Q: What is an eConsult?

A: An electronic consultation (eConsult) occurs when a primary care provider (PCP) electronically sends a question to a specialist through our secure, asynchronous, web-based platform. This can be a simple question (e.g., about a drug dosage) or a more complex question following an initial assessment by the PCP (e.g., sending a question with images of the patient for a virtual dermatology assessment). eConsults may avoid the need to refer a patient to a specialist for diagnosis and treatment.

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Q: How do I join the service? 

A: The Champlain eConsult BASE™ Service primarily serves patients in the Champlain Region. Primary care providers are welcome to join the service by contacting our team at econsultsupport@lhinworks.on.ca.

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Q: How is an eConsult different from an informal consultation?

A: In many hospitals, when a PCP has a question about a patient, they are able to approach a colleague and ask for advice. These “hallway consultations” happen frequently and though the PCP often gets the advice needed, there is no audit trail of the consultation. There is also no way for the specialist to get paid. eConsult enables PCPs to ask questions through our secure, asynchronous, web-based platform to more than 150 specialty groups. This offers increased access to specialist advice and helps to mitigate liability concerns relative to consultation practices due to the maintenance and provision of case records, while also facilitating clinician payment.

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Q: What is the CMPA’s position on PCPs and specialists using eConsult to provide patient care?

A: The CMPA (Canadian Medical Protective Association) has assessed the eConsult flow of care and determined that it provides an opportunity to improve efficiency, enhance patient care, expand access to specialists and provides a clear audit trail of the specialist’s advice given to the PCP for the suggested care of the patient.

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Q: Did a patient consent to this eConsult?

A: No, patient consent is implied in an eConsult as this interaction remains within the Circle of Care; however, PCPs may choose to advise their patient of their use of this tool. 

 

Q: Who is the Most Responsible Physician (MRP) during an eConsult?

A: When using the eConsult service, the PCP remains the MRP for the patient (i.e., when a specialist accepts an eConsult, it does not transfer the responsibility of care or decision-making to the specialist as may be the case with a normal referral).

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Q: How can I embed eConsult into my current workflow?

A: The flexibility of eConsult allows providers to incorporate the service into their workflow in a manner that minimizes interruption. For instance, physicians and nurse practitioners may not be the ones completing the eConsults directly. Instead, they may choose to delegate this responsibility to an assistant, office administrator or referral clerk, who will generate the eConsult based on EMR data or the clinician’s notes.

 

Q: What liability issues are associated with eConsult?

A: The Canadian Medical Protective Association (CMPA) holds eConsults to the same rules as other forms of consultation, including the traditional referral model and more informal "hallway consultations," in which providers discuss a patient's care outside of the clinic setting. The CMPA considered the eConsult service to be a safe and reasonable way to provide care.

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Q: What are the liability considerations for the specialist?

A: Similar to the advice given to a PCP through “hallway consultations”, specialists are accountable for any advice given via eConsult for patient care. eConsult provides a clear audit trail linking the specialist advice to the PCP and is subsequently documented in the patient’s record.

 

Q: How are providers paid?

A: Specialists receive compensation for completing eConsults at a rate of $220 per hour prorated to the amount of time it takes them to complete an eConsult case. Exceptions include non-physician specialists, who are compensated at a different rate, and salaried specialists, who complete eConsult as part of their clinic duties. ​

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Q: What about EMR Integration? 
A: EMR Integrations are not available for the Champlain eConsult BASE service but can be leveraged through the OTNhub using the Ontario eConsult Service. For more information see the Ontario eServices Program.

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Q: What is the Ontario eConsult Program?
A: The Ontario eConsult Program has been created to enable timely and equitable access to specialist advice for all patients in Ontario. The program integrates two successful initiatives: the BASE Managed Specialty model and the Ontario Telemedicine Network’s (OTN) Direct to Specialist model (enables the requesting provider to submit cases directly to individual specialists). The program includes four services: Champlain eConsult BASE™ regional service, Ontario eConsult Service, Teledermatology and Teleophthalmology.

 

Q: What is the BASE Managed Specialty model?
A: This option enables the requesting provider to submit cases to a regional or provincial managed service, which is a group of specialists responding to eConsult cases for a given specialty or sub-specialty (e.g. cardiology). The case is then assigned based on specialist availability.