Long wait times? It's all about the e-consult

By Eva Martin, MD of Elm Tree Medical Inc.

High costs, long wait times, inefficient care... Technology holds promise to fix these and many more problems with the current healthcare system. In Canada, healthcare is universal, and demand for specialists like OBGYNs is high. In Ontario alone, 54,000 patients are referred to specialists every day. The average wait time to see a specialist is now 8.5 weeks. How can a healthcare system manage this high demand, making sure patients get the right care in a timely manner? Technology to the rescue.

In Canada, the average patient waits 8.7 weeks to see a gynecologist and then another 7.4 weeks to receive treatment. That makes 16.1 weeks total in wait time- much too long! In an effort to improve efficiency, the Canadians introduced a electronic consultation (eConsult) service. Using the eConsult service, primary care providers can send specialists an electronic message about the clinical question. The specialist can then provide advice without the need for a face-to-face appointment, which saves overall time for patients and providers.

The authors of a study evaluating the eConsult service for OBGYNs reviewed charts from 2011 to 2015. Of 5,597 eConsults in Ontario, 394 were sent to a single gynecologist by 151 primary care providers. 34.3% of the time, the eConsult allowed the primary care provider to avoid a traditional in-person consultation (and the long wait time!). 18.5% of eConsults still required a traditional visit to the specialist, but providers reported that the visits were more efficient because the specialist could request tests and studies to be completed prior to the in-person visit. 50% of the time, primary care providers reported receiving advice that the eConsult added new information, and 46.7% of eConsults confirmed existing plans.

The most common issues were related to pregnancy (18%) and gynecologic cancer screening (18%). Specific topics related to pregnancy focused on infertility, preconception planning, vaginal bleeding in pregnancy, and medication safety. 13% of inquiries related to vulvovaginal symptoms, 12% to abnormal uterine bleeding, 10% to contraception, 9% to menopause, 8% to abnormal ultrasound results, and 3% to fibroids.

80.5% of eConsults took less than 10 minutes for the OBGYN to complete, and 98.9% took less than 15 minutes. Overall, primary care providers reported that they were highly satisfied with the eConsult service. With an increase in efficiency of care provided, eConsult services are likely here to stay.

We want to hear from you! Do you use an eConsult service? Do you like it?