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Research ArticleOriginal Research

Assessment of the Generalizability of an eConsult Service through Implementation in a New Health Region

Clare Liddy, Isabella Moroz, Ariana Mihan and Erin Keely
The Journal of the American Board of Family Medicine March 2019, 32 (2) 146-157; DOI: https://doi.org/10.3122/jabfm.2019.02.180169
Clare Liddy
C.T. Lamont Primary Healthcare Research Centre, Bruyère Research Institute, Ottawa, Ontario, Canada (CL, IM, AM); Department of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada (CL); Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada (EK); Division of Endocrinology/Metabolism, The Ottawa Hospital, Ottawa, Ontario, Canada (EK).
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Isabella Moroz
C.T. Lamont Primary Healthcare Research Centre, Bruyère Research Institute, Ottawa, Ontario, Canada (CL, IM, AM); Department of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada (CL); Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada (EK); Division of Endocrinology/Metabolism, The Ottawa Hospital, Ottawa, Ontario, Canada (EK).
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Ariana Mihan
C.T. Lamont Primary Healthcare Research Centre, Bruyère Research Institute, Ottawa, Ontario, Canada (CL, IM, AM); Department of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada (CL); Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada (EK); Division of Endocrinology/Metabolism, The Ottawa Hospital, Ottawa, Ontario, Canada (EK).
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Erin Keely
C.T. Lamont Primary Healthcare Research Centre, Bruyère Research Institute, Ottawa, Ontario, Canada (CL, IM, AM); Department of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada (CL); Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada (EK); Division of Endocrinology/Metabolism, The Ottawa Hospital, Ottawa, Ontario, Canada (EK).
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Article Figures & Data

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    Figure 1.

    Distribution of primary care practices that participated in the Southeastern Ontario Academic Medical Organization (SEAMO) pilot of the Champlain Building Access to Specialists through eConsultation (BASE) eConsult service.

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    Figure 2.

    The number of cases submitted through the Champlain Building Access to Specialists through eConsultation (BASE) eConsult service by participants in the Southeastern Ontario Academic Medical Organization (SEAMO) pilot, by month and cumulatively.

Tables

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    Table 1.

    Comparison of the Adoption Targets Assigned by Leadership Teams for the SEAMO eConsult Service Pilot Period (February 1, 2017 to June 15, 2017) and the Actual Numbers Achieved by the Service during This Period

    Adoption Targets Assigned by Leadership Teams for Pilot PeriodActual Numbers Reached during Pilot Period
    At least 40 referrers (physicians and nurse practitioners) registered as pilot users49 active referrers (PCPs)
    At least 10 medical specialties24 specialty services
    At least 150 eConsults sent by referrers during the pilot301 eConsults sent
    263 eConsults completed/closed
    249 close-out surveys completed
    Top 10 priorities identified by SEAMO:Top 10 most requested specialties:
        1. Gastroenterology    1. Dermatology (20%)
        2. Ear, Nose, Throat    2. Cardiology (9%)
        3. Cardiology    3. Gastroenterology (9%)
        4. Urology    4. Endocrinology (7%)
        5. Neurology    5. Neurology (7%)
        6. Psychiatry    6. Hematology (7%)
        7. Obstetrics/Gynecology,    7. Obstetrics/Gynecology (6%)
        8. Dermatology    8. Pediatrics (5%)
        9. Orthopedic Surgery    9. Ear, Nose, Throat (4%)
        10. Including rural site    10. Orthopedic Surgery (4%)
    • SEAMO, Southeastern Ontario Academic Medical Organization; PCPs, primary care providers.

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    Table 2.

    Free Text Responses from Closeout Survey Completed by Primary Care Providers using the Southeastern Ontario Academic Medical Organization (SEAMO) eConsult Service

    Specialty GroupComment
    Dermatology“Although the referral is still needed, the helpful information from the eConsult allowed me to begin diagnosis and treatment rather than waiting for him to see the specialist.”
    “Very efficient - thanks for quick response.”
    “Great system in terms of rapid response to clinical question.”
    Hematology“Great system as long as our referral clerk is the steward of it all.”
    “Simple question for my own learning. eConsult answered my question well, was very educational.”
    “Would have been a good case for eConsult but another specialist referred to Hematology regardless.”
    Medical Oncology“I found the process to be very efficient and accessible.”
    Neurology“This was my first time using BASE eConsult and I was very satisfied with its utility and ease of use.”
    “Patient was presenting with complaint that stumped us, but eConsult mentioned some neuro differentials I had not thought of. Will be ordering MRI now.”
    Neurosurgery“Very expedient.”
    Obstetrics“Fast and clinically useful feedback.”
    Orthopedic Surgery“Great service, answer was concise and short, good explanation. There was no need to see the patient.”
    Pediatrics“Really great advice on an unusual presentation.”
    “What an incredible service. So helpful to be able to ask a quick question and get a specialist's opinion. Please keep this service going.”
    Suggestions for Improvement
        “One of my three security questions is asking for a month and a date of a birthday. I know the month and date but can't seem to figure out which format the system wants … I've tried multiple different combinations of year and month … may be specifying how the system wants the month and date input??”
        “The question was a straightforward one regarding medication options for a particular condition. The specialist declined to comment as the patient was scheduled to see another specialist (different specialty) in the future.”
        “Main challenge I have with this service is that I forget about it and I have to log in to a new site each time to use it…. when will it be incorporated to all EMRs?”
        “It would be helpful if I could see a list of local specialists who provide eConsult and direct my consult directly to one of them… when I tried to scroll the list, Dr X was not even listed.”
    • BASE, Building Access to Specialists through eConsultation; MRI, magnetic resonance imaging; EMR, electronic medical record.

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The Journal of the American Board of Family     Medicine: 32 (2)
The Journal of the American Board of Family Medicine
Vol. 32, Issue 2
March-April 2019
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Assessment of the Generalizability of an eConsult Service through Implementation in a New Health Region
Clare Liddy, Isabella Moroz, Ariana Mihan, Erin Keely
The Journal of the American Board of Family Medicine Mar 2019, 32 (2) 146-157; DOI: 10.3122/jabfm.2019.02.180169

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Assessment of the Generalizability of an eConsult Service through Implementation in a New Health Region
Clare Liddy, Isabella Moroz, Ariana Mihan, Erin Keely
The Journal of the American Board of Family Medicine Mar 2019, 32 (2) 146-157; DOI: 10.3122/jabfm.2019.02.180169
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