eConsult: A case study on supporting timely access to specialist advice, reducing anxiety and decreasing unnecessary referrals

The findings from the Healthcare Experience Survey (2013-2016)¹ conducted by the Ministry of Health and Long-Term Care illustrate that in Waterloo Wellington:

Based on a national physician survey, the referring process poses common frustrations for referring primary care providers, including: finding an available specialist, no receipt of referral, not being informed of appointment times, and no information for follow-up treatment.² For a primary care clinic, this can translate into additional staff work to confirm receipt of referral, relay information between specialist and patient on appointment times, and track information on treatment plan post-specialist visit. The availability of eConsult has shown promise in satisfying primary care needs for quick access to helpful information, enhancing the quality of patient care and avoiding a referral to a specialist.³˒⁴

Dr. Alison Yeung, a primary care provider at a Waterloo Family Health Organization, adopted OTN eConsult in January 2017, and uses it approximately three times per month to provide timely treatment decisions with patients. Thus far, she has found the following benefits for herself and her specialist colleagues:

eConsult has changed my practice in such a positive way. There are so many situations where a
patient really doesn’t need to see a specialist face-to-face, and the physical exam won’t change their management. eConsult is perfect for these situations. It takes me about 5-10 minutes to send off depending how complex the case is, and I typically get a response within a couple days. It reduces staff workload, I’m able to communicate to patients quickly which alleviates anxiety, and it makes me more confident that I’m properly managing the case. The fact that you’re paid for the time you put in doesn’t hurt either!

Dr. Alison Yeung
Waterloo Family Health Organization

The figure below illustrates Dr. Yeung’s experience before the adoption of eConsult, and benefits experienced after the adoption of eConsult:

Two case examples from Dr. Yeung

In one instance, when a patient came to an appointment with lab results in the “grey zone”, Dr. Yeung was able to consult a nephrology specialist who provided her with an expert explanation that she could relay to the patient within a few days, thereby reducing patient anxiety regarding the treatment plan. Dr. Yeung can now use this knowledge with her future patients as well.

In another example, Dr. Yeung used eConsult with a urologist to determine whether a calcification in the testicles put a patient at risk for testicular cancer. The specialist informed her of the most recent evidence and she was able to confidently follow up with the patient without needing a referral to the urologist.

Both of these examples highlight timely access to specialist information and a reduction in the need for referral.

1. MOHLC (2016). Healthcare Experience Survey Results: Waterloo-Wellington LHIN.
2. Canadian Medical Association (2012). Experience with Referrals: Results if two surveys.
3. Liddy, C., Afkham, A. Drosinis, P., Joschko, H, Keely, E. (2015). Impact of and Satisfaction with a New eConsult Service: A Mixed Methods Study of Primary Care Providers. JABFM. 28(3): 394-403.
4. Tran, C., Liddy, C., Pinto, N., Keely, E. (2016). Impact of Question Content on e-Consultation Outcomes.Telemedicine and e-Health. 22(3): 216-222.