Panel Presentation: econsult. Dr. Rob McFadden, Chief of Respirology and Hospital Chief of Medicine, St. Joseph s Health Care

Transcription

1 Panel Presentation: econsult Dr. Rob McFadden, Chief of Respirology and Hospital Chief of Medicine, St. Joseph s Health Care 1

2 What is an econsult? An econsult occurs when a primary care provider (PCP) electronically sends a question to a specialist. 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. An econsult differs from an ereferral in that the patient does not have to go and see the specialist. The patient s condition is discussed between the patient s PCP and the specialist. With an ereferral, the patient goes to the specialist for an initial consultation after the PCP sends the specialist the referral information. 2

3 How will a Provincial econsult Service Benefit Ontario? Access Patient will receive more timely access to care, instead of experiencing a prolonged wait to see a specialist prior to treatment, some problems can be handled without a face to face consultation. Patient Centeredness The patient experience will be improved by the coordination of care between the PCP and specialist, and managed within the primary care setting. Integration Enables increased continuity of care and communication since the PCP and specialist will be more interactive in diagnosing and treating the patient. Efficiency Supports meaningful use of EMR and reduces unnecessary referrals. Effectiveness The right provider for the right problem at the right time, closer to real time. Equity Enables patients living in remote locations to access specialist advice which would not be immediately accessible with the traditional referral system. Move the patient s information, not the patient. Sustainability Offers the province an opportunity to reduce overall system costs by ensuring that patients with less complex conditions are considered quickly, instead of potentially experiencing health deterioration while waiting to see a specialist. Opportunities exist to decrease spending on Northern Travel Grants, multiple more expensive consults, and more effective test ordering. 3

4 Key Objectives of econsult Initiative The province aims to answer the following questions as a result of the econsult Initiative: 1. To what extent will the econsult service reduce wait times from PCP referral to specialist visit and improve the patient s overall experience? 2. How do we refine the features and functionality of the econsult service to accommodate PCP/Specialist workflow and provide a service that leverages existing provincial assets and investments? 3. What are the patient, provider and health system benefits of the econsult service? 4. How do these findings inform decisions on a virtual compensation model? 5. How do we maximize value out of the EMR investment to ensure adoption of the econsult service? 4

5 Participant Targets The provincial econsult Initiative will include 5-6 Regional Partner econsult sites to provide evidence-based results to inform decisions on a provincial econsult service. The partners are accountable for the targets below, which have been established in consultation with OntarioMD. econsult Regional Partners 1. Champlain LHIN BASE (currently exists) 2. LHIN/Hospital/Community (Region TBD) BASE (currently exists) Criteria for participation: # of PCPs # of Specialties # of econsults ~ ~ OTN (currently exists) ~ Toronto Central and Central LHIN Sunnybrook Health Sciences Centre North York General Hospital Toronto East General Hospital 5. South West LHIN London Health Sciences Centre St. Joseph s Health Centre 6. North East LHIN North Bay Regional Health Centre ~ ~ ~ TOTALS ~ Business Process Employs an assigner model Employs a direct Primary Care Provider to Specialist electronic model Three of the participating regional partners have a planned/existing econsult initiative (e.g. BASE Champlain, OTN, FAST) Additional regional partners were included to ensure geographic diversity (e.g. SW LHIN, TC LHIN, NE LHIN) of participants. 5

6 Implementation Plan (High-level) Phase 1 (Approx. duration: 12 months) 1. Assemble Steering Committee, Provider Advisory Group, and Requirements Working Group. 2. Initiate the econsult Regional Partners, and develop enhancements on OTN econsult platform. 3. Initiate requirements gathering process and select EMR vendors to determine EMR requirements and create draft econsult EMR Specification. 4. Complete the Benefits Evaluation to inform Go/No Go decision for Phase 2 (this Evaluation will also be a critical input to discussions regarding provincial compensation for virtual services). Phase 2 Go/No Go Decision 1. Initiate development of the OTN platform to integrate provincial requirements. 2. Develop EMR offerings to reflect requirements and begin the Ontario EMR specification & validation process. 3. Initiate onboarding of new and existing users onto provincial econsult service. 4. Potentially initiate expansion planning for the provincial econsult service to incorporate ereferral functionality. 6

7 Scope of Phase 1: Proof of Concept In Scope 5-6 regions using either BASE or OTN service model PCPs and specialists will request/respond to econsults using the respective services web-based platform OntarioMD & OTN will select 2-3 EMR Vendors to integrate with the OTN econsult service. This exercise will inform the development of a draft econsult EMR Specification The econsult Requirements Working Group will define requirements for a provincial econsult Service A 3 rd party vendor will complete a Benefits Evaluation which will inform the province on whether to proceed with a provincial econsult Service in Phase 2 Out of Scope Integration with hospital EHRs for specialists 7

8 Technology, Operations & Support Stream Business Stream Governance Framework STEERING COMMITTEE MEMBERSHIP MOHLTC OntarioMD OTN ehealth Ontario Chair of Provider Advisory Group Regional Cluster LHIN Leads Steering Committee MOHLTC Sponsor, Approval and Funding OntarioMD Initiative Lead Provider Advisory Group (PAG) PAG RESPONSIBILITIES: Benefits Evaluation Framework and process Learnings and best practices from econsult applications to determine Provincial econsult business requirements Phase 1 Regional Partners OTN Champlain BASE ehealth Ontario Recruit PCPs & specialists Promote use of econsult Service and EMR Adoption PAG participant Requirements Working Group participant Recruit PCPs & specialists Manages direct delivery model PAG participant Requirements Working Group participant Recruit PCPs & specialists Manages the case assigner delivery model PAG participant Requirements Working Group participant Benefits Evaluation Participant Requirements Working Group participant Authentication Develop, host & operate OTN platform Tier 1 / 2 Application Support Authentication Develop, host & operate BASE platform Tier 1 / 2 Application Support Provider Registry Alignment Architecture & Standards 8

9 econsult Participation Current State The South West LHIN has recruited: 58 Primary Care Practitioners as econsult Requestors 23 specialists as econsult Responders from the following specialties in LHSC and St. Joseph s 1. Geriatric Medicine (3) 2. Vascular Surgery (3) 3. Respirology (2) 4. Neurology (2) 5. Endocrinology (2) 6. Hematology (2) 7. Nephrology (2) 8. Perioperative Medicine (1) 9. Gastroenterology (1) 10. Renal Calculi (1) 11. General Internal Medicine (1) 12. Psychiatry (1) 13. Plastic surgery (1) 14. Orthopedics/shoulder (1) 9