Ontario’s Two-Model eConsult Service: Lessons from 26,000 Cases.

Long wait times for specialist care are a well-known challenge in Canada. To address this, Ontario launched a province-wide electronic consultation (eConsult) service in 2018, giving primary care providers (PCPs) access to specialist advice through two models: direct-to-specialist (DTS), where PCPs select a named specialist, and Building Access to Specialists through eConsultation (BASE), where cases are routed to the next available specialist within a managed pool.

A cross-sectional analysis examined over 26,000 eConsults submitted between October 2018 and September 2019. Two-thirds of cases were handled through BASE, which grew rapidly (66% increase), while DTS use grew modestly (6%). Importantly, both models produced similar outcomes. In more than half of cases, referrals initially considered were avoided (51% BASE, 53% DTS). PCPs reported that around 55% of cases led to new or additional clinical information, while about 41% confirmed an intended course of action.

Each model had distinct strengths. BASE promoted equity of access, especially for rural or underserved areas, and required only a small specialist pool to operate effectively. DTS was valued where PCPs had existing relationships with particular specialists or wanted continuity for patients needing in-person follow-up. Together, the models complemented each other, with many high-volume PCPs using both.

The study showed that Ontario’s dual-model system improved access, grew steadily among PCPs and specialists, and allowed flexibility to suit different clinical circumstances. For other regions considering eConsult, the findings suggest that offering multiple access pathways can increase uptake and improve equity of access to specialist advice.

Reference:
Guglani S, Liddy C, Afkham A, Mitchell R, Keely E. The Ontario Electronic Consultation (eConsult) Service: Cross-sectional Analysis of Utilization Data for 2 Models. JMIR Form Res. 2022;6(4):e32101. doi:10.2196/32101