Rapid Access to Consultative Expertise An innovative model for shared care

Quality Forum 2014

February 2014

Margot Wilson RN MSN Director Chronic Disease Management Strategy PHC Dr Garey Mazowita Family Physician Shared Care Lead PHC

Background

Joint partnership between Providence Health Care and the Shared Care Committee in collaboration with Vancouver Coastal Health

Mission to improve care for patients with complex chronic conditions

bullSimplify the patient journey bullImprove outcomes bullReduce costs bullStrengthen relationships

Focus Groups

bullFamily physicians

bullSpecialists

bullPatients

Need for improved

bullCommunication

bullAccess to specialists

bullCollaboration and relationships

Rapid Access to Consultative Expertise RACE

bull One phone line with a selection of specialty services

bull Started in June 2010 with 5 services

bull Currently at 21 services with plans to increase

Current Services Vancouver Coastal Health bull Nephrology bull Heart Failure bull Psychiatry bull Respirology bull Endocrinology bull Cardiovascular Risk amp bull Lipid Management bull General Internal Medicine bull Geriatrics bull Geriatric Psychiatry bull Addictions Medicine bull Hand and Upper Limb Orthopedics bull Dermatology bull Obstetricsgynecology (May 2014)

Vancouver Coastal amp Fraser Health bull Cardiology bull Rheumatology

Provincial Services bull Child amp Adolescent Psychiatry bull Chronic Pain bull Treatment Resistant Psychosis bull HIV Primary Care bull Transgender Primary Care bull Cardiac Transplantation

Evaluation Key Themes

Phase 1 ndash questionnaireinterviews bull ldquoExcellent resourcerdquo

bull ldquoWould like to see it expandedrdquo bull Viewed as a service that could ldquohellipfill the gaphelliprdquo

Phase 2 ndash online survey bull High user satisfaction ndash all would use the service again 95 recommend usage

to colleagues bull All FPs noted that RACE

minus Reduced the number of unnecessary referrals to specialist care minus Prevented ED visits

Phase 3 ndash Interviewssurvey bull 83 of respondents believed it helped manage care for their patients

How RACE Impacts Practice

bull User-friendly decision support system bull Improves clinical judgment bull Receive medical education bull Increases knowledge capacity bull Enhances overall practice efficiencies

Results amp Outcomes

bull Improved patient amp provider experience

bull Improved efficiencies

bull Improved ED flow

bull Increased specialist capacity

Ii

(gt10000 calls data based on 20 of calls)

bull 80 of calls answered within 10 mins

bull 90 are lt15 min in length

bull 60 avoided face-to-face consults

bull 32 avoided ED visits

Reason for Call

bull General management diagnostic therapeutics

Recommendation

bull Medication additional testing reassurance of plan

Cost savings ndash up to $200call

Key Learnings from RACE bull One size does not fit all

bull Care to avoid replacing well established effective communication lines

bull No disruption of referral patterns

bull Requires criteria for specialist participation

ndash Response time collegial interaction knowledge transfer

bull Requires limited resources

ndash Coordination of schedulesre-routing numbers

ndash Medical Services Plan billing code

bull Patient participation was key in the design

bull Keep is simple

bull Be responsive

bull Marketing is key

RACE App

bull For iPhones and Androids bull No more listening to the

tedious VM bull To download - search

RACEconnect

Provincial Scale Up

RACE Process

Identify Needs Service requirements

Program management

Engage Marketplace

Collaboratively Decide

Identify Needs Providence Health

Care

Northern Partners in

Care

South Island Kootenay Boundary

Surrey North Delta

bull Held several team meetings bull Discussed options bull Need to make it

localregional bull Need to have some

consistency bull Need flexibility

Collaboratively Decide

Physicians Users

Providers

Partners Local Sites

bull We will need input from stakeholders

bull Need to select optimal strategy 1 vendor or multiple

bull Cost share bull Solution aligns with long term

plan bull Solution allows for integration

ldquo It is fantastic to be able to get answers immediately that I normally would either

bull refer to a specialist and have to wait months for an appointment

bull try and look up online but not be confident of the answer

bull play telephone tag or fax back and forth with a specialist regarding the clinical situation or

bull just take my best guess with the clinical situation

It has given me a level of professional satisfaction professional empowerment and improved patient carerdquo

Family practitioner frequent user of the RACE line

The Family Physician Perspective

ldquoI find myself educating pediatricians GPs and even other psychiatrists about more complicated psychiatric issues in children--- both sides of the conversation seem to enjoy the collaboration

I learn something about the types of patients and resources available to front-line clinicians and physicians and they learn something about child and adolescent psychiatryrdquo

