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This paper reports on a multimethod cross-sectional study of the Ontario electronic consultation (eConsult) service. Utilization and closeout survey data from July 2018 through June 2020 were analyzed using the Reach Effectiveness Adoption Implementation Maintenance (RE-AIM) framework. Requesting clinicians submitted 60,474 eConsults, and monthly cases increased from 1,487 in July 2018 to 4,179 in June 2020. The median specialist response time was 1 day. An originally contemplated referral was avoided in 51% of cases. Ontario eConsult showed successful uptake across Ontario, demonstrating continued spread and scale, and offering a template for trailblazers looking to implement digital health innovations in their own jurisdictions. Key words: digital technology; eReferral and eConsultation; heath care quality, access and evaluation; health services accessibility; telemedicine Ann Fam Med 2022;20:262-265. https://doi.org/10.1370/afm.2812, INTRODUCTION Excessive wait times for specialist care are a serious issue in Canada, resulting in poorer health outcomes for patients and frustrating challenges for clinicians. (1) The electronic consultation (eConsult) [...]

PURPOSE COVID-19 has increased the need for innovative virtual care solutions. Electronic consultation (eConsult) services allow primary care practitioners to pose clinical questions to specialists using a secure remote application. We examined eConsult cases submitted to a COVID-19 specialist group in order to assess usage patterns, impact on response times and referrals, and the content of clinical questions being asked. METHODS This was a mixed-methods analysis of eConsult cases submitted between March and September 2020 in Ontario, Canada to 2 services. We performed a descriptive analysis of the average response time and the total time spent by the specialist for eConsults. Primary care practitioners completed a post-eConsult questionnaire that asked about the outcome of the eConsult. We performed an inductive and deductive content analysis of a subset of cases to identify common themes among the clinical questions asked. RESULTS A total of 208 primary care practitioners submitted 289 eConsult cases. The median specialist response time was 0.6 days (range = 3 minutes to 15 days); the average time spent by specialists per case was 16 minutes (range = 5 to 59 minutes). In 69 cases (24%), the eConsult enabled avoidance of a face-to-face referral. Content analysis of 51 cases identified 5 major themes: precautions for high-risk and special populations, diagnostic clarification and/or need for COVID-19 testing, guidance on self-isolation and return to work, guidance on personal protective equipment, and management of chronic symptoms. CONCLUSIONS This study demonstrates the considerable potential of eConsults during a pandemic as our service was quickly implemented across Ontario and resulted in primary care practitioners' rapid and low-barrier access to specialist input. Key words: primary care; electronic consultation; Coronavirus 2019; COVID-19; referral; specialist care; telemedicine; remote consultation; public health; health information technology; organizational change; practice-based research Ann Fam Med 2022;20:220-226. https://doi.org/10.1370/afm.2807, INTRODUCTION As a result of the COVID-19 pandemic, many countries have initiated lockdowns to help limit spread of the virus. (1) In Ontario, Canada's most populous province, the provincial government [...]

Context The eConsult service is an online system that primary care practitioners (PCP) submit questions concerning their patients' care to specialists and receive a response within one week. Responses can include suggestions for treatment, recommendations for referral, or requests for additional information. Objective The objective is to examine the use of natural language processing (NLP) in automatic identification of frailty in patient cases and explore semantic characteristics of such cases that distinguished them from non-frailty cases to help refine and inform the definition of frailty and provide its reusable knowledge. Study Design We conducted a machine learning (ML) experimentation using NLP to assess frailty in a dataset of cases submitted through eConsult Service. We used text data prepared and vetted by the experts, as training material to achieve accurate prediction of 'frail' cases automatically. Setting or Dataset In this study, we selected contrasting samples from eConsult cases submitted in the Champlain health region between 2018 and 2019 and filtered them by patient's age 65 and the use of term frail or frailty in their case description. Non-frailty cases were selected among younger patients below 65 years old in whom PCP did not refer to as frail. Population Studied PCPs can keep communicating with the specialist until they are satisfied with the answers to close the case. The population is an unbiased random sample of PCP communications, that were then labeled. Outcome Measures We used 10-fold cross-validation to measure precision, recall, F1 and accuracy to evaluate the results. Results Using text from electronic conversations between primary care providers and specialists we developed a champion algorithm (Random Forest with Bag-of-Words as data representation) that predicted frailty cases with an accuracy of 94% (0.12). This study also provided evidence of semantic characteristics that were specific to frail cases. Among several frail cases, the most frequent topic-terms were related to medications: daily dose, recommended medication and best treatment. Conclusion It was possible to automatically identify Frailty cases in eConsult system with high accuracies using NLP. Noteworthy is that no other patient data were required. The predictions can inform and assist practitioners recognize frailty in patient cases and as a result, provide organized and reusable knowledge to enhance the quality of service for frail patients., Presenters Dr. Arya Rahgozar, PhD, Douglas Archibald, PhD, Sathya Karunananthan, Clare Liddy, MD, MSc, CCFP, Amir Afkham, BEng Hnrs, Erin Keely, [...]

