New results: Innovative program improves patient access to specialist medical advice in primary care across Canada

Jul 18, 2019

July 18, 2019 (Ottawa) - The Canadian Foundation for Healthcare Improvement (CFHI), in partnership with Canada Health Infoway, the College of Family Physicians of Canada and the Royal College of Physicians and Surgeons of Canada, is announcing the successful expansion of provider-to-provider remote consult services, improving patient access to specialist advice in primary care in seven provinces.

Through the 18-month Connected Medicine: Enhancing Primary Access to Specialist Consult collaboration, primary care providers initiated more than 12,300 remote consults with specialists to support patient care. Teams from Newfoundland and Labrador, New Brunswick, Quebec, Manitoba, Saskatchewan, Alberta, British Columbia, and the Department of National Defense, enrolled more than 2,200 primary care practitioners and 800 specialists, including many in underserved rural and remote regions.

These practitioners can now access specialist consults through secure digital technology and telephone services. The result is that eligible patients get care based on specialist advice closer to home, by a primary care provider 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.

Connected Medicine Results:

  • Rapid access to specialist advice: More than 4 in 5 eConsults (85 percent) received a response from a specialist within 7 days (based on a sample of more than 3,200 eConsults). This work addresses a recognized issue in Canada, for example, as identified in the 2016 Commonwealth Fund Survey, where Canada placed last on a measure of specialist access among the 11 countries surveyed, with 56 percent of Canadians reporting waiting four weeks or longer to see a specialist.
  • Care Closer to Home: More than half of eConsults (53 percent) led to an appropriately avoided face-to-face referral to a specialist, where one was originally contemplated but no longer needed based on specialist advice (based on a sample of over 2,600 e-consults).
  • Avoided ED Visits: 2 in 5 remote consults (42 percent) via phone/app led to an appropriately avoided emergency department (ED) visit, where the primary care provider originally contemplated sending the patient to the ED but the visit was no longer needed based on specialist advice (based on a sample of over 600 phone or mobile app consults).

Participating teams are at different stages in their individual implementation given varying program launch dates, program scope, local needs, and provider availability. In some regions, as many as 38 specialties were made available for remote consultation with primary care providers. The most commonly available specialty was psychiatry. Cardiology, nephrology, obstetrics/gynecology and pediatrics were the next most frequently offered specialties. Four services also offered palliative care consults. Results by Team, including highlights, are available in the Backgrounder.

The collaboration spread two proven Canadian healthcare innovations that improve access to specialist advice by allowing 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.

Results from this collaboration are consistent with those that have been achieved through original implementations of these two innovations. Champlain BASETM currently provides access to 114 specialty groups and 1,000 cases each month in Ontario, with a median response time of 21 hours and nearly two thirds (65 percent) of cases resolved without requiring patients to attend a face-to-face specialist visit. An evaluation of data from RACETM found that 60 percent of RACE calls appropriately avoided a face-to-face visit with a specialist and 32 percent of calls appropriately avoided hospital emergency department visits.


“Scaling remote consult solutions to more health systems across Canada makes a real difference for patients and clinicians,” said Jennifer Zelmer, President and CEO of CFHI. “Primary care providers are more confident in their ability to treat patients thanks to timely specialist advice, and access to a remote consult means these patients get the right care, closer to home, and can often avoid longer waits for a specialist appointment or an unnecessary trip to the emergency department.”

“Streamlining the consultation process through eConsults is good for patients, good for clinicians and good for the health system,” said Canada Health Infoway President and CEO Michael Green. “Infoway is proud to be a partner in this important initiative that is improving the way we deliver care in Canada.”

“The expansion of eConsult services is solid proof of the value of ‘connected medicine’ in terms of access and costs, for patients and for specialists providing care,” said Dr. Andrew Padmos, CEO of the Royal College. “We look forward to working with our partners to make virtual care accessible to all patients in all parts of Canada.”

“The ability to enhance patient care through convenient remote consultation is central to our vision of family practice, as a Patient’s Medical Home,” says CFPC Executive Director and CEO Francine Lemire, MDCM, CCFP, FCFP, CAE, ICD.D. “Leveraging technology in this way minimizes unnecessary appointments, reduces visits to the emergency department, and allows family doctors to better meet the needs of patients and their families.”

“Access to specialist advice remains a barrier for many people due to long wait times, geography and living in complex circumstances. We are thrilled to see the expansion of the BASETM eConsult model across Canada and the impact it has made on equitable access to specialist care while supporting and strengthening the role of primary care,” said Dr. Clare Liddy, a family doctor with The Ottawa Hospital Academic Family Health Team and Associate Professor with the Department of Family Medicine, uOttawa and Dr. Erin Keely, an endocrinologist with The Ottawa Hospital, co-founders of Champlain BASETM.

“RACE has been very well received by both family physicians and specialists. Family physicians can access advice in a timely way and specialists report feeling good about supporting their colleagues. Best of all, patients are positive about their ability to access specialist care in a timely manner,” Margot Wilson, Director, Shared Care & Virtual Health with Providence Healthcare and Garey Mazowita, Clinical Professor, University of British Columbia Faculty of Medicine, co-founders of RACETM.

For more information:

Additional resources:

About the Canadian Foundation for Healthcare Improvement
The Canadian Foundation for Healthcare Improvement (CFHI) works shoulder-to-shoulder with partners to accelerate the identification, spread and scale of proven healthcare innovations. Together, we’re delivering lasting improvement in patient experience, work life of healthcare providers, value for money and the health of everyone in Canada.

CFHI is a not-for-profit organization funded by Health Canada. Visit for more information.

About Canada Health Infoway
Infoway helps to improve the health of Canadians by working with partners to accelerate the development, adoption and effective use of digital health across Canada. Through our investments, we help deliver better quality and access to care and more efficient delivery of health services for patients and clinicians. Infoway is an independent, not-for-profit organization funded by the federal government.

About the College of Family Physicians of Canada
The College of Family Physicians of Canada (CFPC) is the professional organization that represents more than 38,000 members across the country. The College establishes the standards for and accredits postgraduate family medicine training in Canada’s 17 medical schools. It reviews and certifies continuing professional development programs and materials that enable family physicians to meet certification and licensing requirements. The CFPC provides high-quality services, supports family medicine teaching and research, and advocates on behalf of family physicians and the specialty of family medicine, family physicians, and the patients they care for.

Royal College of Physicians and Surgeons of Canada
The Royal College of Physicians and Surgeons of Canada is the national professional association that oversees the medical education of specialists in Canada. We accredit the university programs that train resident physicians for their specialty practices, and we administer the examinations that residents must pass to become certified as specialists. In collaboration with health organizations and government agencies, the Royal College also plays a role in developing sound health policy in Canada.

The views expressed herein do not necessarily represent the views of Health Canada.

For more information, or to arrange media interviews, please contact:
Christine LaRocque, Senior Communications Lead
Canadian Foundation for Healthcare Improvement
343-998-5143 /