Connected Medicine: Enhancing Primary Care Access to Specialist Consult

Canadians often wait for specialist care after referral from a primary care provider. In a 2016 survey by the Commonwealth Fund, Canada placed last on a measure of specialist access among the 11 countries surveyed, with 56 percent of Canadians reporting that they wait four weeks or longer to see a specialist.¹

The Canadian Foundation for Healthcare Improvement (CFHI) partnered with Canada Health Infoway, the College of Family Physicians of Canada and the Royal College of Physicians and Surgeons of Canada to spread the adoption of two proven innovations that had substantially increased access to primary care specialty services.

Through this 18 month quality improvement collaborative, 11 teams from across Canada improved primary care provider access to specialist advice by adapting and implementing one or both of the RACE™ and BASE™ proven remote consult models of care. CFHI identified both RACE™ and BASE™ through the EXTRA Executive Program.

RACE™ is a telephone advice line and app that originated at Providence Health Care and Vancouver Coastal Health in British Columbia, and BASE™ is a secure web-based eConsult service that originated with the Champlain Local Health Integration Network in Ontario.

The quality improvement collaborative built on the 2016-17 Connected Medicine e-collaborative in which 10 national and international teams came together to develop business cases and strategies to implement remote consult services in their jurisdictions.

Some of the participating teams have since joined CFHI’s Momentum Challenge – an invitation-only CFHI program that assists teams, who have completed a collaborative, to expand the reach of an innovation and sustain its impact.

How Connected Medicine contributes to better healthcare in Canada

Connected Medicine is part of CFHI’s ongoing efforts to spread and scale proven innovations that deliver high quality care closer to home and the community.

Through the remote consultations, eligible patients can access specialist advice closer to home by primary care providers they know and trust. The process is typically faster than being referred for a face-to-face specialist appointment and often avoids unnecessary trips to the emergency department.

In 2019, together with our partners, we announced the results of this successful collaborative. During the collaborative, more than 2,200 primary care providers registered in a remote consult service and continue to benefit from it – rapidly accessing specialist advice, typically within a week or less. More than 800 specialists have enrolled and are consulting through a BASE™ or RACE™-like service; the most common specialty service is psychiatry, followed by cardiology, nephrology, obstetrics, gynecology and pediatrics.

Between June 2017 and September 2019, more than 19,000 remote consults were conducted with specialists.

The Approach

Publicly-funded Canadian healthcare delivery organizations, ministries and providers participated in the Connected Medicine collaborative from June 2017 until 2018. The collaborative focused on supporting teams in the spread and adaption of RACE™ and BASE™– that improved primary care access to specialist advice through telephone services and digital technology.

Up to $600,000 in seed funding was made available to participating teams in addition to support in the implementation, spread, scale and evaluation of the innovations within their project areas. Teams took part in a curriculum to enhance their quality improvement skills. This included educational webinars, in-person workshops, access to a network of expert faculty and coaches, and peer-to-peer networking.

Teams took part in a curriculum to enhance their quality improvement skills. This included educational webinars, in-person workshops, access to a network of expert faculty and coaches, and peer-to-peer networking.

The Teams and Faculty