PURPOSE Electronic consultation (eConsult) services can improve access to specialist advice. Little is known, however, about whether and how often primary care clinicians adhere to the advice they receive. We evaluated how primary care clinicians use recommendations conveyed by specialists via the Champlain BASE (Building Access to Specialists through eConsultation) eConsult service and how eConsult affects clinical management of patients in primary care. METHODS This is a descriptive analysis based on a retrospective chart audit of 291 eConsults done between January 20, 2017 and August 31, 2017 at the Bruyere Family Health Team, located in Ottawa, Canada. Patients' charts were reviewed until 6 months after specialist response for the following main outcomes: implementation of specialist advice by primary care clinicians, communication of the results to the patients, method, and time frame of communication. RESULTS Primary care clinicians adhered to specialist advice in 82% of cases. Adherence ranged from 62% to 93% across recommendation categories. Questions asked by primary care clinicians related to diagnosis (63%), management (27%), drug treatment (10%), and procedures (1%). Recommendations of the eConsult were communicated to patients in 79% of cases, most often by face-to-face visit (38%), telephone call (32%), or use of the patient portal (9%). Communication occurred in a median of 5 days. CONCLUSIONS We found little evidence of barriers to implementing specialist advice with use of eConsult, which suggests recommendations given through service were actionable. With a high primary care clinician adherence to specialist recommendations and primary care clinician-to-patient communication, we conclude that eConsult delivers good-quality care and improves patient management. Key words: access to care; eConsult; primary care clinician adherence; professional practice; coordination of care; delivery of health care, integrated; communication; decision making; health informatics; practice-based research, INTRODUCTION Access to specialist care remains a serious problem in Canada because of excessive wait times. The Commonwealth Fund's 2016 survey reported that 56% of Canadian adults waited more than [...]

Purpose: Excessive wait times for specialist appointments pose a serious barrier to patient care. To improve access to specialist care and reduce wait times, we launched the Champlain BASE (Building Access to Specialists through eConsultation) eConsult service in April 2011. The objective of this study is to report on the impact of our multiple specialty eConsult service during the first 5 years of use after implementation, with a focus on growth and sustainability.Methods: We conducted a cross-sectional study of all eConsult cases submitted between April 1, 2011 and April 30, 2016, and measured impact with system utilization data and mandatory close-out surveys completed at the end of each eConsult. Impact indicators included time interval to obtain specialist advice, effect of specialist advice on the primary care clinician's course of action, and rate of avoidance of face-to-face visits.Results: A total of 14,105 eConsult cases were directed to 56 different medical specialty groups, completed with a median response time of 21 hours, and 65% of all eConsults were resolved without a specialist visit. We observed rapid growth in the use of eConsult during the study period: 5 years after implementation the system was in use by 1,020 primary care clinicians, with more than 700 consultations taking place per month.Conclusions: This study presents the first in-depth look at the growth and sustainability of the multispecialty eConsult service. The results show the positive impact of an eConsult service and can inform other regions interested in implementing similar systems. [ABSTRACT FROM AUTHOR]

