Connected Medicine

Enhancing connected medicine through new models of care

People living in Canada often wait for specialist care after referral from a primary care provider. In a Commonwealth Fund survey in 2016, Canada placed last on specialist access among the 11 countries surveyed, with 56 percent of people living in Canada reporting that they wait four weeks or longer to see a specialist.¹

The Canadian Foundation for Healthcare Improvement (CFHI – now Healthcare Excellence Canada) partnered with Canada Health Infoway, the College of Family Physicians of Canada and the Royal College of Physicians and Surgeons of Canada to spread the adoption of two proven innovations that had substantially increased access to primary care specialty services:

• Champlain BASE^TM (Building Access to Specialists through eConsultation), a secure web-based eConsult service which originated with the Champlain Local Health Integration Network in Ontario

• Rapid Access to Consultative Expertise (RACE^TM), a telephone advice line and app launched at Providence Health Care and Vancouver Coastal Health. (CFHI identified RACE™ through the EXTRA Executive Program.)

Through this 18-month quality improvement collaborative, 11 teams from across Canada improved primary care provider access to specialist advice by adapting and implementing one or both of the RACE™ and Champlain BASE™ proven remote consult models of care.

The quality improvement collaborative built on the 2016-17 Connected Medicine e-collaborative in which 10 provincial/territorial and international teams came together to develop business cases and strategies to implement remote consult services in their jurisdictions.

Some of the participating teams have since joined HEC’s Momentum Challenge – an invitation-only program that assists teams which have completed a collaborative to expand the reach of the innovation and sustain its impact.

How Connected Medicine contributes to better healthcare in Canada

Connected Medicine is part of HEC’s ongoing efforts to spread and scale proven innovations that deliver high quality care closer to home and the community.

Through remote consultations, eligible patients can access specialist advice closer to home from primary care providers they know and trust. The process is typically faster than being referred for a face-to-face specialist appointment and often avoids unnecessary trips to the emergency department.

During the collaborative, more than 2,200 primary care providers participated in a remote consult service and continue to benefit from it – rapidly accessing specialist advice, typically within a week or less. By the end of the collaborative, more than 800 specialists had enrolled and were consulting through a BASE™ or RACE™-like service; the most common specialty service is psychiatry, followed by cardiology, nephrology, obstetrics/gynecology and pediatrics.

Between June 2017 and September 2019, patients took part in more than 19,000 remote consults with specialists.

Using an improvement collaborative to spread new models of care

Publicly-funded Canadian healthcare delivery organizations, ministries and providers participated in the Connected Medicine collaborative from June 2017 until September 2018. The collaborative focused on supporting teams in the spread and adaption of RACE™ and BASE™ – that improved primary care access to specialist advice through telephone services and digital technology.

Participating teams had up to $600,000 in seed funding available, in addition to support with the implementation, spread, scale and evaluation of the innovations within their project areas. Teams took part in a curriculum to enhance their quality improvement skills. This included educational webinars, in-person workshops, access to a network of expert faculty and coaches, and peer-to-peer networking.

Connected Medicine Collaboration Results

The Connected Medicine collaboration spread two proven Canadian healthcare innovations that improved access to specialist advice by enabling primary care providers, such as family doctors and nurse practitioners, to ask specialists patient care questions: Champlain BASE^TM and RACE^TM.

Results from this collaboration are consistent with those that have been achieved through original implementations of these two innovations. The Connected Medicine collaboration brought about improvements for patients and providers in a number of areas.

Improvements for providers

Primary care providers initiated more than 12,300 remote consults with specialists to support patient care. Teams from Newfoundland and Labrador, New Brunswick, Quebec, Manitoba, Saskatchewan, Alberta, British Columbia and the Department of National Defence enrolled more than 2,200 primary care practitioners and 800 specialists, including many in underserved rural and remote regions.

In some regions, primary care providers had access to as many as 38 specialties for remote consultation. The most commonly available specialty was psychiatry, followed by cardiology, nephrology, obstetrics/gynecology and pediatrics. Four services also offered palliative care consults. Results by team are available in the Results of Collaborative. These practitioners can now access specialist consults through secure digital technology and telephone services.

Improvements for patients

Eligible patients receive care based on specialist advice closer to home, from a primary care provider they know and trust. The process is typically faster than being referred for a face-to-face specialist appointment and often avoids unnecessary trips to the emergency department.

Key facts and figures

• Champlain BASE^TM currently provides access to 114 specialty groups and 1,000 cases each month in Ontario, with a median response time of 21 hours and nearly two thirds (65 percent) of cases resolved without requiring patients to attend a face-to-face specialist visit1.

• A RACE^TM data evaluation found that 60 percent of RACE calls appropriately avoided a face-to-face visit with a specialist and 32 percent of calls appropriately avoided hospital ED visits.

• Rapid access to specialist advice: More than four in five eConsults (85 percent) received a response from a specialist within seven days (based on a sample of more than 3,200 eConsults). This work addresses a recognized issue in Canada as identified, for example, in the 2016 Commonwealth Fund Survey – where Canada placed last on a measure of specialist access among the 11 countries surveyed, with 56 percent of the people living in Canada reporting waiting four weeks or longer to see a specialist.

• Care closer to home: More than half of eConsults (53 percent) led to an appropriately avoided face-to-face referral to a specialist, where the primary care provider originally contemplated it but no longer needed to do so based on specialist advice (based on a sample of over 2,600 e-Consults).

• Avoided emergency department visits: Two in five remote consults (42 percent) via phone/app led to an appropriately avoided emergency department (ED) visit, where the primary care provider originally contemplated sending the patient to the ED but the visit was no longer needed based on specialist advice (based on a sample of over 600 phone or mobile app consults).

¹ Canadian Institute for Health Information, The Commonwealth Fund’s 2016 International Health Policy Survey of Adults in 11 Countries. Accessed via: https://www.cihi.ca/en/commonwealth-fund-survey-2016