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The 10 Steps to Establishing an eConsultation Service to Improve Access to Specialist Care

The 10 Steps to Establishing an eConsultation Service to Improve Access to Specialist Care. Dr. Clare Liddy , Amir Afkham , Dr. Erin Keely ccelerating Change. Champlain BASE Service: Building Access to Specialists through eConsultation.

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The 10 Steps to Establishing an eConsultation Service to Improve Access to Specialist Care

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  1. The 10 Steps to Establishing an eConsultation Service to Improve Access to Specialist Care Dr. Clare Liddy, Amir Afkham, Dr. Erin Keelyccelerating Change

  2. Champlain BASE Service: Building Access to Specialists through eConsultation • “Timely feedback Excellent information that I can relay to my patient for excellent quality of care. I really appreciate this service!  and so do my patients”

  3. The eConsultation Team A collaboration between: • The Ottawa Hospital (TOH) • The Bruyère Research Institute (BRI) • Winchester District Memorial Hospital (WDMH) • Champlain Local Health Integration Network (LHIN) Funding: • TOHAMO AFP Innovation Fund • Champlain LHIN • e-Health Ontario

  4. What is eConsult? • A web-based service for primary care providers to access specialist care for their patients • Leverages existing secure regional collaboration space. • Primary Care Provider uses a simple template • Prompted for key information • May attach additional information (test results, images, EMR-generated consult letter)

  5. Answering an e-Consultation Assigned to appropriate specialist Specialist receives an email notification Expected to answer within one week Can give one of three replies: A reply to the question A request for additional information A recommendation for referral (along with any tests etc. to be completed beforehand) Initiator can then provide additional information, submit follow-up questions/clarification, or close the case (and respond to a brief survey)

  6. Widely available in Champlain region… 244 PCP’s registered (MDs, NPs, and delegates) from 50 clinics in 24 different geographical areas

  7. Current status – 25 specialty services • Internal Medicine • Thrombosis • Hematology • Radiology: • Abdominal • Musculoskeletal • NeuroRadiology • Thoracic • Urology • ENT & Head/Neck Surgery • Diabetes Education • General Pediatrics • OB/GYN • Pediatric Hematology/Oncology • Rheumatology • Palliative Care • Infectious Disease • Clinical Pharmacy • Cardiology • Dermatology • Nephrology • Neurology • Endocrinology • Pain Medicine • PainConnect “Re-Consult” • Psychiatry As of May 15th 2013: 1163 cases in total

  8. Value of eConsults for patients[from PCP survey responses completed for each case] 91% of PCP’s rate as high or very high value for their patients Overall value of the eConsult service in this case for patient (1083 Completed Cases) AVG.: 4.56/5 Eliminate travel to specialist Dramatically reduce wait time Appropriate treatment starts quickly, avoids deterioration Reduced anxiety

  9. Impact of eConsultation on Need for Face-to-Face Referral[from PCP survey responses completed for each case] N=1083 cases 40% of cases led to a referral being avoided

  10. 10 Steps to eConsultation • 1. Partners • Form your project team • Establish the key working partnerships • Clinical champions • Regional support • Technology partner

  11. 10 Steps to e-Consultation • 1. Partners • Form your project team • 2. Platform • Leverage what’s already deployed • Choose a platform for the e-Consultation system • Should be based on local existing infrastructure • Facilitated by ensuring that key partners are part of initial project team • System should be user-friendly, simple, and to the point – easy to learn and re-learn

  12. 10 Steps to e-Consultation • 1. Partners • Form your project team • 2. Platform • Leverage what’s already deployed • 3. Pilot • Start small and grow • Start small and build • Facilitates the engagement of all users • Allows you to identify obstacles early

  13. 10 Steps to e-Consultation • 1. Partners • Form your project team • Design the e-Consultation form • ONE FORM for all specialties • Three formats were explored: • Free text • Directed form (mandatory fields) • Existing EMR forms • Consult with users to match form to workflow • Use common tools for development to keep modifications quick and easy • 2. Platform • Leverage what’s already deployed • 3. Pilot • Start small and grow • 4. Product • Practical form & workflow design

