Connected Medicine: Enhancing Primary Care Access to Specialist Consult
People living in Canada often wait for specialist care after referral from a primary care provider. In a Commonwealth Fund survey in 2016, Canada placed last on specialist access among the 11 countries surveyed, with 56 percent of people living in Canada reporting that they wait four weeks or longer to see a specialist. 1
Enhancing connected medicine through new models of care
The Canadian Foundation for Healthcare Improvement (CFHI – now Healthcare Excellence Canada) partnered with Canada Health Infoway, the College of Family Physicians of Canada and the Royal College of Physicians and Surgeons of Canada to spread the adoption of two proven innovations that had substantially increased access to primary care specialty services.
Through this 18-month quality improvement collaborative, 11 teams from across Canada improved primary care provider access to specialist advice by adapting and implementing one or both of the RACE™ and Champlain BASE™ proven remote consult models of care. CFHI identified RACE™ through the EXTRA Executive Program.
RACE™ is a telephone advice line and app that originated at Providence Health Care and Vancouver Coastal Health in British Columbia, and BASE™ is a secure web-based eConsult service that originated with the Champlain Local Health Integration Network in Ontario.
The quality improvement collaborative built on the 2016-17 Connected Medicine e-collaborative in which 10 provincial/territorial and international teams came together to develop business cases and strategies to implement remote consult services in their jurisdictions.
Some of the participating teams have since joined HEC’s Momentum Challenge – an invitation-only program that assists teams which have completed a collaborative to expand the reach of the innovation and sustain its impact.
How Connected Medicine contributes to better healthcare in Canada
Connected Medicine is part of HEC’s ongoing efforts to spread and scale proven innovations that deliver high quality care closer to home and the community.
Through remote consultations, eligible patients can access specialist advice closer to home from primary care providers they know and trust. The process is typically faster than being referred for a face-to-face specialist appointment and often avoids unnecessary trips to the emergency department.
During the collaborative, more than 2,200 primary care providers participated in a remote consult service and continue to benefit from it – rapidly accessing specialist advice, typically within a week or less. By the end of the collaborative, more than 800 specialists had enrolled and were consulting through a BASE™ or RACE™-like service; the most common specialty service is psychiatry, followed by cardiology, nephrology, obstetrics/gynecology and pediatrics.
Between June 2017 and September 2019, patients took part in more than 19,000 remote consults with specialists.
Using an improvement collaborative to spread new models of care
Publicly-funded Canadian healthcare delivery organizations, ministries and providers participated in the Connected Medicine collaborative from June 2017 until September 2018. The collaborative focused on supporting teams in the spread and adaption of RACE™ and BASE™ – that improved primary care access to specialist advice through telephone services and digital technology.
Participating teams had up to $600,000 in seed funding available, in addition to support with the implementation, spread, scale and evaluation of the innovations within their project areas. Teams took part in a curriculum to enhance their quality improvement skills. This included educational webinars, in-person workshops, access to a network of expert faculty and coaches, and peer-to-peer networking.
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The Teams and Faculty
Connected Medicine Spread Collaborative Teams (2017 – 2018)
Calgary Zone Specialty Integration, Alberta
Canadian Forces Health Services, National
eConsult NB, New Brunswick
Fraser RACEApp Collaborative, British Columbia
Interior EASE (Electronic Access to Specialist Expertise), British Columbia
LINK 2.0, Saskatchewan
NL BASE™ eConsult Team, Newfoundland and Labrador
Providence Health Care eCASE team, British Columbia
RACE™ North, British Columbia
Quebec eConsult project, Quebec
Connected Medicine Spread Collaborative Faculty (2017 – 2018)
Dr. Clare Liddy, Clinical Investigator, CT Lamont Primary Health Care Research Centre, Bruyère Research Institute, co-founder of Champlain BASE™
Dr. Erin Keely, Endocrinologist, The Ottawa Hospital, co-founder of Champlain BASE™
Dr. Garey Mazowita, Clinical Professor, Faculty of Medicine, University of British Columbia
Margot Wilson, Director, Providence Health Care Chronic Disease Management Strategy
Jennifer Thornhill Verma, Senior Director, Canadian Foundation for Healthcare Improvement
Neil Drimer, Director of Programs, Canadian Foundation for Healthcare Improvement
Kirby Kirvan, Improvement Lead, Canadian Foundation for Healthcare Improvement
Connected Medicine e-Collaborative (2016 – 2017)
Department of Health and Social Services, Northwest Territories
Mater University of Queensland Centre for Primary Health Care Innovation/Mater Aged Care in an Emergency (MACIAE) – Mater Health Services, Brisbane, Australia
McGill University Health Centre: Neurosciences Mission, Montréal, Quebec
MonMedical Ltd. – UK National Health Service (NHS), Redditch, United Kingdom
New Brunswick Department of Health, Fredericton, New Brunswick Providence Health Care and Vancouver Coastal Health, Vancouver, British Columbia
Saskatchewan Health, Regina, Saskatchewan
St. Mary’s University – Halifax, Nova Scotia
University of Manitoba – Department of Family Medicine, Winnipeg, Manitoba
If one group had tried this project in isolation, it wouldn’t have worked. This was never a ‘top-down’ initiative. It was always seen as a true collaborative, with all stakeholders at the table.
Karla Faig, Healthcare Consultant, Department of Health, New Brunswick (2019)
1 Canadian Institute for Health Information, The Commonwealth Fund’s 2016 International Health Policy Survey of Adults in 11 Countries. Accessed via: https://www.cihi.ca/en/commonwealth-fund-survey-2016
