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BackgroundElectronic consultation (eConsult) programs are crucial components of modern healthcare that facilitate communication between primary care providers (PCPs) and specialists. eConsults between PCPs and specialists. They also provide a unique opportunity to use real-world patient scenarios for reflective learning as part of professional development. However, tools that guide and document learning from eConsults are limited. The purpose of this study was to develop and pilot two eConsult reflective learning tools (RLTs), one for PCPs and one for specialists, for those participating in eConsults.MethodsWe performed a four-phase pragmatic mixed methods study recruiting PCPs and specialists from two public health systems located in two countries: eConsult BASE in Canada and San Francisco Health Network eConsult in the United States. In phase 1, subject matter experts developed preliminary RLTs for PCPs and specialists. During phase 2, a Delphi survey among 20 PCPs and 16 specialists led to consensus on items for each RLT. In phase 3, we conducted cognitive interviews with three PCPs and five specialists as they applied the RLTs on previously completed consults. In phase 4, we piloted the RLTs with eConsult users.ResultsThe RLTs were perceived to elicit critical reflection among participants regarding their knowledge and practice habits and could be used for quality improvement and continuing professional development.ConclusionPCPs and specialists alike perceived that eConsult systems provided opportunities for self-directed learning wherein they were motivated to investigate topics further through the course of eConsult exchanges. We recommend the RLTs be subject to further evaluation through implementation studies at other sites.

BackgroundExpanding healthcare innovations from the local to national level is a complex pursuit requiring careful assessment of all relevant factors. In this study (a component of a larger eConsult programme of research), we aimed to identify the key factors involved in the spread and scale-up of a successful regional eConsult model across Canada.MethodsWe conducted a constant comparative thematic analysis of stakeholder discussions captured during a full-day National eConsult Forum meeting held in Ottawa, Canada, on 11 December 2017. Sixty-four participants attended, representing provincial and territorial governments, national organisations, healthcare providers, researchers and patients. Proceedings were recorded, transcribed and underwent qualitative analysis using the Framework for Applied Policy Research.ResultsThis study identified four main themes that were critical to support the intentional efforts to spread and scale-up eConsult across Canada, namely (1) identifying population care needs and access problems, (2) engaging stakeholders who were willing to roll up their sleeves and take action, (3) building on current strategies and policies, and (4) measuring and communicating outcomes.ConclusionsEfforts to promote innovation in healthcare are more likely to succeed if they are based on an understanding of the forces that drive the spread and scale-up of innovation. Further research is needed to develop and strengthen the conceptual and applied foundations of the spread and scale-up of healthcare innovations, especially in the context of emergent learning health systems across Canada and beyond.

