Scaling up eConsult for access to specialists in primary healthcare across four Canadian provinces: study protocol of a multiple case study

• Published in: Health research policy and systems Vol. 17; no. 1; p. 83
• Main Authors: Breton, Mylaine, Smithman, Mélanie Ann, Liddy, Clare, Keely, Erin, Farrell, Gerard, Singer, Alexander, Lamoureux-Lamarche, Catherine, Dumas Pilon, Maxine, Nabelsi, Véronique, Gaboury, Isabelle, Gagnon, Marie-Pierre, Steele Gray, Carolyn, Shaw, Jay, Hudon, Catherine, Aubrey-Bassler, Kris, Gagnon, Justin, Côté-Boileau, Élizabeth, Bush, Paula Louise
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 12.09.2019; BioMed Central; BMC
• Subjects: Access to healthcare; Canada; Case studies; E-health; eConsult; electronic consultation; Health care; Health care expenditures; Health care policy; Health services; Health Services Accessibility - organization & administration; Health Services Research - organization & administration; Humans; Innovations; Jurisdiction; Land; Learning; Literature reviews; Medical consultation; Medical research; Patient satisfaction; Patients; Physicians; Pilot projects; Policy analysis; Policy making; Primaries & caucuses; Primary care; Primary health care; Primary Health Care - methods; process research; Program Development; Provinces; Referral and Consultation - organization & administration; Remote Consultation - organization & administration; Scaling; Scaling up; Specialists; Specialization; Stakeholders; Study Protocol; Technology application; Canada; Manitoba Canada; Newfoundland & Labrador Canada; Quebec Canada; eConsult; scaling up; implementation; primary care; electronic consultation; process research; diffusion of innovation; Access to healthcare; policy
• ISSN: 1478-4505; 1478-4505
• DOI: 10.1186/s12961-019-0483-5

Canada has been referred to as the land of 'perpetual pilot projects'. Effective innovations often remain small in scale, with limited impact on health systems. Several innovations have been developed in Canada to tackle important challenges such as poor access to services and excessive wait times - one of the most promising innovations that has been piloted is eConsult, which is a model of asynchronous communication that allows primary care providers to electronically consult with specialists regarding their patients' medical issues. eConsult pilot projects have been shown to reduce wait times for specialist care, prevent unnecessary referrals and reduce health system costs. eConsult has been spread throughout Ontario as well as to certain regions in Manitoba, Quebec, and Newfoundland and Labrador. Our aim is to understand and support the scale-up process of eConsult in Ontario, Quebec, Manitoba, and Newfoundland and Labrador. Our specific objectives are to (1) describe the main components of eConsult relevant to the scale-up process in each province; (2) understand the eConsult scale-up process in each province and compare across provinces; (3) identify policy issues and strategies to scaling up eConsult in each province; and (4) foster cross-level and cross-jurisdictional learning on scaling up eConsult. We will conduct a qualitative multiple case study to investigate the scaling up of eConsult in four Canadian provinces using a grey literature review, key stakeholder interviews (10 interviews/province), non-participant observations, focus groups and deliberative dialogues. We will identify the main components of eConsult to be scaled up using logic models (obj. 1). Scaling up processes will be analysed using strategies adapted from process research (obj. 2). Policy issues and strategies to scale-up eConsult will be analysed thematically (obj. 3). Finally, a symposium will foster pan-Canadian learning on the process of scaling up eConsult (obj. 4). This study will likely increase learning and support evidence-based policy-making across participating provinces and may improve the capacity for a pan-Canadian scale-up of eConsult, including in provinces where eConsult has not yet been implemented. This work is essential to inform how similar innovations can reshape our health systems in the evolving information age.