Ottawa

The doctor will email you now: CHEO pilot reduced unnecessary referrals

Dr. Lillian Lai shares the results of a pilot project at the Children's Hospital of Eastern Ontario that allowed family doctors to email her and other specialists with questions about their patients.

2-year e-consulting trial allowed family doctors to check in with variety of pediatric specialists

The study found unnecessary in-person visits with pediatric specialists were avoided about 37 per cent of the time. (John Konstantaras/Associated Press for Phonak)

Pediatric cardiologist Dr. Lillian Lai's young patients and their families sometimes have to wait more than a year for an appointment they don't end up needing — and all that waiting can be stressful.

So to speed things up, she and some of her colleagues at the Children's Hospital of Eastern Ontario (CHEO) took part in an e-consulting pilot project that allows family doctors to message specialists like her with questions about whether their patients need referrals.

The Champlain BASE program was created in 2009 by Drs. Clare Liddy and Erin Keely.

Among their adult patients, the primary doctors who took part reported better and faster access to the advice of specialists, and the process averted up to 40 per cent of face-to-face referrals.

To see how it would work for young patients, CHEO conducted its own pilot project from 2014 to 2016.

Dr. Lillian Lai, a pediatric cardiologist at the Children's Hospital of Eastern Ontario (CHEO), took part in a two-year e-consultation pilot project which allowed family doctors to ask questions of specialists by email. (Kristy Nease/CBC)

Unnecessary appointments averted

More than 1,000 eConsult requests from 367 primary caregivers were answered by 23 pediatric specialists representing 14 specialties, according to the study. The top three subjects were general pediatrics (36.9 per cent), orthopedics (15.2 per cent) and psychiatry (11.6 per cent).

On average it took less than a day for specialists to respond, and more than 60 per cent of the requests took fewer than 10 minutes for specialists to answer. About 37 per cent of the time, face-to-face referrals were unnecessary, according to the study.

Lai, who led the study, said she has seen a lot of unnecessary anxiety among young patients and their families who ended up not needing to see her in the first place.

"In the end, most times, some of the things that I see are completely normal, and they would never have had to be so anxious during that whole year [waiting to see me]. But because it was something that was not urgent, that's why they had to wait," she said.

Some patients even fly from remote locations such as Baffin Island, only to find out they didn't need to, Lai added.

'I'm doing more appropriate work'

"This is really improving, for me personally as a specialist, the type of patients that I see in my clinic. It's weeding out all the patients that don't need to be seen face-to-face, and so I'm doing more appropriate work in the hospital," Lai said.

"And if a patient needs to be seen and I've already discussed it with the family doctor, I can actually have them do all the tests that need to be done before they come, so when the patient actually comes to see me it's a much more worthwhile first-time encounter."

As for liability concerns,, Lai said specialists screen questions to look for potential problems.

"Definitely, as a specialist, when we go through the eConsult questions, if there is something that should not be answered that way we will tell them that a face-to-face is required," Lai said.

So far, the program isn't overburdening specialists with extra work. They get paid to answer the questions  — the money goes into a research pot at CHEO, according to Lai — and the specialists who took part in the pilot all recommended that it continue.

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