Background: Increasing strain on public health resources in Canada, in particular with respect to accessing specialist care, necessitates the exploration of alternative models of care. The aim of this study was to assess the efficacy of electronic consultation (eConsult) in providing orthopedic surgery specialist service to patients in the Champlain Local Health Integration Network (LHIN) of Ontario. Methods: This was a cross-sectional review of all 564 Champlain LHIN orthopedic surgery referral requests received via the Champlain Building Access to Specialist service through the eConsult (BASE) system in 2017. Primary outcome measures were impact on primary care provider (PCP) referral pattern and time to receive orthopedic consultation. Results: eConsult prevented unnecessary in-person consultation 64% of the time, while PCP referral decisions were modified 51% of the time. Of all eConsults, 94% were rated as valuable to PCPs in their practice and 97% of eConsults resulted in actionable advice. eConsults took an average of 14.5 minutes of specialist time to complete, and the mean time from referral to response was 3.7 days. Conclusion: The eConsult system spares unnecessary consultation to orthopedic surgery; catches important referrals that would have otherwise been missed; saves time for patients, PCPs and orthopedic surgeons; and improves efficiency in a socialized health care system. Contexte : La pression croissante exercee sur les ressources de sante publique au Canada, tout particulierement en matiere d'acces a des soins specialises, necessite l'exploration de modeles de soins alternatifs. Par consequent, le but de la presente etude etait d'evaluer l'efficacite de la consultation electronique (eConsult) sur la prestation de services specialises en chirurgie orthopedique aux patients du Reseau local d'integration des services de sante (RLISS) Champlain, en Ontario. Methodes : Il s'agit d'une revue transversale de l'ensemble des 564 demandes de consultation en chirurgie orthopedique recues au RLISS Champlain au moyen du service Building Access to Specialists de Champlain associe au systeme de consultation electronique eConsult BASE pour l'annee 2017. Les criteres d'evaluation primaires etaient l'effet des habitudes d'orientation des fournisseurs de soins de sante primaires et la duree de la periode entre la demande et l'obtention de la consultation en orthopedie. Resultats : Le systeme eConsult a evite des consultations en personne inutiles dans 64 % des cas, alors que les fournisseurs de soins de sante primaires ont modife leurs decisions d'orientation dans 51 % des cas. De toutes les consultations eConsult, les fournisseurs de soins de sante primaires ont note que 94 % d'entre elles etaient utiles et que 97 % aboutissaient a un conseil pratique. Une consultation electronique eConsult prenait en moyenne 14,5 minutes du temps du specialiste et la duree de l'intervalle entre la demande de consultation et la reponse etait de 3,7 jours. Conclusion : Le systeme eConsult evite des demandes de consultation en chirurgie orthopedique inutiles, il detecte les demandes de consultation importantes qui seraient autrement perdues, il permet aux patients, aux fournisseurs de soins de sante primaires et aux chirurgiens orthopediques de ne pas perdre leur temps et il ameliore l'efficacite dans un systeme de soins de sante socialise., Wait times for specialist services, including orthopedic surgery, are growing in Canada owing to the inability of the limited resources provided by a socialized health care system to meet the [...]

This paper reports on a multimethod cross-sectional study of the Ontario electronic consultation (eConsult) service. Utilization and closeout survey data from July 2018 through June 2020 were analyzed using the Reach Effectiveness Adoption Implementation Maintenance (RE-AIM) framework. Requesting clinicians submitted 60,474 eConsults, and monthly cases increased from 1,487 in July 2018 to 4,179 in June 2020. The median specialist response time was 1 day. An originally contemplated referral was avoided in 51% of cases. Ontario eConsult showed successful uptake across Ontario, demonstrating continued spread and scale, and offering a template for trailblazers looking to implement digital health innovations in their own jurisdictions. Key words: digital technology; eReferral and eConsultation; heath care quality, access and evaluation; health services accessibility; telemedicine Ann Fam Med 2022;20:262-265. https://doi.org/10.1370/afm.2812, INTRODUCTION Excessive wait times for specialist care are a serious issue in Canada, resulting in poorer health outcomes for patients and frustrating challenges for clinicians. (1) The electronic consultation (eConsult) [...]