Specialist provides service on the RACE line

The Specialist Perspective

Summary RACE has the potential to

bull Enhance the care experience by bull provide knowledge transfer bull improve the specialistprimary care interface through improved communication bull simplify the patient journey

bull Population health improved bull access to care is enhanced

bull Per capita cost of health care bull at least controlled

ndash avoidable consults and emergency visits

Online Resources on RACE bullhttpwwwRACEconnectca

bullhttpwwwyoutubecomwatchv=TQyKe0CKh_A

bullhttpswwwbcmaorgsuccess-stories

bullhttpblogsvancouversuncom20130918how-to-get-speedy-telephone-advice-from-medical-experts-the-race-program

bullhttpwwwcmajcacontentearly20131104cmaj109-4627fullpdf+html

Background

Joint partnership between Providence Health Care and the Shared Care Committee in collaboration with Vancouver Coastal Health

Mission to improve care for patients with complex chronic conditions

bullSimplify the patient journey bullImprove outcomes bullReduce costs bullStrengthen relationships

Focus Groups

bullFamily physicians

bullSpecialists

bullPatients

Need for improved

bullCommunication

bullAccess to specialists

bullCollaboration and relationships

Rapid Access to Consultative Expertise RACE

bull One phone line with a selection of specialty services

bull Started in June 2010 with 5 services

bull Currently at 21 services with plans to increase

Current Services Vancouver Coastal Health bull Nephrology bull Heart Failure bull Psychiatry bull Respirology bull Endocrinology bull Cardiovascular Risk amp bull Lipid Management bull General Internal Medicine bull Geriatrics bull Geriatric Psychiatry bull Addictions Medicine bull Hand and Upper Limb Orthopedics bull Dermatology bull Obstetricsgynecology (May 2014)

Vancouver Coastal amp Fraser Health bull Cardiology bull Rheumatology

Provincial Services bull Child amp Adolescent Psychiatry bull Chronic Pain bull Treatment Resistant Psychosis bull HIV Primary Care bull Transgender Primary Care bull Cardiac Transplantation

Evaluation Key Themes

Phase 1 ndash questionnaireinterviews bull ldquoExcellent resourcerdquo

bull ldquoWould like to see it expandedrdquo bull Viewed as a service that could ldquohellipfill the gaphelliprdquo

Phase 2 ndash online survey bull High user satisfaction ndash all would use the service again 95 recommend usage

to colleagues bull All FPs noted that RACE

minus Reduced the number of unnecessary referrals to specialist care minus Prevented ED visits

Phase 3 ndash Interviewssurvey bull 83 of respondents believed it helped manage care for their patients

How RACE Impacts Practice

bull User-friendly decision support system bull Improves clinical judgment bull Receive medical education bull Increases knowledge capacity bull Enhances overall practice efficiencies

Results amp Outcomes

bull Improved patient amp provider experience

bull Improved efficiencies

bull Improved ED flow

bull Increased specialist capacity

Ii

(gt10000 calls data based on 20 of calls)

bull 80 of calls answered within 10 mins

bull 90 are lt15 min in length

bull 60 avoided face-to-face consults

bull 32 avoided ED visits

Reason for Call

bull General management diagnostic therapeutics

Recommendation

bull Medication additional testing reassurance of plan

Cost savings ndash up to $200call

Key Learnings from RACE bull One size does not fit all

bull Care to avoid replacing well established effective communication lines

bull No disruption of referral patterns

bull Requires criteria for specialist participation

ndash Response time collegial interaction knowledge transfer

bull Requires limited resources

ndash Coordination of schedulesre-routing numbers

ndash Medical Services Plan billing code

bull Patient participation was key in the design

bull Keep is simple

bull Be responsive

bull Marketing is key

RACE App

bull For iPhones and Androids bull No more listening to the

tedious VM bull To download - search

RACEconnect

Provincial Scale Up

RACE Process

Identify Needs Service requirements

Program management

Engage Marketplace

Collaboratively Decide

Identify Needs Providence Health

Care

Northern Partners in

Care

South Island Kootenay Boundary

Surrey North Delta

bull Held several team meetings bull Discussed options bull Need to make it

localregional bull Need to have some

consistency bull Need flexibility

Collaboratively Decide

Physicians Users

Providers

Partners Local Sites

bull We will need input from stakeholders

bull Need to select optimal strategy 1 vendor or multiple

bull Cost share bull Solution aligns with long term

plan bull Solution allows for integration

ldquo It is fantastic to be able to get answers immediately that I normally would either

bull refer to a specialist and have to wait months for an appointment

bull try and look up online but not be confident of the answer

bull play telephone tag or fax back and forth with a specialist regarding the clinical situation or

bull just take my best guess with the clinical situation

It has given me a level of professional satisfaction professional empowerment and improved patient carerdquo

