Ask the eConsultant: Improving access to haematology expertise using an asynchronous eConsult system

Abstract

Introduction The Champlain BASE (Building Access to Specialists through eConsultation) eConsultation service was designed to address the limited access to specialist care in Canada, which can lead to long waiting times and, subsequently, negative patient outcomes. Our primary objective was to perform an in-depth analysis of the use, content, and perceived value of haematology electronic consults (eConsults) submitted by primary care providers (PCPs) to the eConsult service. Methods We conducted a cross-sectional study using descriptive statistics to examine post-eConsult surveys for PCPs and other collected data including PCP designation, time for specialist to complete the eConsult, specialist response time, perceived value of the eConsult by the PCP, and the need for a face-to-face referral following the eConsult. A medically-trained author reviewed all haematology eConsults from April 2011 to January 2015, and categorized them by clinical topic and question type using validated taxonomies. Results Haematology accounted for 436 out of 5601 (7.8%) total eConsults, making it the third most popular service utilized. In 66% of haematology eConsults, a face-to-face consultation was not needed. Anaemia, neutropenia, and hyperferritinemia were the most common clinical queries. Most eConsult question types concerned the management of haematological disorders or the interpretation of laboratory tests. Most eConsults were answered within three days, using less than 15 minutes of the specialists' time. PCPs highly valued the service. Discussion This initiative increases access to haematology care and has the potential to reduce the long waiting times for non-urgent traditional consultation, along with the benefit of cost savings to the healthcare system.

Improving access to urologists through an electronic consultation service

“…Our results our similar to what has been reported in other specialties in Champlain BASE and other eReferral/eConsult studies examining preconsultation exchanges between PCP and specialists. [24][25][26][27] These studies have shown similar numbers of referrals that did not actually need to be seen by specialists. This is important, as it helps to allay some of the fear that patients are being missed by not being physically eConsultations in urology seen, as multiple studies across specialties consistently show eConsult to be an evolving and safe method of triaging patient referrals.…”

“…Despite being based on a small sample population, this referral avoidance rate is comparable to other services offered through Champlain BASE and other large eConsult services. [24][25][26] Being able to decrease in-office visits by a third would have significant effects on wait times, allowing those who need in-office consultations to access care more quickly. Further adding to the safety aspect of this service, we found that 8% of patients were found to require an in-office visit, although the PCP did not initially think this was necessary.…”

Electronic consultations (E-consults) and their outcomes: a systematic review

“…Sleep medicine e-consultation followed by the specialists' order of a sleep study and positive airway pressure therapy, if indicated, resulted in a decrease over 4 years in the interval between sleep consult and positive airway pressure prescription from 60 days to 7 days. 38 More than a dozen studies report a response time (i.e., the time between when the e-consult is requested and when the responding specialist provides the response) of a few days or less, 11,13,14,16,20,21,28,32,34,35,40,46,47,51,56,61,62,67,69 whereas face-toface visits generally require days to weeks to be completed.…”

“…62 Several publications from the Champlain BASE program report on a PCP survey question at the end of each e-consult request about whether a face-to-face consult would have been sent in the absence of the e-consult option. Depending on specialty of the consultation being requested, 32%-80% of PCPs report that a face-to-face visit would have been required absent the e-consult, [12][13][14]16,[18][19][20][21]24,26,[28][29][30][31][32][33][34][35][36]41,47,51,58,62,65 suggesting that up to as many as 4 out of 5 e-consults are perceived to obviate a face-to-face visit. Using these data on face-to-face referrals avoided, the Champlain BASE group calculated payer costs decreasing from $131.05 to $6.45 (CAD) per econsult from year 1 to year 3 of the program.…”

Improving access to otolaryngology–head and neck surgery expert advice through eConsultations

“…As of May 2016, over 15,000 nonurgent consults spanning 86 different specialties have been submitted using this system, 7 making it one of the largest multispecialty eConsult services worldwide. 9 The development and implementation of this system has been detailed at length in multiple previous publications. 6,10,11 Each eConsult submitted to OTO-HNS was answered by one of two Royal College of Physician and Surgeons of Canadacertified (FRCSC) otolaryngologists (P.M., D.T.).…”