PURPOSE COVID-19 has increased the need for innovative virtual care solutions. Electronic consultation (eConsult) services allow primary care practitioners to pose clinical questions to specialists using a secure remote application. We examined eConsult cases submitted to a COVID-19 specialist group in order to assess usage patterns, impact on response times and referrals, and the content of clinical questions being asked. METHODS This was a mixed-methods analysis of eConsult cases submitted between March and September 2020 in Ontario, Canada to 2 services. We performed a descriptive analysis of the average response time and the total time spent by the specialist for eConsults. Primary care practitioners completed a post-eConsult questionnaire that asked about the outcome of the eConsult. We performed an inductive and deductive content analysis of a subset of cases to identify common themes among the clinical questions asked. RESULTS A total of 208 primary care practitioners submitted 289 eConsult cases. The median specialist response time was 0.6 days (range = 3 minutes to 15 days); the average time spent by specialists per case was 16 minutes (range = 5 to 59 minutes). In 69 cases (24%), the eConsult enabled avoidance of a face-to-face referral. Content analysis of 51 cases identified 5 major themes: precautions for high-risk and special populations, diagnostic clarification and/or need for COVID-19 testing, guidance on self-isolation and return to work, guidance on personal protective equipment, and management of chronic symptoms. CONCLUSIONS This study demonstrates the considerable potential of eConsults during a pandemic as our service was quickly implemented across Ontario and resulted in primary care practitioners' rapid and low-barrier access to specialist input. Key words: primary care; electronic consultation; Coronavirus 2019; COVID-19; referral; specialist care; telemedicine; remote consultation; public health; health information technology; organizational change; practice-based research Ann Fam Med 2022;20:220-226. https://doi.org/10.1370/afm.2807, INTRODUCTION As a result of the COVID-19 pandemic, many countries have initiated lockdowns to help limit spread of the virus. (1) In Ontario, Canada's most populous province, the provincial government [...]

Objectives: To evaluate the accessibility of multispecialty advice for primary care providers (PCPs) within correctional facilities, catering to the healthcare needs of individuals in federal custody in Ontario, Canada, through the utilization of electronic consultation (eConsult). Design: Retrospective, cross-sectional, descriptive analysis. Setting: eConsults submitted by PCPs within federal correctional facilities through the Ontario eConsult Service between April 1st, 2019, and March 31st, 2023. Participants: 906 completed eConsults were submitted by 21 PCPs in correctional facilities. Results: The top three specialties sent to were cardiology (46%, N = 417), dermatology (14%, N = 128), and endocrinology and metabolism (8%, N = 68). The median specialist response time was 0.9 days. The median time specialists spent responding to each case was 15 minutes. PCPs received advice on a new or additional course of action in 34% of eConsult cases. In-person specialist appointments were avoided in 81% of cases. Conclusions: Ontario eConsult provides an ideal venue to improve access to multispecialty advice for people who are incarcerated. This service reduces the need for face-to-face specialist visits, decreases cost-of-care, and avoids unnecessary transportation outside of correctional facilities with potential security issues. [ABSTRACT FROM AUTHOR]

BackgroundElectronic consultation is an emerging mode of specialty care delivery that allows primary care providers and their patients to obtain specialist expertise without an in-person visit. While studies of individual programs have demonstrated benefits related to timely access to specialty care, electronic consultation programs have not achieved widespread use in the United States. The lack of common evaluation metrics across health systems and concerns related to the generalizability of existing evaluation efforts may be hampering further growth. We sought to identify gaps in knowledge related to the implementation of electronic consultation programs and develop a set of shared evaluation measures to promote further diffusion.MethodsUsing a case study approach, we apply the Reach, Effectiveness, Adoption, Implementation and Maintenance (RE-AIM) and the Quadruple Aim frameworks of evaluation to examine electronic consultation implementation across diverse delivery systems. Data are from 4 early adopter healthcare delivery systems (San Francisco Health Network, Mayo Clinic, Veterans Administration, Champlain Local Health Integration Network) that represent varied organizational structures, care for different patient populations, and have well-established multi-specialty electronic consultation programs. Data sources include published and unpublished quantitative data from each electronic consultation database and qualitative data from systems' end-users.ResultsOrganizational drivers of electronic consultation implementation were similar across the systems (challenges with timely and/or efficient access to specialty care), though unique system-level facilitators and barriers influenced reach, adoption and design. Effectiveness of implementation was consistent, with improved patient access to timely, perceived high-quality specialty expertise with few negative consequences, garnering high satisfaction among end-users. Data about patient-specific clinical outcomes are lacking, as are policies that provide guidance on the legal implications of electronic consultation and ideal remuneration strategies.ConclusionA core set of effectiveness and implementation metrics rooted in the Quadruple Aim may promote data-driven improvements and further diffusion of successful electronic consultation programs.