  14. 10 Steps to e-Consultation • 1. Partners • Form your project team • 2. Platform • Leverage what’s already deployed • Privacy impact, and threat risk assessments were performed • Most health regions/health care orgs. will have a privacy office/officer who can help • 3. Pilot • Start small and grow • 4. Product • Practical form & workflow design • 5. Privacy • Ensure security & privacy requirements met

  15. 10 Steps to e-Consultation • 1. Partners • Form your project team • 2. Platform • Leverage what’s already deployed • 3. Pilot • Start small and grow • Determine the workflow • Must fit as seamlessly as possible into physician’s usual workflow to ensure participation • Important to minimize system usage time • 4. Product • Practical form & workflow design • 5. Privacy • Ensure security & privacy requirements met • 6. Process • Fit into clinics’ workflows

  16. 10 Steps to e-Consultation • 1. Partners • Form your project team • 2. Platform • Leverage what’s already deployed • 3. Pilot • Start small and grow • 4. Product • Practical form & workflow design • 5. Privacy • Ensure security & privacy requirements met • 6. Process • Fit into clinics’ workflows

  17. 10 Steps to e-Consultation • 1. Partners • Form your project team • 2. Platform • Leverage what’s already deployed • Solidifying clinical champions is the first important step in recruitment • Physician participation will determine the success of e-Consultation-focus on motivated/enthusiastic participants • Keep physician engagement aspects (joining, training, ongoing support) simple • 3. Pilot • Start small and grow • 4. Product • Practical form & workflow design • 5. Privacy • Ensure security & privacy requirements met • 7. Participants • Sustained engagement • 6. Process • Fit into clinics’ workflows

  18. 10 Steps to e-Consultation • 1. Partners • Form your project team • 2. Platform • Leverage what’s already deployed • Determine payment and liability aspects • Specialist billing rate of $200/hr was established • Avg. of 11.7 min per case was observed • Consultation with CMPA ensured that no novel litigation risks were created • 3. Pilot • Start small and grow • 4. Product • Practical form & workflow design • 8. Payment • Remuneration and duty of care • 5. Privacy • Ensure security & privacy requirements met • 7. Participants • Sustained engagement • 6. Process • Fit into clinics’ workflows

  19. 10 Steps to e-Consultation • 1. Partners • Form your project team • 2. Platform • Leverage what’s already deployed • Build in continuous quality feedback • System usage and outcomes continuously evaluated • Usage and outcome data fed back to users to encourage ongoing participation • 3. Pilot • Start small and grow • 9. Provide Feedback • Evolve based on regular feedback • 4. Product • Practical form & workflow design • 8. Payment • Remuneration and duty of care • 5. Privacy • Ensure security & privacy requirements met • 7. Participants • Sustained engagement • 6. Process • Fit into clinics’ workflows

  20. 10 Steps to e-Consultation • 1. Partners • Form your project team • 2. Platform • Leverage what’s already deployed • 10. Plan the Transition • Prepare for sustainability • 3. Pilot • Start small and grow • Plan your transition from pilot to sustainable program • Three key elements are needed to ensure sustainability: • Maintaining the benefit of the service • Funded infrastructure • HR support • 9. Provide Feedback • Evolve based on regular feedback • 4. Product • Practical form & workflow design • 8. Payment • Remuneration and duty of care • 5. Privacy • Ensure security & privacy requirements met • 7. Participants • Sustained engagement • 6. Process • Fit into clinics’ workflows

  21. 10 Steps to e-Consultation • 1. Partners • Form your project team • 2. Platform • Leverage what’s already deployed • 10. Plan the Transition • Prepare for sustainability • 3. Pilot • Start small and grow • 9. Provide Feedback • Evolve based on regular feedback • 4. Product • Practical form & workflow design • 8. Payment • Remuneration and duty of care • 5. Privacy • Ensure security & privacy requirements met • 7. Participants • Sustained engagement • 6. Process • Fit into clinics’ workflows

  22. On the Right Track![Direct quotes from PCP Surveys] “Excellent collaboration, very quick response – so glad to have access to this service!” • “Invaluable service for GPs” "Fast, easy to use service. very user friendly. The advice I received was thorough and helpful. I am very grateful!" "This eConsult saved an in-person referral and months of wait. This is such an excellent service. Also, as a Nurse Practitioner, I really value this service ... I get direct, timely access - this is improving care for my clients.“ “I love this service”

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