By Clare Liddy and Erin Keely
It all started when the two of us sat down over a cup of coffee. As a family physician and endocrinologist, we stand on opposite sides of a large chasm called patient wait times, and we both started seeing more and more of our patients getting swallowed up by this abyss.
In her role as a family doctor, Clare noticed how long some of her patients had to wait for an appointment with a specialist. In Erin’s case, patients were waiting months for their appointments with her as an endocrinologist, often for problems their family doctors could have addressed with just a little guidance.
Surely, we thought, there was a better way, a quicker path that could save patients the meandering months-long waits they were too often facing?
From this conversation, we came up with an innovative solution: what if, instead of a family doctor making a referral every time they faced a question about a patient’s care, they could instead reach out to a knowledgeable specialist directly? Perhaps, in some cases, the specialist could guide the family doctor, saving the patient a long wait for an in-person appointment. And this could save the beleaguered public health system important resources in the process.
With public grant funding and the support of regional partners — including the Champlain Local Health Integration Network and the Winchester District Memorial Hospital — we created the Champlain BASE eConsult service: a secure online platform that allows primary care providers to ask specialists questions about a patient’s care. Specialists respond within a week — two days on average — with advice on the patient’s care, recommendations for referral or requests for more information.
Eight years since its founding, the eConsult service has completed over 30,000 cases, enrolled more than 1,300 primary care providers and allowed thousands of patients to receive high quality care without needing a face-to-face specialist visit.
Other innovators in several provinces have partnered with us to bring the BASE eConsult model of care to their jurisdictions, and the Government of Ontario has recently committed to expanding the service across the province.
The eConsult service made the leap from pilot into practice — no easy feat in the often intractable and rigid Canadian health system. Over the years, we’ve learned a number of important lessons about creating and implementing healthcare innovations, which too often fail to sustain themselves beyond an initial pilot phase.
Straddle the divide between research and practice
Successful innovations are built on a foundation of sound evidence and that evidence comes from solid research. But research alone can’t launch a service and many promising innovations have remained cloistered in academic journals — valuable platforms, but ones that rarely resonate outside of their immediate circles. In order to get something implemented, you need to reach the people who do the actual implementing: clinicians, policymakers, and especially patients, whose voices must be heard.
Technology should be the vehicle, not the driver
We created eConsult first and foremost to solve a problem: poor access to specialist care. Our solution to this problem embraced technology, but when choosing this path, we remained set on our destination, which was always improving access for patients. By remaining agnostic to the particular technology we used, we ensured that the platform we ultimately chose was the best one for the job and avoided being hemmed in by the limitations of a particular program or vendor.
Stay flexible, but stay focused
Implementation is an ongoing process and adapting to new facts or changing needs is vital. For instance, in the early days of eConsult, we considered building the service around an email client. However, Ontario’s privacy legislation doesn’t allow transmission of patient data through email because it’s too insecure, so we switched to a platform with more robust security measures.
While such adjustments are inevitable and must be taken in stride, the overall goal of the innovation should remain at the forefront of its implementation. Many programs suffer from a gradual broadening of their scope, which can dilute their impact on the objective they originally meant to achieve.
Take risks
In research, failure is often preferable to inaction, because failure brings with it lessons on how to improve, while inaction teaches us nothing. Mistakes are inevitable, and the best way to learn from them is to seek continuous feedback from the providers and patients who use or benefit from the service.
We’ve seen firsthand the positive impact eConsult can have on patient care, and hope that one day every Canadian can avoid the pitfalls of excessive wait times — which range from inconvenience to serious deterioration of health — and benefit from improved access to specialist care.
Dr. Clare Liddy is a Clinical Investigator at the C.T. Lamont Primary Health Care Research Centre of the Bruyère Research Institute, a Tier 2 Chair and Associate Professor at the University of Ottawa’s Department of Family Medicine, and a practicing family physician and an expert advisor with EvidenceNetwork.ca.
Dr. Erin Keely is an endocrinologist with The Ottawa Hospital, a Professor at the University of Ottawa’s Department of Medicine, and a Clinician Researcher with the Ottawa Hospital Research Institute.