eConsult enables virtual water cooler chats

Dr. Boji Varghese, a Sudbury endocrinologist and eConsult champion for eConsult in northeastern Ontario.

Dr. Boji Varghese, a Sudbury endocrinologist and eConsult champion for eConsult in northeastern Ontario.

eConsults are covered by an OHIP billing code, ensuring remuneration for both the primary care provider and the specialist

An eConsult program that allows primary care providers to have “a virtual water cooler chat” with a specialist through a secure email application developed by the Ontario Telemedicine Network (OTN) is slowly catching on in northeastern Ontario.

An offshoot of the OTN’s successful Teledermatology program, eConsult was rolled out to three local health integration networks, including the North East LHIN, in 2014, and is now in the process of being deployed in northwestern Ontario.

eConsult is ideal for primary care providers who may be unsure about a patient’s symptoms or test results. Instead of subjecting the patient to a three to six month wait to see a specialist, the family physician or nurse practitioner can simply log on to eConsult with a question, upload supporting documentation from the patient’s electronic medical record, and receive a response in a few days.

Ninety-eight per cent of primary care providers and specialists who participated in a pilot involving three LHINs agreed that eConsult improved patient care, according to a 2015 benefit evaluation study by Deloitte.

A large percentage of primary care providers – 86.7 per cent –also agreed that their interactions with specialists expanded their clinical knowledge through case-based learning.

“In the past, a patient could be referred to a specialist and wait six months only to find out that the issue could have been addressed earlier by the primary care provider with advice from the specialist,” said Dr. Boji Varghese, a Sudbury endocrinologist and eConsult champion for the North East LHIN.

The specialist could ask the primary care provider to order additional tests, or fast-track an appointment depending on the patient’s condition.

eConsult is ideal for general practitioners fresh out of medical school who are confronted with a complex medical condition and aren’t sure what to do.

“If I’m a physician in Kapuskasing it’s hard for me to keep up with all the specialists in the region,” said Jennifer Michaud, executive liaison with the North East LHIN. “I might not know their names, their sub-specialty or their eligibility criteria. With eConsult, I can send a question to “Endocrinology” and OTN will triage it and send it to the most appropriate specialist.

It’s also a valuable tool for primary care providers in a city like Sudbury, where “some primary care providers have hospital privileges and some don’t,” said Varghese.

In the past, family physicians were more apt to cross paths with specialists in hospital. Today, they practise much more in silos. They may not know the specialists in town and are less likely to be able to pull them aside for a real water cooler chat.

eConsult also beats trying to phone a specialist for a quick consult because “if they’re busy, they don’t want to be disturbed,” said Varghese.

“The good thing about eConsult is that I can respond at my leisure. I just did three last night. I normally get back with a response within a day or two.”

And unlike telephone conversations and hallway chats, eConsults are covered by an OHIP billing code, ensuring remuneration for both the primary care provider and the specialist.

eConsults from family physicians and nurse practitioners in the northeast can be directed to specialists anywhere in the province, but it’s probably advisable to seek out a local specialist if the patient’s condition eventually warrants an office visit.

“Until one month ago, I was getting most of my referrals from Windsor, Kitchener and Toronto, but now I’m only getting referrals from the northeast,” said Varghese.

When processing an eConsult, primary care providers have the option of specifying a specialist they know, or directing it to the specialty for triaging by the OTN.

Integration with electronic medical record systems is yet to occur, but referring offices can attach test results or notes from their EMR.

To date, most primary care providers are delegating eConsult requests to their administrative staff, said Michaud.

One of the primary goals of eConsult is to reduce wait times for specialists.

According to the Deloitte study, median wait times in Ontario range from 39 to 76 days for medical specialties and 33 to 68 days for surgical specialties.

In Northern Ontario, wait times can be even longer. Until recently, for example, patients could wait up to 18 months to see Dr. Varghese. Now, with the recruitment of Sudbury’s second endocrinologist, Dr. Nisha Haroon, the wait time is down to “a couple of months.”

Province-wide, Hematology and Endocrinology have garnered the most referrals to date, followed by Neurology, Obstetrics and Gynecology, Cardiology and Pediatrics.

According to Michaud, the service is especially beneficial for rheumatology consults.

“We have long wait times for rheumatologists in Ontario. If we start with an eConsult, a rheumatologist can tell the primary care provider, ‘Here’s what you can do in the meantime to manage a patient’s pain.’”

As of the end of September, there were 361 primary care providers and 18 specialists in 11 specialty areas in the northeast registered with eConsult, but only 81 active primary care users. From October 2015 to September 2016, there were 453 eConsults processed.

Field staff from the OTN, Ontario MD and the North East LHIN are actively trying to increase these numbers.

In the northwest, eConsult is still in the process of being rolled out,

It’s still early in the process, but we believe there’s definite interest from both primary care and specialists,” said David Newman, director of project management for the North West LHIN.

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