Electronic consultation system reduces wait times, increases access to specialty care

An electronic consultation system designed to reduce excessive wait times for appointments with specialists experienced exponential growth during a recent five-year period.

The Champlain BASE eConsult service was created to provide primary care clinicians in Ontario, Canada with a range of high quality and timely (up to one week) specialty input.

Unlike electronic consultation systems that provide direct links between clinicians, this service enables primary care clinicians to search a directory, select a specialist, and contact her/him through a secure channel. The system, created in 2010, had four completed eConsult cases in April, 2011 compared to 769 cases in April, 2016, with primary care clinicians submitting 14,105 cases to 56 specialties during the 5-year period. Specialties receiving the highest number of eConsults were dermatology (17 percent); endocrinology, obstetrics/gynecology, and hematology (7 percent each); cardiology (6 percent); and neurology (6 percent). Specialists responded in a median of 21 hours; in 75 percent of cases they responded within three days. Self-reported billing time for specialists ranged from less than 10 minutes (in 48 percent of cases) to more than 20 minutes (4 percent of cases). By the end of the study period, approximately 80 percent of primary care clinicians in the region had adopted the eConsult service, which is poised for expansion across Canada. The study demonstrates that, once integrated into a practice's specialty referral workflow, the eConsult service has the potential to reduce wait times for specialty care.