Family practitioner frequent user of the RACE line

The Family Physician Perspective

ldquoI find myself educating pediatricians GPs and even other psychiatrists about more complicated psychiatric issues in children--- both sides of the conversation seem to enjoy the collaboration

I learn something about the types of patients and resources available to front-line clinicians and physicians and they learn something about child and adolescent psychiatryrdquo

Specialist provides service on the RACE line

The Specialist Perspective

Summary RACE has the potential to

bull Enhance the care experience by bull provide knowledge transfer bull improve the specialistprimary care interface through improved communication bull simplify the patient journey

bull Population health improved bull access to care is enhanced

bull Per capita cost of health care bull at least controlled

ndash avoidable consults and emergency visits

Online Resources on RACE bullhttpwwwRACEconnectca

bullhttpwwwyoutubecomwatchv=TQyKe0CKh_A

bullhttpswwwbcmaorgsuccess-stories

bullhttpblogsvancouversuncom20130918how-to-get-speedy-telephone-advice-from-medical-experts-the-race-program

bullhttpwwwcmajcacontentearly20131104cmaj109-4627fullpdf+html

Focus Groups

bullFamily physicians

bullSpecialists

bullPatients

Need for improved

bullCommunication

bullAccess to specialists

bullCollaboration and relationships

Rapid Access to Consultative Expertise RACE

bull One phone line with a selection of specialty services

bull Started in June 2010 with 5 services

bull Currently at 21 services with plans to increase

Current Services Vancouver Coastal Health bull Nephrology bull Heart Failure bull Psychiatry bull Respirology bull Endocrinology bull Cardiovascular Risk amp bull Lipid Management bull General Internal Medicine bull Geriatrics bull Geriatric Psychiatry bull Addictions Medicine bull Hand and Upper Limb Orthopedics bull Dermatology bull Obstetricsgynecology (May 2014)

Vancouver Coastal amp Fraser Health bull Cardiology bull Rheumatology

Provincial Services bull Child amp Adolescent Psychiatry bull Chronic Pain bull Treatment Resistant Psychosis bull HIV Primary Care bull Transgender Primary Care bull Cardiac Transplantation

Evaluation Key Themes

Phase 1 ndash questionnaireinterviews bull ldquoExcellent resourcerdquo

bull ldquoWould like to see it expandedrdquo bull Viewed as a service that could ldquohellipfill the gaphelliprdquo

Phase 2 ndash online survey bull High user satisfaction ndash all would use the service again 95 recommend usage

to colleagues bull All FPs noted that RACE

minus Reduced the number of unnecessary referrals to specialist care minus Prevented ED visits

Phase 3 ndash Interviewssurvey bull 83 of respondents believed it helped manage care for their patients

How RACE Impacts Practice

bull User-friendly decision support system bull Improves clinical judgment bull Receive medical education bull Increases knowledge capacity bull Enhances overall practice efficiencies

Results amp Outcomes

bull Improved patient amp provider experience

bull Improved efficiencies

bull Improved ED flow

bull Increased specialist capacity

Ii

(gt10000 calls data based on 20 of calls)

bull 80 of calls answered within 10 mins

bull 90 are lt15 min in length

bull 60 avoided face-to-face consults

bull 32 avoided ED visits

Reason for Call

bull General management diagnostic therapeutics

Recommendation

bull Medication additional testing reassurance of plan

Cost savings ndash up to $200call

Key Learnings from RACE bull One size does not fit all

bull Care to avoid replacing well established effective communication lines

bull No disruption of referral patterns

bull Requires criteria for specialist participation

ndash Response time collegial interaction knowledge transfer

bull Requires limited resources

ndash Coordination of schedulesre-routing numbers

ndash Medical Services Plan billing code

bull Patient participation was key in the design

bull Keep is simple

bull Be responsive

bull Marketing is key

RACE App

bull For iPhones and Androids bull No more listening to the

tedious VM bull To download - search

RACEconnect

Provincial Scale Up

RACE Process

Identify Needs Service requirements

Program management

Engage Marketplace

Collaboratively Decide

Identify Needs Providence Health

Care

Northern Partners in

Care

South Island Kootenay Boundary

Surrey North Delta

bull Held several team meetings bull Discussed options bull Need to make it

localregional bull Need to have some

consistency bull Need flexibility

Collaboratively Decide

Physicians Users

Providers

Partners Local Sites

bull We will need input from stakeholders

bull Need to select optimal strategy 1 vendor or multiple

bull Cost share bull Solution aligns with long term

plan bull Solution allows for integration

ldquo It is fantastic to be able to get answers immediately that I normally would either

bull refer to a specialist and have to wait months for an appointment

bull try and look up online but not be confident of the answer

bull play telephone tag or fax back and forth with a specialist regarding the clinical situation or

bull just take my best guess with the clinical situation

It has given me a level of professional satisfaction professional empowerment and improved patient carerdquo

