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Amir Afkham

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    OS22 - eServices: Better Than Paper! (ID 35)

    • Event: e-Health 2019 Virtual Meeting
    • Type: Oral Session
    • Track: Clinical Delivery
    • Presentations: 1
    • Coordinates: 5/28/2019, 01:15 PM - 02:15 PM, Pod 7
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      OS22.02 - How to Maximize eConsult’s Impact?  Integrate! (ID 525)

      Amir Afkham, Champlain LHIN; Ottawa/CA

      • Abstract
      • Slides

      BASE? eConsult service has experienced tremendous traction and growth within the clinician communities across Canada. Its managed service approach has offered primary care providers (PCPs) a reliable mechanism for obtaining timely advice from specialists, which ultimately results in better care for patients. Yet the systemic benefits of eConsult are far from being realized. A PCP may decide to eConsult a specialty that ordinarily is difficult to access (long wait times, geographical constraints), and consequently the positive impact for that particular patient will be evident. However, for an overall reduction in wait times for all patients of that specialty, the option to address patients? needs via eConsult must ultimately become embedded in its standard referral workflow. Data demonstrating the potential impact of merging eConsult into referral processes will be presented, along with key considerations.

      Analysis of data across a number of specialties has been conducted, reflecting how eConsult currently represents a relatively small proportion of overall referral volumes. At the same time, research has been conducted on a statistically significant sample size of eConsult cases, demonstrating excellent average response intervals, and offering insights into the potential reductions in the number of unnecessary in-person referrals to specialists. A study of eReferral implementations that have embedded eConsult essentially as part of the triage step offers further evidence of the opportunities before us to make a bigger impact on improving access and reducing wait times.

      A study of referral versus eConsult patterns indicated that with the current decoupled approach, PCPs on average make 250 referrals per year, compared to 10 eConsult per year. When eConsult was used, an analysis of surveys completed by PCPs for over 40,000 eConsult cases indicates that 40% of all eConsult cases were originally contemplated as an in-person referral which was subsequently avoided as a result of the eConsult step. Combining these findings with examples of integrated eReferral/eConsult processes in other jurisdictions, such as San Francisco and Los Angeles, highlight tremendous opportunities for further improvements in accessibility of timely care. Results from LA County?s Safety-Net program that has implemented an integrated eReferral/eConsult process indicate 25% of all referrals received are addressed via eConsult without the need for a specialist visit, which has also led to a 17% drop in the wait time to see a specialist. To make this possible in a Canadian setting, there are other considerations including specialist remuneration, integration with electronic medical record systems for both primary care providers and specialists, and overall better organized central intake models for referrals.

      Across many regions, strategies are being developed to better organize key specialty pathways, and establish/enhance Central Intake models to better, and more appropriately, distribute case loads. To make this all possible in a more automated fashion, eReferral solutions are being implemented. Inclusion/addition of eConsult as a simple option for a specialist during the standard triage phase of an eReferral will be a small process change with a significant impact on improving wait times. Governing bodies can promote, support, or even more boldly mandate this change for the better.

      140 Character Summary:
      Integrating eConsult into referral workflows will unleash its systemic benefits, significantly reducing unnecessary in-person visits and overall wait times

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