Context: Accessing specialty medical services in rural Ontario is a longstanding issue. Numerous barriers, including a scarcity of local specialist offices and excess travel times to urban centres, results in inequitable access to care for rural patients and can negatively impact health outcomes. Objective: To determine the proportion of rural vs. urban eConsults in each Ontario Health (OH) Region as well as the number of providers, specialty distribution, response interval, time billed, and results from a close-out survey. Study design and Analysis: Retrospective, cross-sectional descriptive analysis. Setting or Dataset: Ontario, Canada. Population studied: 72,948 eConsults submitted through Ontario eConsult Service (OES) between January 01 - December 31, 2021 were included. Intervention/Instrument: The OES allows clinicians to securely access asynchronous specialist advice in Ontario through the Ontario Telemedicine Network. Outcome measures: The proportion of rural vs. urban eConsults in OH regions were identified using the forward sortation area (FSW) of the primary organization for each requesting provider. FSWs with 0 as the second character were identified as rural and values 1-9 were identified as urban. Results: 10% (n=7550) of eConsults were submitted by 591 providers with a rural FSW. 1.74 eConsults per 1000 residents were sent by rural providers in OH North and 0.98, 0.62, 0.05 and 0.0 per 1000 residents in OH Regions West, East, Central and Toronto respectively. The top four specialties for both rural and urban eConsults were Dermatology, Obstetrics/Gynecology, Hematology & Allergy/Clinical Immunology. For both rural and urban eConsults, the median specialist response time was 1.0 days and the median specialist time spent was 15 minutes. In 76% of rural eConsults, specialist appointments were avoided vs. 75% in urban. In 58% of rural eConsults, providers indicated that they received good advice for a new/additional course of action vs. 54% in urban cases. Conclusions: Rural and urban eConsults had similar results for specialty distribution, time spent, response interval and survey results. The OES is successfully improving equity of access in rural Ontario across different health regions. Further research should determine clinical content and types of questions that are being asked by rural vs. urban providers. [ABSTRACT FROM AUTHOR]

The article presents a study which examines the overall effect size of practice facilitation within primary care settings. The study utilizes the 4 electronic databases and reference lists of published literature reviews to find practice facilitation studies that identified evidence-based guideline implementation within primary care practices as the outcome. It concludes that practice facilitation has a moderately robust effect on evidence-based guideline adoption within primary care.

The article presents the methods of achieving high interrater reliability (IRR) in data collection of chart abstractors within a randomized trial of cardiovascular care from the primary care medical records. It provides recommendations related to determining sample size, frequency of verification, and minimum thresholds for 2 measures of IRR. It mentions the 4 parts of data quality monitoring procedure design.

Context: The Canadian Team to Improve Community-Based Cancer Care along the Continuum (CanIMPACT) is a group of researchers, primary care providers (PCPs), cancer specialists, patients and caregivers working to improve cancer care coordination between PCPs and cancer specialists. Previous research by CanIMPACT and others has identified problems related to communication, coordination, and continuity of care. Objective: Describe findings from qualitative interviews with cancer specialists on implementation of an online communication system with PCPs. Study Design: Hybrid type I effectiveness-implementation study that included a qualitative research component and a pragmatic RCT. Setting: Ottawa Hospital Cancer Program and primary care practices in the Champlain region. Population Studied: Cancer specialists (nurses, medical and radiation oncologists, program administrators). Interviews conducted with 12 cancer specialists. Intervention: Cancer-specific adaptation of Champlain BASE™ eConsult, an online communication system for PCPs and cancer specialists called "eOncoNote". For patients receiving treatment for prostate or breast cancer, cancer specialists had an opportunity to participate in eOncoNote discussion with PCP for 4-6 months; for breast and colorectal cancer survivors, the eOncoNote discussion lasted for 1 year post discharge to the patient's PCP. Results: Cancer specialists described limited PCP involvement in cancer care while patients received active treatment, with one-way communication and notes being "sent into a vacuum". There was more communication with PCPs regarding patients with metastatic disease, comorbid conditions, after patients have completed treatment, or during palliative care. Patients and caregivers play a critical role in coordinating cancer care, helping to facilitate coordination. Lack of access to the same electronic medical record (EMR) among healthcare providers poses a barrier to cancer care coordination. eOncoNote had the potential to be useful tool but it was not used extensively. Conclusions: Accessing eOncoNote as a separate system was challenging to incorporate into the workflow, and cancer specialists highlighted the need for integration with their EMR. eOncoNote did not affect information sharing with PCPs, as there was limited uptake within primary care., Competing Interests: Authors report none., (2021 Annals of Family Medicine, Inc.)