Family practitioner frequent user of the RACE line

The Family Physician Perspective

ldquoI find myself educating pediatricians GPs and even other psychiatrists about more complicated psychiatric issues in children--- both sides of the conversation seem to enjoy the collaboration

I learn something about the types of patients and resources available to front-line clinicians and physicians and they learn something about child and adolescent psychiatryrdquo

Specialist provides service on the RACE line

The Specialist Perspective

Summary RACE has the potential to

bull Enhance the care experience by bull provide knowledge transfer bull improve the specialistprimary care interface through improved communication bull simplify the patient journey

bull Population health improved bull access to care is enhanced

bull Per capita cost of health care bull at least controlled

ndash avoidable consults and emergency visits

Online Resources on RACE bullhttpwwwRACEconnectca

bullhttpwwwyoutubecomwatchv=TQyKe0CKh_A

bullhttpswwwbcmaorgsuccess-stories

bullhttpblogsvancouversuncom20130918how-to-get-speedy-telephone-advice-from-medical-experts-the-race-program

bullhttpwwwcmajcacontentearly20131104cmaj109-4627fullpdf+html

Rapid Access to Consultative Expertise RACE

bull One phone line with a selection of specialty services

bull Started in June 2010 with 5 services

bull Currently at 21 services with plans to increase

Current Services Vancouver Coastal Health bull Nephrology bull Heart Failure bull Psychiatry bull Respirology bull Endocrinology bull Cardiovascular Risk amp bull Lipid Management bull General Internal Medicine bull Geriatrics bull Geriatric Psychiatry bull Addictions Medicine bull Hand and Upper Limb Orthopedics bull Dermatology bull Obstetricsgynecology (May 2014)

Vancouver Coastal amp Fraser Health bull Cardiology bull Rheumatology

Provincial Services bull Child amp Adolescent Psychiatry bull Chronic Pain bull Treatment Resistant Psychosis bull HIV Primary Care bull Transgender Primary Care bull Cardiac Transplantation

Evaluation Key Themes

Phase 1 ndash questionnaireinterviews bull ldquoExcellent resourcerdquo

bull ldquoWould like to see it expandedrdquo bull Viewed as a service that could ldquohellipfill the gaphelliprdquo

Phase 2 ndash online survey bull High user satisfaction ndash all would use the service again 95 recommend usage

to colleagues bull All FPs noted that RACE

minus Reduced the number of unnecessary referrals to specialist care minus Prevented ED visits

Phase 3 ndash Interviewssurvey bull 83 of respondents believed it helped manage care for their patients

How RACE Impacts Practice

bull User-friendly decision support system bull Improves clinical judgment bull Receive medical education bull Increases knowledge capacity bull Enhances overall practice efficiencies

Results amp Outcomes

bull Improved patient amp provider experience

bull Improved efficiencies

bull Improved ED flow

bull Increased specialist capacity

Ii

(gt10000 calls data based on 20 of calls)

bull 80 of calls answered within 10 mins

bull 90 are lt15 min in length

bull 60 avoided face-to-face consults

bull 32 avoided ED visits

Reason for Call

bull General management diagnostic therapeutics

Recommendation

bull Medication additional testing reassurance of plan

Cost savings ndash up to $200call

Key Learnings from RACE bull One size does not fit all

bull Care to avoid replacing well established effective communication lines

bull No disruption of referral patterns

bull Requires criteria for specialist participation

ndash Response time collegial interaction knowledge transfer

bull Requires limited resources

ndash Coordination of schedulesre-routing numbers

ndash Medical Services Plan billing code

bull Patient participation was key in the design

bull Keep is simple

bull Be responsive

bull Marketing is key

RACE App

bull For iPhones and Androids bull No more listening to the

tedious VM bull To download - search

RACEconnect

Provincial Scale Up

RACE Process

Identify Needs Service requirements

Program management

Engage Marketplace

Collaboratively Decide

Identify Needs Providence Health

Care

Northern Partners in

Care

South Island Kootenay Boundary

Surrey North Delta

bull Held several team meetings bull Discussed options bull Need to make it

localregional bull Need to have some

consistency bull Need flexibility

Collaboratively Decide

Physicians Users

Providers

Partners Local Sites

bull We will need input from stakeholders

bull Need to select optimal strategy 1 vendor or multiple

bull Cost share bull Solution aligns with long term

plan bull Solution allows for integration

ldquo It is fantastic to be able to get answers immediately that I normally would either

bull refer to a specialist and have to wait months for an appointment

bull try and look up online but not be confident of the answer

bull play telephone tag or fax back and forth with a specialist regarding the clinical situation or

bull just take my best guess with the clinical situation

It has given me a level of professional satisfaction professional empowerment and improved patient carerdquo

