Dr David Cooper: My perspective of eConsult, 5 years in

Dr David Cooper recently took part in a webinar about digital asynchronous consultations where he spoke about the patient and practice benefits of having used eConsult for the past 5 years. You can watch his presentation below, or have a read through some of the key benefits and examples he mentioned.

Old Machar Medical Practice was one of the very first users to pilot eConsult in Scotland in 2016. We’re a big practice with around 19,000 patients across two sites. We’ve got lots of doctors as well as various other locums, physiotherapists, pharmacists, counsellors – all of whom are doing eConsults. It goes to show that eConsults can be redirected to the most appropriate person and managed by the whole practice team, it’s not just your GPs picking them up.

We really took on the mantle of eConsults, or asynchronous consulting, mainly because of the way that it provides a slightly more controlled environment, rather than a two-way conversation by email. You can see all the patient’s information. I’m a massive fan of eConsult. It provides us with a brilliant way of getting the information that we need to make relatively straightforward decisions for most people. 

My own opinion is that actually, we cannot keep going the way that we used to do pre-pandemic. Without eConsults or an asynchronous system, we would never have managed to get through the pandemic as well as we did. 

The people that need appointments, which we’ve never been able to do, will get a face to face appointment that day, let alone wait three weeks to actually get a telephone consultation. So without this kind of software or way of consulting, we would have been in big trouble. 

Patient benefits

Patient preference

Patients have told us that it fits with their personal circumstances. People are working at home or they’re at work during practice hours; they’ve got busy lives. They don’t want to spend hours sitting in a waiting room because we’re running late. They prefer this as their way to interact with their GP, and personally, it’s how I interact with my GP. It gets the answers that I need as quickly and as efficiently as possible. 

Sensitive conditions

Some mental health patients find that this is the way that they’d much rather put their feelings and thoughts onto paper so they can think about them properly. Patients prefer online consultations for conditions that might be sensitive, things like mental health or sexual health.

Conveying information

People with language difficulties or understanding difficulties quite like it because we can send them lots more information via post-consult messaging. We can send links to patient information leaflets directly from the eConsult toolbar or clinical documents. We send our medical certificates via eConsult as an attachment so patients don’t have to come to the practice and collect them and we don’t have to post them to patients. 

Infection control

Safety considerations have come right to the fore during the pandemic, obviously, we have a lot fewer people coming into the waiting room. We are only seeing the people in our waiting room that we have to see. There’s an add-on from the eConsult view in that it does screen for COVID so we know that it’s been done even when we do need to bring patients in. 

Improved access

It’s hugely beneficial to the patient for access; you’re going to get a reply from your practice within hours. That doesn’t necessarily mean a resolution within that time frame, but a confirmation of the fact that we’ve got it. For example, if patients request a copy of their notes we can respond and say yes, but we’ll send you those when we can or as per the statutory requirements.

Appropriate care

The patient gets a response from the right person, so the musculoskeletal stuff goes to the physical therapist, the pharmacy questions go to the pharmacists, etc. If it’s not appropriate for it to come to us, we can easily reply back and just say no, actually, you need to be going somewhere more appropriate.

Self-help signposting

You’ve also got to remember that even before they actually send in a consultation, you’ve got things like signposting and self-health options that patients can get. We get told how many people have been redirected before they submit a consultation, but I think there are probably more that don’t reach us because they’ve got actual appropriate self-help information so definitely that’s a bonus of eConsult.

Improved care

From the practice perspective, and personally, I think eConsult does improve patient care because we can deal with the minor stuff a lot faster. Then we can provide a lot more capacity for the people who do need to be seen. We can point the people in the right direction with better educational input. To be honest, we’ve got lots and lots of people who just go direct to test or direct to referral – they send in photos or their symptoms and you’re able to say “Thanks very much, we’ll refer you” or “We’ll get this blood test done”.

Organisational benefits

COVID safety

We’ve had people working at home through either isolation or family members being sick, you can quite easily manage eConsults from home. And we certainly know that, if you are struggling from a practice point of view, you can get your eConsults done with some external help.

Workflow management

You can get eConsults sent to the right place at the right time. You can also turn it on based on availability and you can turn it off when you need to, even if that’s in the middle of the day. So for example, if something drastic happens in the practice and you turn it off, just be aware that the workload doesn’t go away, it just gets moved to some other time. 

Efficiency savings

Where before we would have ten-minute face to face slots, most of our clinicians can review an eConsult in between three and four minutes. So you can maybe help three patients in the same amount of time. We’ve also created an Excel sheet of stock responses for simple things like coughs, colds, sore backs or ankles that we can potentially copy and paste, which saves you quite a lot of time.

Predictability

We find the pattern and number of incoming eConsults are predictable. It helps you manage your workload and the number of staff you need to be able to deliver. Both in terms of volume and time distribution, you can actually work it out based on the data that eConsult provides you. So you do have to have your eye on that just to make sure you’ve got the rotas and staff in place.

Final thoughts

I think this is probably the way forward for remote consulting.  There are a few considerations for practices to think about but the eConsult team and other practices can help you or give you ideas about their set-up:

1. Work out what kind of model you’re going to use: total triage, an additional route into the practice, or some kind of hybrid.
2. Look at your clinical and administrative staff numbers and schedule.
3. Decide on who in your practice is going to process them and whether you will assign them to specific clinician lists and appointment slots or have them sit in a shared list that clinicians work from.
4. Training the staff and reworking processes to increase efficiency.

What we do

We decided to have set slots for our doctors to do eConsult in, and the number of slots depends on the number of doctors that are in and our predicted number of eConsults. 

We’ve tried keeping it on and also switching it off over the weekend. We found that people that would have otherwise put them in over the weekend just submit them on Monday. So it’s not a workload that disappears because you switch it off, it just comes in at a different time. My advice to people is, if you’re thinking about switching off evenings and weekends, be aware that it probably won’t change your numbers, it will just change when they come in to you.

We find the eConsult toolbar has been brilliant from a post-consult messaging perspective. It provides a range of response facilities from video consultations, telephone calls, email and text messages. 

It is a different way of consulting and doctors will need to learn how to do that. We all had to learn how to do consulting in the old traditional style, so you do need to learn how to do it in this new way too.