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Supporting the spread and scale-up of electronic consultation across Canada: cross-sectional analysis
  1. Clare Liddy1,2,
  2. Aminu Bello3,
  3. Jean Cook4,
  4. Neil Drimer5,
  5. Maxine Dumas Pilon6,
  6. Gerard Farrell7,
  7. Jodi Glassford8,
  8. Laurie Ireland9,
  9. Rana McDonald9,
  10. Véronique Nabelsi10,
  11. Luis Oppenheimer11,
  12. Alex Singer12,
  13. Erin Keely13,14
  1. 1 CT Lamont Primary Health Care Research Centre, Department of Family Medicine, University of Ottawa, Ottawa, Ontario, Canada
  2. 2 Bruyère Research Institute, Ottawa, Ontario, Canada
  3. 3 Department of Medicine, University of Alberta, Calgary, Alberta, Canada
  4. 4 Canadian Foundation for Healthcare Improvement, Ottawa, Ontario, Canada
  5. 5 Department of Family Medicine, McGill University, Montreal, Quebec, Canada
  6. 6 Newfoundland and Labrador Medical Association, St John’s, Newfoundland and Labrador, Canada
  7. 7 Department of Family Medicine, Memorial University, St John’s, Newfoundland and Labrador, Canada
  8. 8 Alberta Referral Pathways, Calgary, Alberta, Canada
  9. 9 Nine Circles Community Health Centre, Winnipeg, Manitoba, Canada
  10. 10 Université du Quebec en Outaouais, Gatineau, Quebec, Canada
  11. 11 Department of Surgery, University of Manitoba, Winnipeg, Manitoba, Canada
  12. 12 Department of Family Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
  13. 13 Division of Endocrinology/Metabolism, The Ottawa Hospital, Ottawa, Ontario, Canada
  14. 14 Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
  1. Correspondence to Dr Clare Liddy; cliddy{at}


Objective To examine the process of implementing an electronic consultation (eConsult) service and evaluate its impact along key metrics outlined by the Reach, Effectiveness, Adoption, Implementation and Maintenance (RE-AIM) framework.

Design Cross-sectional study.

Setting Clinics using eConsult in four provinces across Canada: Alberta, Manitoba, Quebec and Newfoundland and Labrador.

Participants All eConsult cases submitted in four participating provinces were included.

Intervention The eConsult service is a secure online application that allows primary care providers and specialists to communicate regarding a patient’s care. We measured the impact using system utilisation data and mandatory close-out surveys completed at the end of each eConsult.

Main outcome measures Implementation progress and impact were examined using the five categories outlined by the RE-AIM framework: reach, effectiveness, adoption, implementation and maintenance.

Results Four provinces provided data from different periods, ranging from 4 years (Alberta) to 10 months (Manitoba). Total cases completed ranged from 96 (Manitoba) to 6885 (Alberta). Newfoundland had the largest menu of available specialties (n=35), while Alberta and Quebec had the smallest (n=22). The most frequently requested groups varied across provinces, with only endocrinology appearing in the top five for all provinces. The average specialist response time ranged from 3 days (Manitoba) to 16.7 days (Alberta). Between 54% (Newfoundland) and 66% (Manitoba) of cases resulted in new or additional information. Primary care providers avoided completing referrals they had originally considered in 36% (Newfoundland) to 53% of cases (Manitoba), while only between 27 % (Quebec) and 29% (Newfoundland) of cases resulted in a referral. In every province, services demonstrated higher rates of usage in their last quarter of data than their first.

Conclusions eConsult was successfully implemented in four new provinces across Canada. Implementation strategies and scope varied, but services demonstrated substantial consistency on several key metrics, most notably on whether new information was learnt and impact on decision to refer.

  • primary care
  • eConsult
  • referral
  • access to care
  • wait times.

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  • Contributors CL and EK conceived of and designed the study, and contributed to the data analysis and drafting of the publication. AB, JC, MDP, GF, JG, LI, LO, RM, VN and AS contributed data to the study and were involved with its conception, conduct, analysis and reporting. ND contributed to its data analysis. All authors helped write and edit the manuscript and approved the final draft.

  • Funding Funding for this project was provided through the Canadian Institutes of Health Research. The authors affirm their independence from these funders. The funders played no part in the study design, collection,analysis or interpretation of the data, in the writing of the report or in the decision to submit the article for publication. All authors had full access to all the data in the study and can take responsibility for the integrity of the data and the accuracy of the data analysis.

  • Competing interests None declared.

  • Ethics approval This study was approved by the Ottawa Health Science Network Research Ethics Board (Protocol #2009848-01H).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement Data from the study are available from the corresponding author on reasonable request.

  • Patient consent for publication Not required.

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