Family practitioner frequent user of the RACE line

The Family Physician Perspective

ldquoI find myself educating pediatricians GPs and even other psychiatrists about more complicated psychiatric issues in children--- both sides of the conversation seem to enjoy the collaboration

I learn something about the types of patients and resources available to front-line clinicians and physicians and they learn something about child and adolescent psychiatryrdquo

Specialist provides service on the RACE line

The Specialist Perspective

Summary RACE has the potential to

bull Enhance the care experience by bull provide knowledge transfer bull improve the specialistprimary care interface through improved communication bull simplify the patient journey

bull Population health improved bull access to care is enhanced

bull Per capita cost of health care bull at least controlled

ndash avoidable consults and emergency visits

Online Resources on RACE bullhttpwwwRACEconnectca

bullhttpwwwyoutubecomwatchv=TQyKe0CKh_A

bullhttpswwwbcmaorgsuccess-stories

bullhttpblogsvancouversuncom20130918how-to-get-speedy-telephone-advice-from-medical-experts-the-race-program

bullhttpwwwcmajcacontentearly20131104cmaj109-4627fullpdf+html

Current Services Vancouver Coastal Health bull Nephrology bull Heart Failure bull Psychiatry bull Respirology bull Endocrinology bull Cardiovascular Risk amp bull Lipid Management bull General Internal Medicine bull Geriatrics bull Geriatric Psychiatry bull Addictions Medicine bull Hand and Upper Limb Orthopedics bull Dermatology bull Obstetricsgynecology (May 2014)

Vancouver Coastal amp Fraser Health bull Cardiology bull Rheumatology

Provincial Services bull Child amp Adolescent Psychiatry bull Chronic Pain bull Treatment Resistant Psychosis bull HIV Primary Care bull Transgender Primary Care bull Cardiac Transplantation

Evaluation Key Themes

Phase 1 ndash questionnaireinterviews bull ldquoExcellent resourcerdquo

bull ldquoWould like to see it expandedrdquo bull Viewed as a service that could ldquohellipfill the gaphelliprdquo

Phase 2 ndash online survey bull High user satisfaction ndash all would use the service again 95 recommend usage

to colleagues bull All FPs noted that RACE

minus Reduced the number of unnecessary referrals to specialist care minus Prevented ED visits

Phase 3 ndash Interviewssurvey bull 83 of respondents believed it helped manage care for their patients

How RACE Impacts Practice

bull User-friendly decision support system bull Improves clinical judgment bull Receive medical education bull Increases knowledge capacity bull Enhances overall practice efficiencies

Results amp Outcomes

bull Improved patient amp provider experience

bull Improved efficiencies

bull Improved ED flow

bull Increased specialist capacity

Ii

(gt10000 calls data based on 20 of calls)

bull 80 of calls answered within 10 mins

bull 90 are lt15 min in length

bull 60 avoided face-to-face consults

bull 32 avoided ED visits

Reason for Call

bull General management diagnostic therapeutics

Recommendation

bull Medication additional testing reassurance of plan

Cost savings ndash up to $200call

Key Learnings from RACE bull One size does not fit all

bull Care to avoid replacing well established effective communication lines

bull No disruption of referral patterns

bull Requires criteria for specialist participation

ndash Response time collegial interaction knowledge transfer

bull Requires limited resources

ndash Coordination of schedulesre-routing numbers

ndash Medical Services Plan billing code

bull Patient participation was key in the design

bull Keep is simple

bull Be responsive

bull Marketing is key

RACE App

bull For iPhones and Androids bull No more listening to the

tedious VM bull To download - search

RACEconnect

Provincial Scale Up

RACE Process

Identify Needs Service requirements

Program management

Engage Marketplace

Collaboratively Decide

Identify Needs Providence Health

Care

Northern Partners in

Care

South Island Kootenay Boundary

Surrey North Delta

bull Held several team meetings bull Discussed options bull Need to make it

localregional bull Need to have some

consistency bull Need flexibility

Collaboratively Decide

Physicians Users

Providers

Partners Local Sites

bull We will need input from stakeholders

bull Need to select optimal strategy 1 vendor or multiple

bull Cost share bull Solution aligns with long term

plan bull Solution allows for integration

ldquo It is fantastic to be able to get answers immediately that I normally would either

bull refer to a specialist and have to wait months for an appointment

bull try and look up online but not be confident of the answer

bull play telephone tag or fax back and forth with a specialist regarding the clinical situation or

bull just take my best guess with the clinical situation

It has given me a level of professional satisfaction professional empowerment and improved patient carerdquo

