’s Ambassador to Canada, Her Excellency, Mrs. Anne Kari Hansen Ovind, and the Minister of Health and Care Services, Mr. Bent Høie and his delegation, to our office. The purpose of the visit was to discuss common themes in digital health faced by Norway and Ontario, and how lessons learned in both jurisdictions can impact how we enable system priorities, leadership, and innovation looking forward.

The Norwegian delegation was very interested in learning about OntarioMD’s success in implementing electronic medical records (EMRs) in community-based family physician and specialist practices and how successes with EMR integrated products and services align with Ontario’s Patient’s First Digital Health strategy and priorities. While there will always be more to do, these products and services are already leading to a more connected digital health system in Ontario given the strong and connected foundation that they now represent.

We talked about the critical success factors and methodologies used to deploy products and services to physician practices. OntarioMD’s engaged EMR vendor community and our EMR Certification Program are key enablers for digital health and have created a very valuable mechanism to translate health system priorities using EMR Specifications, into EMR functionality that drives EMR use by physicians. Other   partnerships have also led to the success of our work. There are many organizations that want to deploy their products to physicians but reaching the diversity and range of physician practices across the province is a challenge.  There is increasing recognition that to be more effective as a system we must make it easier for physicians to adopt technology, being very attentive to minimizing the administrative burden for physicians and minimizing disruption at the practice level which means a responsibility to create alignment with our partners.  We also need to provide the opportunity for innovative vendors with great solutions in health care to have a delivery channel that makes sense for all.

For the adoption and sustained use of digital health products and services, robust change management support is a core ingredient.  This support is available to  physician practices anywhere in Ontario and  provided by Practice Advisors with in-depth knowledge of EMRs and other digital health products and services; a network of over 50 Peer Leaders (physicians, nurse practitioners and clinic managers) mentor and educate physicians and their staff on how to make improvements to their EMR use; and the EMR Practice Enhancement Program that provides intensive coaching for physician practices to standardize data, improve the quality and integrity of data, improve preventive care, improve internal workflow processes to enhance the patient experience and much more.  We agreed that digital health is often NOT about the availability of technology, but about creating capacity and support for the clinicians who are end users.

The delegation and OntarioMD had a lot of shared themes to discuss – from population health priorities, the impact of privacy and security, access to data, quality improvement, and patient engagement and how innovation and new technology will continue to present great opportunities and challenges alike. Norway has tackled many of these themes and has also developed methodologies and best practices that have been effective in its digital health eco-system. With increased globalization, we increasingly recognize that forums, such as the one we were privileged to participate in, will continue to advance our paradigms and challenge our thinking about the future of digital health.