Context The eConsult service is an online system that primary care practitioners (PCP) submit questions concerning their patients' care to specialists and receive a response within one week. Responses can include suggestions for treatment, recommendations for referral, or requests for additional information. Objective The objective is to examine the use of natural language processing (NLP) in automatic identification of frailty in patient cases and explore semantic characteristics of such cases that distinguished them from non-frailty cases to help refine and inform the definition of frailty and provide its reusable knowledge. Study Design We conducted a machine learning (ML) experimentation using NLP to assess frailty in a dataset of cases submitted through eConsult Service. We used text data prepared and vetted by the experts, as training material to achieve accurate prediction of 'frail' cases automatically. Setting or Dataset In this study, we selected contrasting samples from eConsult cases submitted in the Champlain health region between 2018 and 2019 and filtered them by patient's age 65 and the use of term frail or frailty in their case description. Non-frailty cases were selected among younger patients below 65 years old in whom PCP did not refer to as frail. Population Studied PCPs can keep communicating with the specialist until they are satisfied with the answers to close the case. The population is an unbiased random sample of PCP communications, that were then labeled. Outcome Measures We used 10-fold cross-validation to measure precision, recall, F1 and accuracy to evaluate the results. Results Using text from electronic conversations between primary care providers and specialists we developed a champion algorithm (Random Forest with Bag-of-Words as data representation) that predicted frailty cases with an accuracy of 94% (0.12). This study also provided evidence of semantic characteristics that were specific to frail cases. Among several frail cases, the most frequent topic-terms were related to medications: daily dose, recommended medication and best treatment. Conclusion It was possible to automatically identify Frailty cases in eConsult system with high accuracies using NLP. Noteworthy is that no other patient data were required. The predictions can inform and assist practitioners recognize frailty in patient cases and as a result, provide organized and reusable knowledge to enhance the quality of service for frail patients., Presenters Dr. Arya Rahgozar, PhD, Douglas Archibald, PhD, Sathya Karunananthan, Clare Liddy, MD, MSc, CCFP, Amir Afkham, BEng Hnrs, Erin Keely, [...]

PURPOSE Electronic consultation (eConsult) services can improve access to specialist advice. Little is known, however, about whether and how often primary care clinicians adhere to the advice they receive. We evaluated how primary care clinicians use recommendations conveyed by specialists via the Champlain BASE (Building Access to Specialists through eConsultation) eConsult service and how eConsult affects clinical management of patients in primary care. METHODS This is a descriptive analysis based on a retrospective chart audit of 291 eConsults done between January 20, 2017 and August 31, 2017 at the Bruyere Family Health Team, located in Ottawa, Canada. Patients' charts were reviewed until 6 months after specialist response for the following main outcomes: implementation of specialist advice by primary care clinicians, communication of the results to the patients, method, and time frame of communication. RESULTS Primary care clinicians adhered to specialist advice in 82% of cases. Adherence ranged from 62% to 93% across recommendation categories. Questions asked by primary care clinicians related to diagnosis (63%), management (27%), drug treatment (10%), and procedures (1%). Recommendations of the eConsult were communicated to patients in 79% of cases, most often by face-to-face visit (38%), telephone call (32%), or use of the patient portal (9%). Communication occurred in a median of 5 days. CONCLUSIONS We found little evidence of barriers to implementing specialist advice with use of eConsult, which suggests recommendations given through service were actionable. With a high primary care clinician adherence to specialist recommendations and primary care clinician-to-patient communication, we conclude that eConsult delivers good-quality care and improves patient management. Key words: access to care; eConsult; primary care clinician adherence; professional practice; coordination of care; delivery of health care, integrated; communication; decision making; health informatics; practice-based research, INTRODUCTION Access to specialist care remains a serious problem in Canada because of excessive wait times. The Commonwealth Fund's 2016 survey reported that 56% of Canadian adults waited more than [...]