eConsult: A case study from a specialist perspective on outcomes of providing consultation to primary care providers using eConsult

Although widely occurring, requests for informal consultations from primary care providers to specialists can interrupt a specialist’s work day and pose concerns about the quality and adequacy of information exchanged, confidentiality, privacy and security.¹ In addition, there are many cases where specialists are not compensated for their time, with a National Physician Survey² noting that 84% of specialists in Ontario providing email consultations to other physicians do not have a method of compensation.

Provision of consultation to support patient management in primary care is important but access can be difficult due to the wait times of many specialists.¹ Electronic consultations (eConsults) pose an opportunity to enable consultations through a medium that addresses the concerns of traditional informal consultations while supporting specialist compensation.¹ The optimal use of eConsult, where appropriate, to support specialist resources efficiently and to meet patient needs, ensure that only patients that need to have an in-person visit, receive one.

As of January 2020, there are >900 specialists and >150 specialties on eConsult in Ontario

Dr. Bob Lee adopted eConsult, a secure email messaging system that uses the Ontario Telemedicine Network to connect primary care providers with specialists, and now serves as a consultant specialist addressing questions from primary care providers across Ontario on a broad spectrum of cases related to sports and exercise-related injuries.

As an advocate of digital technologies that support clinical workflow and information sharing and management, Dr. Lee recognized the great potential in eConsult as a tool to streamline information flow and provide a medium for knowledge exchange to enable timely patient care.

eConsult presents an opportunity to not only provide timely patient advice through a secure communication channel and avoid ‘soft’ referrals, it also provides me with the opportunity to teach and share best practice management guidelines backed by evidence-informed research in the field. When used to its full potential, eConsult greatly enhances secure information sharing between specialists and primary care providers, and provides a better option to seek specialist advice, providing care for patients who may not need to visit the specialist in person.

Dr. Bob Lee, MD

Dip. Sport Medicine, (CASEM)

Since adopting eConsult, Dr. Lee has seen the following benefits:

• Easily fits within the workflow
• Secure web portal supports access to specialist advice through a secure channel
• Billable time spent consulting on a case and communications with primary care
• Efficient care coordination with primary care, eliminating the need to bring a patient in for an in-person visit, where appropriate
• Opportunity to enhance learning and build collaborative relationship with primary care providers to help manage patient in primary care

Dr. Lee’s experiences are in accordance with a study conducted with other specialists who have adopted eConsult, noting innovative patient care, reduced patient wait times, and improved direct communications with primary care providers. In addition, a study conducted on the impact of eConsults illustrated that 39% of eConsults conducted avoided a referral to the specialist², meeting patient needs in a timely manner and ensuring appropriate referrals, so that specialist resources are used effectively and efficiently.

As a higher number of primary care providers adopt eConsult, the optimal use of eConsult not only supports better care coordination and timely patient care through a secure communication platform, but it also supports specialist compensation while allowing for a seamless fit into their clinical workflow.

1. Liddy, C, Rowan, MS, Afkham, A, Maranger, J, & Keely, E. (2013). Building access to specialist care through e-consultation. Open Med. 7(1):e1-e8.
2. National Physician Survey. (2014). The College of Family Physicians of Canada. Canada Medical Association. The Royal College of Physicians and Surgeons of Canada.
3. Keely, E., Williams, R., Epstein, G., Afkham, A., & Liddy, C. (2019). Specialist perspectives on Ontario Provincial Electronic Consultation Services. Telemed J E Health 25(1):3-10.
4. Keely, E. (2019). The successful integration of eConsult service into a Family Health Team’s workflow. Ontario eConsult Centre of Excellence.