PT  - JOURNAL ARTICLE
AU  - Clare Liddy
AU  - Aminu Bello
AU  - Jean Cook
AU  - Neil Drimer
AU  - Maxine Dumas Pilon
AU  - Gerard Farrell
AU  - Jodi Glassford
AU  - Laurie Ireland
AU  - Rana McDonald
AU  - Véronique Nabelsi
AU  - Luis Oppenheimer
AU  - Alex Singer
AU  - Erin Keely
TI  - Supporting the spread and scale-up of electronic consultation across Canada: cross-sectional analysis
AID  - 10.1136/bmjopen-2018-028888
DP  - 2019 May 01
TA  - BMJ Open
PG  - e028888
VI  - 9
IP  - 5
4099  - http://bmjopen.bmj.com/content/9/5/e028888.short
4100  - http://bmjopen.bmj.com/content/9/5/e028888.full
SO  - BMJ Open2019 May 01; 9
AB  - 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.