Program Objectives

Waiting for specialist care is a significant health issue in Canada, with many patients waiting months for specialist appointments. The NL BASE™ eConsult service provides primary care providers (PCP) with an asynchronous electronic communication tool that allows them to communicate directly with specialists via a web-based portal so they can obtain advice about their patient’s care.

The NL BASE™ model and vision is that primary care providers and their patients will have equitable access to specialist advice through eConsult. Our goal is to facilitate the spread of our model so each Regional Health Authority in Newfoundland and Labrador will have access to eConsult services.

Role of PCPs

Any PCP that wishes to improve access to specialist advice on behalf of their patient is required to register for the NL BASE™ eConsult service and attend an orientation session (via telephone).

PCPs are responsible to manage each eConsult (or case) that they initiate. This includes ensuring they provide the specialist with sufficient information to answer their question, and using the highest standards to protect patient privacy and confidentiality. They are responsible for closing the case once the questions have been answered to their satisfaction, and completing the close out survey to help ensure the ongoing quality of the eConsult service.

Role of Specialists

Specialists responding to eConsults are responsible for providing an opinion based on the information included in the eConsult. If further information is required, or an opinion cannot be provided, this should be communicated to the PCP who submitted the question.  It is expected that the responding specialist will reply within seven (7) days of receiving the eConsult, and indicate their billing time for the purposes of remuneration. The billing times are processed quarterly based on the agreed pro-rated hourly rate for fee-for-service specialists.

Role of Delegates (if applicable)

In some circumstances, a PCP will delegate the responsibilities for entering/retrieving eConsult data to an appropriate staff member (i.e. referral clerk) within their practice, or use eConsult to support their residents to submit cases under their supervision. The PCP is responsible for ensuring that the delegate has the necessary training and credentials for this role, and is responsible for advising the NL BASE™ eConsult service when staff member no longer has a role as a delegate to the eConsult service.

Privacy and Confidentiality

The PCP submitting patient information maintains their role as health information custodian, as all direct collection of patient information is done within the originating provider circle of care, following all existing rules, regulations and laws. Individual PCPs, who are the custodians of the patient’s health information, provide sufficient information so that a specialist may provide needed healthcare advice and recommendations for treatment.

The eConsult service collects personal health information indirectly as its database is a secure repository for patient information submitted by a provider. Through a series of workflows, information is transferred from this database into forms which only the identified parties involved in the eConsult interaction can access.

Access to the eConsult system requires individualized user accounts and is password protected. Requesting PCPs will only have visibility of consultations created by them (or by a delegate on their behalf), while responding specialists will only have visibility of consultations assigned to them. PCPs that use delegates to input information on their behalf are required to notify the NL BASE™ eConsult service immediately once a delegate has changed roles or left the practice and should no longer have access on behalf of the assigning PCP.

The consultation response will be included in the record of the eConsult which can be accessed by the PCP following the closure of the case. The record can be downloaded by the PCP or their delegate and stored locally in paper or electronic formats. All privacy and security policies that apply to patient charts in the PCP office will apply to the consultation reply. 


Use of Data for Research and Quality Improvement Initiatives

The primary use of the data submitted through the NL BASE™ eConsult service will be to provide specialist advice to primary care or other PCPs sent on behalf of their patients.

Secondary use of the data may be used for quality improvement initiatives or to answer research questions. We do not combine or link personal information or personal health information as part of service operations. Linkage does occur using de-identified data as part of the research mandate, under the requirements for the use of data set by the research ethics board, and by the use of data sharing agreements when required.

All research data will be kept for 10 years after termination of the study and then destroyed.

Potential Risk

There is a potential risk that patients may prefer to see a specialist in person rather than have their PCP receive advice through an eConsultation. This process will not replace the need for all face to face consultations, and the PCP’s will be asked to discuss the rationale for the request for the eConsultation with the patient.

Contacts

If you have any questions about this program of research, you may contact: econsult@nlma.nl.ca.
 

If you have questions about the operations of the service or experience any problems with the service, you may contact service.desk@easternhealth.ca.

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* Consent

I have had an opportunity to read the information above and I understand the risks and benefits to me by participating in the service. I understand that I may withdraw at any time. I understand that the information may be published but my name will not be released in any publication or report associated with any research or quality improvement initiatives unless required by law

Participation is voluntary. I understand that by completing the registration process and participating in the eConsult service, my consent to participate in this service and program of research is implied.

User Account Information

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* Name:

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* Work Mailing Address (Please Include the Clinic or Hospital, Street Address, City/Town, and Postal Code):

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* Work Phone Number:

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* Preferred Email Address: 

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* Specialty

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* Regional Health Authority:

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