Electronic system for non-urgent consultations proves valuable

VANCOUVER – Waiting for an in-person visit with a specialist can delay a patient’s treatment, especially if a confirmation of the referring physician’s initial treatment plan is all that’s required.

Waiting to see a specialist for a non-urgent case can also cause unnecessary stress for a patient.

Since the introduction of dr2dr Secure Messaging into Providence Health Care’s eCASE project this past year, however, healthcare providers are seeing greater improvements in patient care and treatment timeframes.

Providence Health Care now operates 17 sites in British Columbia. In 2016-2017, it had almost 635,000 patient visits and 118,000 ED visits alone.

In 2010, Providence Health Care launched Rapid Access to Consultative Expertise (RACE), an organized telephone-based service to connect GPs with specialists who could respond to urgent consultation requests over the phone within a two-hour timeframe.

As soon as RACE was introduced, the program was quickly picked up as both GPs and specialists recognized its potential. With RACE’s quick response time, urgent consultations could be dealt with almost immediately, expediting the treatment plans and care of patients.

However, as the adoption of RACE increased, Providence Health began to see an increased, non-urgent use. GPs wanted a system for clinical questions that might not be urgent, but still required a specialist’s consultation.

In 2017 Providence Health launched eCASE, electronic Consultative Access to Specialist Expertise, using Microquest’s dr2dr Secure Messaging Platform.

According to Providence Health Care, “for traditional referrals, patients might wait months to see a specialist, however, minor advice may be all that is needed.”

Enter dr2dr. Using a number of dr2dr’s built-in features, Providence Health Care created a unique consultation service: Specialists are grouped together based on their specialty, and given access to a clinic mailbox.

Depending on which specialist is on call, that specialist will be set to receive notifications when a new message has arrived in the clinic mailbox. When that specialist is done their on-call rotation, notifications are turned off for them and turned on for the next on-call specialist.

Providence Health Care has already started seeing dramatic results with dr2dr and eCASE. Since the pilot started, the majority of eCASE questions sent through dr2dr have avoided unnecessary specialist referrals.

For Dr. Micaela Coombs, dr2dr and eCASE have become a welcome tool for patient care. “As a rural family physician, I use eCASE frequently,” says Dr. Coombs. “The consultants are able to provide definitive, practical advice. It has allowed me to safely reduce the number of investigations and referrals I order. With each consultation I learn something new. And my patients are happy they don’t need to travel to see a specialist.”

In cases where a consultation with a specialist might be needed, but where that particular consult doesn’t require an in-person visit between the patient and specialist, dr2dr provides GPs the ability to still consult with a specialist.

“A recent case that I recall involved a question about some incidental findings on an echocardiogram, which was done on a 29 year old woman with a family history of bicuspid aortic valves,” recalls Dr. Brett Heilbron of St. Paul’s Hospital. “I was able to reassure the physician that the echo findings were likely of no clinical significance, and hence avoided the need for an office consultation.”

The value of dr2dr and the eCASE system has been recognized throughout the dr2dr user base.

“eCASE is a great tool for clinical care and for education,” says Dr. Stephane Voyer, General Internal Medicine at St. Paul’s Hospital. “I recently addressed a GP’s concerns about a DVT. There were questions about the need for a workup, the choice of agent to use, and the duration of treatment. I was able to answer the questions to the referring doctor’s satisfaction, providing an up-to-date, tailored plan, without having to bring the patient in for an in-person assessment. In my opinion, this provides incredible value for the patient.”