Photo: Flickr/Creative Commons, nursingschoolsnearme.com

Limited access to specialist care is a major barrier to health care in Canada. But what started as a pilot project by two frustrated doctors from Ontario is now prompting healthcare providers to rethink the traditional (and time consuming) consultant referral model.

Champlain BASE is a secure, web-based tool that allows family doctors to quickly access specialist care for their patients, often without referring patients for a face-to-face visit. Through the eConsult service, a family doctor can submit a non-urgent patient-specific question to a specialist – who has seven days to respond.

The eConsult service allows family doctors to communicate with specialists directly via a web-based tool. Photo: Public domain.

While the eConsult service was developed for as a tool for healthcare providers, its benefit extends to all Canadians – including older Canadians and those who are caring for loved ones.

Dr. Clare Liddy, a family physician with the Riverside Family Health Team and Dr. Erin Keely, a specialist physician with the Division of Endocrinology and Metabolism, Ottawa Hospital, understand the complex consultation referral process – especially for non-urgent referrals.

“Clare and I talked about it over a cup of coffee,” says Dr. Keely. As a specialist, Dr. Keely sees patients waiting months to receive guidance. “There had to be a better way to get advice for patients across specialty areas,” adds Dr. Liddy.

In response, the two doctors co-founded Champlain BASE (Building Access to Specialists through eConsultation) in 2009. The pair say their initial idea started as a research study. Today, the eConsult service continues to flourish, helping around 1,300 patients in the region each month. The system has more than 200 specialists, with expertise in pharmacy to cancer screening to cardiology.

Getting access to specialists is difficult for many Canadians. Photo: Flickr/Creative Commons, Vic.

The original model from eight years ago has since expanded across Ontario. Dr. Keely says Champlain BASE has already helped 80,000 people in Ontario, and that number is set to grow across Canada, with Newfoundland, Quebec and Manitoba adopting the service. “The big transformation is really about being able to get access to specialist advice for people across Canada in way that is much more equitable and efficient,” she says.

For some people, dealing with a consultant can create a lot of anxiety, Dr. Liddy points out. By using the eConsult service, a family doctor can manage their patients’ care. For Canadians – as well as caretakers – it can be reassuring to know their family doctor, who they have a high level of trust, continues to be their primary carer. “It allows their family doctor to coordinate and integrate their care,” she explains. “It’s very much a patient/doctor dialogue.”

Dr. Liddy says Champlain BASEcan benefit to the long-term care community and older Canadians. According to the 2016 Census, almost seven percent of Canadians aged 65 years and older are living in a nursing home or seniors’ residence. It has been reported that of those in long-term care, 97 percent have two or more chronic conditions.

“There’s a very big inequity for people in long term care and for people
with dementia.”

“There’s a very big inequity for people in long term care and for people with dementia,” says Dr. Liddy. “It raises issues such as arranging for a caregiver to take them to appointments, or mobility issues for patients.” One advantage to the eConsult service is it can offer the long-term care community with better access to a specialist. Champlain BASE currently has doctors who specialize in geriatrics in the areas of dementia, medications and mobility.

The eConsult service can also help bridge one of Canada’s other problems: geography. “We do know that our more rural and remote communities are not getting the same access to specialist advice,” says Dr. Keely. However, with eConsult, doctors can access a specialist who is hours away. Drs. Keely and Liddy hope to expand the service to more remote communities, including Nunavut.

Even for Canadians who live close to larger city centres, Dr. Keely makes the point that driving into a bigger city centre becomes more difficult as we age. Or the appointment may require a family member to take a day off work to accompany patients.

Champlain BASE is also being rolled out for federal correction facilities in Ontario. And the two doctors see there are other opportunities for the service, which can reduce costs for Canadian health care. “There’s a huge opportunity in the military,” says Dr. Liddy. Future users of the service could also include non-physician specialists, such as pharmacists or social workers. “We see the opportunity to expand to other people providing high value care,” says Dr. Keely. She adds there are some patient populations emerging as high needs and high volume, such as Canadians dealing with addiction.

The two doctors have seen the positive impact their eConsult service has in avoiding some of the pitfalls of excessive wait times for patients waiting to receive specialist health care. Dr. Keely says that the eConsult service is not meant to replace a face-to-face visit. “But it can be used as a pre-visit, so patients are getting the right tests done,” she says. However, the doctors hope to see a scenario where the use of eConsult becomes more widespread and patients are the ones who visit their doctor and ask, “Do you think you can do that with the eConsult?”