Presentation to ARRNL NP 2017 Susan MacDonald Jean Cook - - PowerPoint PPT Presentation

Improving Access to Specialists through the Champlain BASE eConsult Service

Presentation to ARRNL NP 2017

Susan MacDonald Jean Cook

Disclosure of Commercial Support

This program has not received financial support from commercial interests. Potential for conflict(s) of interest: none

Objectives

• Overview of the NL BASE eConsultation service
• Impact of eConsult access to care
• Ongoing research and collaboration

The NL eConsult Team

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A Collaboration Between:

• The Newfoundland & Labrador Medical Association

(NLMA)

• Department of Health and Community Services
• eHealth Research Unit, Memorial University
• Champlain BASE* eConsult Service
• Eastern Health

Current Research Funding

• Clinical Stabilization Fund (CSF)
• Canadian Foundation for Healthcare Improvement (CFHI)

Christopher Kovacs Specialist Physician Susan MacDonald Specialist Physician Lead Jackie Elliott Family Physician Lead Ann Hollett Research Coordinator Don Sturge Patient Representative Jean Cook Engagement & Implementation Lead Gerard Farrell Technology Lead

Wait Times for Specialty Care in NL

• Median wait time from PCP referral to specialist visit in NL:

14.5 weeks

• Specialties with the longest wait:
• Neurosurgery (48 weeks)
• Internal Medicine (22 weeks)
• Specialties with the shortest wait:
• Radiation Oncology (1 week)
• Medical Oncology (1 week)

Barua B. Feixue R. Waiting Your Turn: Wait Times for Health Care in Canada. Fraser Institute, 2016

Access to Care for Rural Populations

• Rural communities face greater inequities in care

delivery as compared to urban communities

• Some of the barriers to accessing care include:
• Access to transportation
• High costs of travel

A possible solution to improve access to specialists: eConsultation

“eConsult allowed me to access advice for my patient without having to go through the referral

• process. A referral would

have taken several years! ”

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• A secure web-based service for primary care

providers to access specialist care for their patients

How Does eConsult Work?

PCP logs onto secure webpage Completes simple form to submit to a “specialty” Assigned to an appropriate specialist (availability/rotation)) Response received within 7 days; back and forth communication can occur between PCP and specialist PCP closes eConsult and completes survey

How eConsult Works

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Specialist replies within 1 week with: 1) A reply to the question 2) A request for additional information 3) A recommendation for referral (along with any tests etc. to be completed beforehand)

How eConsult Works

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• PCPs can ask additional questions of specialists
• r close the case
• PCPs complete a brief closeout survey at the

conclusion of each case

• Service generates a PDF transcript available to

PCPs and specialists

NL BASE eConsult Service

▪ Funding provided through the Clinical Stabilization Fund for the demonstration phase ▪ Soft launch July 2016 ▪ Hard launch October 2016 ▪ Recruitment is ongoing

Participating Specialties

✓ Addictions Medicine ✓ Hepatology ✓ Pediatrics ✓ Cardiology ✓ Internal Medicine ✓ Public Health & Preventative Medicine ✓ Chronic Pain ✓ Nephrology ✓ Respirology ✓ Dermatology ✓ Neurology ✓ Surgery ✓ Endocrinology & Metabolism ✓ Opioid Dependency ✓ Urology ✓ Gastroenterology ✓ Orthopedics ✓ Wound Care ✓ Hematology ✓ Palliative Care ✓ HIV Provincial Program ✓ Psychiatry

PCP Engagement

10 15 17 18 34 41 54 66 83 89 97

25 50 75 100 125 Jul/16 Aug/16 Sept/16 Oct/16 Nov/16 Dec/16 Jan/17 Feb/17 Mar/17 Apr/17 May/17 cumulative

Monthly Volumes (cases completed)

* As of May 4th, 2017

Cases Completed per Month

Specialty Distribution (188 cases)

Specialist response interval from receipt of request

❖Median (ie, half the case were responded to in less than): 2 days ❖Average: ~ 4.5 days ❖90th Percentile (ie, 90% were responded to in less than): ~ 11 days ❖Fastest response: 24 minutes! (Endocrinology)

* Based on data from 188 cases processed to May 4th , 2017

Open to Nurse Practitioners

• In the role of primary clinician
• In the role of specialist (various clinics have

NPs with highly specialized knowledge)

Survey Results

Cases Completed – By Patient Age Group

[% of total ]

* As of May 4th , 2017

Impact of eConsultation on Referral

[from PCP survey responses completed for each case]

72% did not require a face-to-face visit with the specialist 36% unnecessary referral was avoided (Arguably 56%) N=187 cases

*As of May 4th, 2017

Patient Value

[from PCP survey responses completed for each case]

Overall value of the eConsult service in this case for patient

(187 Completed Cases) AVG.: 4.75/5

Eliminate travel to specialist Dramatically reduce wait time Appropriate treatment starts quickly, avoids deterioration Reduced anxiety 93% as high or very high value

*As of May 4th , 2017

Clinical Value * from PCP survey responses completed for each case

Overall Value of the eConsult Service

(AVG.: 4.77/5)

*As of May 4th , 2017

1+2 = 98% 4+5 = 95%

Latest data

As of Sept 16th,

• 538 eConsults.
• 22 NPs,
• 129 family physicians
• 44 specialists

Clinician Comments

“I received 3 communications from a specialist within 24 hours! This is amazing…”

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“This was a frustrating case and the information provided allowed me to help reassure the patient regarding the course of action” “Excellent information from urology re: helping with this and future cases” “Very prompt and useful response’’

Clinician Comments

“Most important, the patient will be reassured knowing I spoke with a specialist”

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“The feedback is very beneficial as if I had sent a consult I would still be unsure as to whether or not it was necessary” “Very helpful advice from Dr. Goodridge, avoided long wait for a formal consult” “Great to be able to do the necessary bloodwork before she sees the specialist’’

Clinicians Comments

“It has already dramatically changed the way I practice and I am convinced it is leading to better outcomes. I have received responses to all eConsults in a timely manner <1week, and the comments and suggestions were excellent. Please keep doing what you are doing and I look forward to continuing this in the future. ”

Conclusion

eConsult is quickly being adopted here in NL Preliminary analysis indicates savings are already generated Overall consensus is positive

• For more information about the NL BASE eConsult service, please

contact: Susan MacDonald Chris Kovacs Jackie Elliott Gerard Farrell Jean Cook

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