Family practitioner frequent user of the RACE line

The Family Physician Perspective

ldquoI find myself educating pediatricians GPs and even other psychiatrists about more complicated psychiatric issues in children--- both sides of the conversation seem to enjoy the collaboration

I learn something about the types of patients and resources available to front-line clinicians and physicians and they learn something about child and adolescent psychiatryrdquo

Specialist provides service on the RACE line

The Specialist Perspective

Summary RACE has the potential to

bull Enhance the care experience by bull provide knowledge transfer bull improve the specialistprimary care interface through improved communication bull simplify the patient journey

bull Population health improved bull access to care is enhanced

bull Per capita cost of health care bull at least controlled

ndash avoidable consults and emergency visits

Online Resources on RACE bullhttpwwwRACEconnectca

bullhttpwwwyoutubecomwatchv=TQyKe0CKh_A

bullhttpswwwbcmaorgsuccess-stories

bullhttpblogsvancouversuncom20130918how-to-get-speedy-telephone-advice-from-medical-experts-the-race-program

bullhttpwwwcmajcacontentearly20131104cmaj109-4627fullpdf+html

Evaluation Key Themes

Phase 1 ndash questionnaireinterviews bull ldquoExcellent resourcerdquo

bull ldquoWould like to see it expandedrdquo bull Viewed as a service that could ldquohellipfill the gaphelliprdquo

Phase 2 ndash online survey bull High user satisfaction ndash all would use the service again 95 recommend usage

to colleagues bull All FPs noted that RACE

minus Reduced the number of unnecessary referrals to specialist care minus Prevented ED visits

Phase 3 ndash Interviewssurvey bull 83 of respondents believed it helped manage care for their patients

How RACE Impacts Practice

bull User-friendly decision support system bull Improves clinical judgment bull Receive medical education bull Increases knowledge capacity bull Enhances overall practice efficiencies

Results amp Outcomes

bull Improved patient amp provider experience

bull Improved efficiencies

bull Improved ED flow

bull Increased specialist capacity

Ii

(gt10000 calls data based on 20 of calls)

bull 80 of calls answered within 10 mins

bull 90 are lt15 min in length

bull 60 avoided face-to-face consults

bull 32 avoided ED visits

Reason for Call

bull General management diagnostic therapeutics

Recommendation

bull Medication additional testing reassurance of plan

Cost savings ndash up to $200call

Key Learnings from RACE bull One size does not fit all

bull Care to avoid replacing well established effective communication lines

bull No disruption of referral patterns

bull Requires criteria for specialist participation

ndash Response time collegial interaction knowledge transfer

bull Requires limited resources

ndash Coordination of schedulesre-routing numbers

ndash Medical Services Plan billing code

bull Patient participation was key in the design

bull Keep is simple

bull Be responsive

bull Marketing is key

RACE App

bull For iPhones and Androids bull No more listening to the

tedious VM bull To download - search

RACEconnect

Provincial Scale Up

RACE Process

Identify Needs Service requirements

Program management

Engage Marketplace

Collaboratively Decide

Identify Needs Providence Health

Care

Northern Partners in

Care

South Island Kootenay Boundary

Surrey North Delta

bull Held several team meetings bull Discussed options bull Need to make it

localregional bull Need to have some

consistency bull Need flexibility

Collaboratively Decide

Physicians Users

Providers

Partners Local Sites

bull We will need input from stakeholders

bull Need to select optimal strategy 1 vendor or multiple

bull Cost share bull Solution aligns with long term

plan bull Solution allows for integration

ldquo It is fantastic to be able to get answers immediately that I normally would either

bull refer to a specialist and have to wait months for an appointment

bull try and look up online but not be confident of the answer

bull play telephone tag or fax back and forth with a specialist regarding the clinical situation or

bull just take my best guess with the clinical situation

It has given me a level of professional satisfaction professional empowerment and improved patient carerdquo

Family practitioner frequent user of the RACE line

The Family Physician Perspective

ldquoI find myself educating pediatricians GPs and even other psychiatrists about more complicated psychiatric issues in children--- both sides of the conversation seem to enjoy the collaboration

I learn something about the types of patients and resources available to front-line clinicians and physicians and they learn something about child and adolescent psychiatryrdquo

