July 2019

Intensive physician engagement in New Brunswick eConsult rollout accelerates access to specialist advice photo

(L-R) Karla Faig, Emma Boulay and Dr. Pam Jarrett from New Brunswick.

Wait times for specialist care are a challenge in many parts of Canada. In the 2016 Commonwealth Fund Survey, Canada placed last on a measure of specialist access among the 11 countries surveyed, with 56% of Canadians reporting waiting four weeks or longer to see a specialist.

Through Connected Medicine: Enhancing Primary Access to Specialist Consult collaboration, teams have been spreading remote consult models to healthcare teams across Canada to help improve wait times and access to specialist advice.

The 18-month collaboration, which is a partnership with between CFHI, the College of Family Physicians of Canada (CFPC), Canada Health Infoway (Infoway), and the Royal College of Physicians and Surgeons of Canada (The Royal College), is spreading two proven Canadian healthcare innovations that improve access to specialist advice by enabling primary care providers, such as family doctors and nurse practitioners, to ask specialists patient care questions:

  • Champlain BASETM (Building Access to Specialists through eConsultation), a secure web-based eConsult service which originated with the Champlain Local Health Integration Network in Ontario, and
  • Rapid Access to Consultative Expertise (RACETM), a telephone advice line and app launched at Providence Health Care and Vancouver Coastal Health.

One team participating in the collaborative is led by New Brunswick’s Department of Health, with collaboration from two Regional Health Authorities, the New Brunswick Medical Society, the College of Physicians and Surgeons of New Brunswick, the College of Family Physicians of New Brunswick, and physicians. The team introduced an econsult platform – modeled after Champlain BASETM – across the province with positive results, and now plans to expand.

New Brunswick faces challenges similar to other provinces in providing timely access to specialist care. The province is largely rural, and most specialists work in urban centres. This creates transportation challenges for many people. In addition, because New Brunswick is an officially bilingual province, patients may need to travel to access specialist care in their language of choice.

“We were hoping from the outset of this project to make travel less necessary for people to get care in the language of their choice,” said Karla Faig, a Healthcare Consultant leading the project from the Department of Health. “We see eConsult as an ideal way to support family physicians in their home communities so they can better care for their patients. This has the potential to shorten the wait times for those who require a face-to-face consult with a specialist, while still maintaining a high quality of patient care.”

In designing the initiative, the New Brunswick team included seven specialties, and recruited 85 family physicians and 33 specialists to take part – more than 10 percent of the province’s 1,200 physicians. From May 2018 to November 2018, 84% of consults received a response from a specialist within 7 days. New Brunswick’s eConsult initiative avoided face-to-face referral to a specialist, where one was originally contemplated but avoided based on specialist advice, in 67 percent of consults.

“We are very happy with this result,” said Dr. Pamela Jarrett, a Geriatrician and Medical Officer with the Department of Health. “This allowed many patients to receive the necessary specialist care in a timely manner, and allowed the family physician to continue to provide care to the patient without the need for a face-to-face consult.”

The New Brunswick team attributed the early success of its eConsult initiative to a few key features of the project.

First, New Brunswick is small, with networks of family doctors and specialists across the province interested in being part of this project. In addition, the collaborative nature of eConsult encouraged physician engagement and uptake.

Second, the team recognized early the importance of tailoring communication strategies to specific physician groups. The team sent out information, talked to specialists and worked with physician groups to inform specialists – and inspire them to attend meetings about the initiative.

Engaging family physicians sometimes required a more personal touch, such as meeting physicians in coffee shops and travelling to remote communities for one-on-one sessions. The team’s Coordinator and Project Support, Emma Boulay, is the “point person” for the 84 participating family physicians and specialists. Emma responded to their questions at all hours, provided support on billing and technology, and solved any other logistical issues the physicians faced.

“Putting effort into that front end of communication and support, and designating one person for physicians to call, was key to the project’s success,” said Faig. “We spent a lot of time in engagement, on the phone, explaining and answering questions. All the physicians involved in the project know Emma by name.”

Third, the New Brunswick team adapted the Champlain BASE model in a major way. Instead of using the web-based SharePoint as their collaborative platform (a potential platform for teams adopting Connected Medicine), they made the bold decision to embed their eConsult platform into the province’s electronic health record (EHR), eHealthNB. The EHR is accessible to all physicians in the province, and is a central repository for clinical documents and hospital records (such as labs, x-rays, and hospital admission information). New Brunswick’s eConsult transformed the EHR from view-only to transactional, which means physicians can now communicate with each other about patients on a secure, web-based platform.

“We made this decision based on the advice and future vision of the Department of Health’s eHealth and Innovation team,” said Faig. “We realized early on that we could work together toward common goals, and the collaboration led to a result that we feel is the best we could have hoped for.” She said the IT team worked around the clock in the weeks before the launch because they could see the obvious value in the innovation.

With the “proof of concept” project complete, the New Brunswick team will continue its eConsult project into the future. “We’re exploring options for what might be possible in future and we’re excited about the possibilities,” said Dr. Jarrett.

The New Brunswick team’s best advice for success with eConsult is to create a collaborative project culture from the outset. “Look around to see what resources you need, and align yourself with people who have similar goals,” said Faig. “Start working with people who want the same things as you – people who see the value of the change. People who don’t seem interested will come on board once they see your success.”

“If one group had tried this project in isolation, it wouldn’t have worked. This was never a ‘top-down’ initiative. It was always seen as a true collaborative, with all stakeholders at the table.”

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