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N. Miraftab



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    OS22 - Digital Health Big Data: Promises and Possibilities (ID 30)

    • Event: e-Health 2018 Virtual Meeting
    • Type: Oral Session
    • Track: Clinical Delivery
    • Presentations: 1
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      OS22.04 - C<sup>3</sup> - Collaboration and Connection with eCASE<sup></sup> (ID 352)

      N. Miraftab, Patient Transitions, Providence Health Care; Vancouver/CA

      • Abstract
      • Slides

      Purpose/Objectives: eCASE supports patients in the community and streamlines the patient journey by connecting primary and specialty care through technology. As a complementary service to the successful RACE telephone advice line, eCASE allows primary care providers (PCPs) such as family physicians and nurse practitioners to submit non-urgent questions to participating specialty areas. Through the ‘dr2dr’ website and mobile app, questions can include patient documentation such as a lab test or ECG to aid the specialist in providing informed advice, within a one week timeframe. The intention is for this advice to expand PCPs’ scope of practice, avoiding unnecessary specialist visits, and ensuring appropriate tests are ordered in advance of specialist visits when they’re needed.

      Methodology/Approach: A phased implementation approach was taken, given the novelty of this care model and limited nature of this prototype. Expanding from a single specialty area, we leveraged the relationships formed through RACETM to include 6 additional specialties over the first 4 months. Similarly, access to the system was expanded across Vancouver Coastal and to Nurse Practitioners and Medical Residents over the course of the prototype. We worked closely with stakeholders from the Champlain BASE™ eConsultation service in Ottawa, through a collaborative delivered by the Canadian Foundation for Healthcare Improvement, to tailor our implementation approach.

      Finding/Results: Data has been gathered through the dr2dr platform, as well as through surveys sent to the referring provider and consulting specialist after every conversation. 56% of conversations avoided a face-to-face referral, while 20% resulted in a previously unconsidered referral. eCASE was viewed positively by both primary care providers and specialists; when asked whether they would recommend eCASE to their colleagues, primary care providers averaged 4.4 on a 5-point scale from ‘Strongly Disagree’ to ‘Strongly Agree’, while specialists averaged 4.1 on this same scale. Challenges related to fee codes for remuneration, and a sustainable technology to facilitate the conversations, are key to sustainability and are currently being addressed.

      Conclusion/Implications/Recommendations: eCASE has proven effective at streamlining the patient journey by connecting providers through technology. Our metrics closely mirror those attained by the Champlain BASE™ service over their 7 years of operations, demonstrating the potential of this model in our local BC context. The eCASE team will resume the recruitment of additional specialty areas to provide greater value to primary care, and continue to socialize this model to community providers through further expansion. Specific change ideas will be generated through evaluation interviews with both primary care providers and specialists, and these will be implemented to the greatest degree possible over the next Phase of this project. Specifically, direct integration into provider EMRs would eliminate the need for these conversations to take place in a separate system, resulting in fewer necessary steps to ask a question or provide a response. We believe that this efficiency would serve to direct primary care providers away from referrals, and hence away from unnecessary patient transfers. The team is currently investigating ways to influence the implementation of fees, and embedding this process within providers’ existing systems.

      140 Character Summary: eCASE is a non-urgent email advice service connecting primary care providers with specialists, which is effective at streamlining the patient journey.

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