Specialist provides service on the RACE line

The Specialist Perspective

Summary RACE has the potential to

bull Enhance the care experience by bull provide knowledge transfer bull improve the specialistprimary care interface through improved communication bull simplify the patient journey

bull Population health improved bull access to care is enhanced

bull Per capita cost of health care bull at least controlled

ndash avoidable consults and emergency visits

Online Resources on RACE bullhttpwwwRACEconnectca

bullhttpwwwyoutubecomwatchv=TQyKe0CKh_A

bullhttpswwwbcmaorgsuccess-stories

bullhttpblogsvancouversuncom20130918how-to-get-speedy-telephone-advice-from-medical-experts-the-race-program

bullhttpwwwcmajcacontentearly20131104cmaj109-4627fullpdf+html

How RACE Impacts Practice

bull User-friendly decision support system bull Improves clinical judgment bull Receive medical education bull Increases knowledge capacity bull Enhances overall practice efficiencies

Results amp Outcomes

bull Improved patient amp provider experience

bull Improved efficiencies

bull Improved ED flow

bull Increased specialist capacity

Ii

(gt10000 calls data based on 20 of calls)

bull 80 of calls answered within 10 mins

bull 90 are lt15 min in length

bull 60 avoided face-to-face consults

bull 32 avoided ED visits

Reason for Call

bull General management diagnostic therapeutics

Recommendation

bull Medication additional testing reassurance of plan

Cost savings ndash up to $200call

Key Learnings from RACE bull One size does not fit all

bull Care to avoid replacing well established effective communication lines

bull No disruption of referral patterns

bull Requires criteria for specialist participation

ndash Response time collegial interaction knowledge transfer

bull Requires limited resources

ndash Coordination of schedulesre-routing numbers

ndash Medical Services Plan billing code

bull Patient participation was key in the design

bull Keep is simple

bull Be responsive

bull Marketing is key

RACE App

bull For iPhones and Androids bull No more listening to the

tedious VM bull To download - search

RACEconnect

Provincial Scale Up

RACE Process

Identify Needs Service requirements

Program management

Engage Marketplace

Collaboratively Decide

Identify Needs Providence Health

Care

Northern Partners in

Care

South Island Kootenay Boundary

Surrey North Delta

bull Held several team meetings bull Discussed options bull Need to make it

localregional bull Need to have some

consistency bull Need flexibility

Collaboratively Decide

Physicians Users

Providers

Partners Local Sites

bull We will need input from stakeholders

bull Need to select optimal strategy 1 vendor or multiple

bull Cost share bull Solution aligns with long term

plan bull Solution allows for integration

ldquo It is fantastic to be able to get answers immediately that I normally would either

bull refer to a specialist and have to wait months for an appointment

bull try and look up online but not be confident of the answer

bull play telephone tag or fax back and forth with a specialist regarding the clinical situation or

bull just take my best guess with the clinical situation

It has given me a level of professional satisfaction professional empowerment and improved patient carerdquo

Family practitioner frequent user of the RACE line

The Family Physician Perspective

ldquoI find myself educating pediatricians GPs and even other psychiatrists about more complicated psychiatric issues in children--- both sides of the conversation seem to enjoy the collaboration

I learn something about the types of patients and resources available to front-line clinicians and physicians and they learn something about child and adolescent psychiatryrdquo

Specialist provides service on the RACE line

The Specialist Perspective

Summary RACE has the potential to

bull Enhance the care experience by bull provide knowledge transfer bull improve the specialistprimary care interface through improved communication bull simplify the patient journey

bull Population health improved bull access to care is enhanced

bull Per capita cost of health care bull at least controlled

ndash avoidable consults and emergency visits

Online Resources on RACE bullhttpwwwRACEconnectca

bullhttpwwwyoutubecomwatchv=TQyKe0CKh_A

bullhttpswwwbcmaorgsuccess-stories

bullhttpblogsvancouversuncom20130918how-to-get-speedy-telephone-advice-from-medical-experts-the-race-program

bullhttpwwwcmajcacontentearly20131104cmaj109-4627fullpdf+html

Results amp Outcomes

bull Improved patient amp provider experience

bull Improved efficiencies

bull Improved ED flow

bull Increased specialist capacity

Ii

(gt10000 calls data based on 20 of calls)

bull 80 of calls answered within 10 mins

bull 90 are lt15 min in length

bull 60 avoided face-to-face consults

bull 32 avoided ED visits

Reason for Call

bull General management diagnostic therapeutics

Recommendation

bull Medication additional testing reassurance of plan

Cost savings ndash up to $200call

Key Learnings from RACE bull One size does not fit all

bull Care to avoid replacing well established effective communication lines

bull No disruption of referral patterns

bull Requires criteria for specialist participation

ndash Response time collegial interaction knowledge transfer

bull Requires limited resources

ndash Coordination of schedulesre-routing numbers

ndash Medical Services Plan billing code

bull Patient participation was key in the design

bull Keep is simple

bull Be responsive

bull Marketing is key

RACE App

bull For iPhones and Androids bull No more listening to the

tedious VM bull To download - search

RACEconnect

Provincial Scale Up

RACE Process

Identify Needs Service requirements

Program management

Engage Marketplace

Collaboratively Decide

Identify Needs Providence Health

Care

Northern Partners in

Care

South Island Kootenay Boundary

Surrey North Delta

bull Held several team meetings bull Discussed options bull Need to make it

localregional bull Need to have some

consistency bull Need flexibility

Collaboratively Decide

Physicians Users

Providers

Partners Local Sites

bull We will need input from stakeholders

bull Need to select optimal strategy 1 vendor or multiple

bull Cost share bull Solution aligns with long term

plan bull Solution allows for integration

ldquo It is fantastic to be able to get answers immediately that I normally would either

bull refer to a specialist and have to wait months for an appointment

bull try and look up online but not be confident of the answer

bull play telephone tag or fax back and forth with a specialist regarding the clinical situation or

bull just take my best guess with the clinical situation

It has given me a level of professional satisfaction professional empowerment and improved patient carerdquo

Family practitioner frequent user of the RACE line

The Family Physician Perspective

ldquoI find myself educating pediatricians GPs and even other psychiatrists about more complicated psychiatric issues in children--- both sides of the conversation seem to enjoy the collaboration

I learn something about the types of patients and resources available to front-line clinicians and physicians and they learn something about child and adolescent psychiatryrdquo

Specialist provides service on the RACE line

The Specialist Perspective

Summary RACE has the potential to

bull Enhance the care experience by bull provide knowledge transfer bull improve the specialistprimary care interface through improved communication bull simplify the patient journey

bull Population health improved bull access to care is enhanced

bull Per capita cost of health care bull at least controlled

ndash avoidable consults and emergency visits

Online Resources on RACE bullhttpwwwRACEconnectca

bullhttpwwwyoutubecomwatchv=TQyKe0CKh_A

bullhttpswwwbcmaorgsuccess-stories

bullhttpblogsvancouversuncom20130918how-to-get-speedy-telephone-advice-from-medical-experts-the-race-program

bullhttpwwwcmajcacontentearly20131104cmaj109-4627fullpdf+html

Key Learnings from RACE bull One size does not fit all

bull Care to avoid replacing well established effective communication lines

bull No disruption of referral patterns

bull Requires criteria for specialist participation

ndash Response time collegial interaction knowledge transfer

bull Requires limited resources

ndash Coordination of schedulesre-routing numbers

ndash Medical Services Plan billing code

bull Patient participation was key in the design

bull Keep is simple

bull Be responsive

bull Marketing is key

RACE App

bull For iPhones and Androids bull No more listening to the

tedious VM bull To download - search

RACEconnect

Provincial Scale Up

RACE Process

Identify Needs Service requirements

Program management

Engage Marketplace

Collaboratively Decide

Identify Needs Providence Health

Care

Northern Partners in

Care

South Island Kootenay Boundary

Surrey North Delta

bull Held several team meetings bull Discussed options bull Need to make it

localregional bull Need to have some

consistency bull Need flexibility

Collaboratively Decide

Physicians Users

Providers

Partners Local Sites

bull We will need input from stakeholders

bull Need to select optimal strategy 1 vendor or multiple

bull Cost share bull Solution aligns with long term

plan bull Solution allows for integration

ldquo It is fantastic to be able to get answers immediately that I normally would either

bull refer to a specialist and have to wait months for an appointment

bull try and look up online but not be confident of the answer

bull play telephone tag or fax back and forth with a specialist regarding the clinical situation or

bull just take my best guess with the clinical situation

It has given me a level of professional satisfaction professional empowerment and improved patient carerdquo

Family practitioner frequent user of the RACE line

The Family Physician Perspective

ldquoI find myself educating pediatricians GPs and even other psychiatrists about more complicated psychiatric issues in children--- both sides of the conversation seem to enjoy the collaboration

I learn something about the types of patients and resources available to front-line clinicians and physicians and they learn something about child and adolescent psychiatryrdquo

Specialist provides service on the RACE line

The Specialist Perspective

Summary RACE has the potential to

bull Enhance the care experience by bull provide knowledge transfer bull improve the specialistprimary care interface through improved communication bull simplify the patient journey

bull Population health improved bull access to care is enhanced

bull Per capita cost of health care bull at least controlled

ndash avoidable consults and emergency visits

Online Resources on RACE bullhttpwwwRACEconnectca

bullhttpwwwyoutubecomwatchv=TQyKe0CKh_A

bullhttpswwwbcmaorgsuccess-stories

bullhttpblogsvancouversuncom20130918how-to-get-speedy-telephone-advice-from-medical-experts-the-race-program

bullhttpwwwcmajcacontentearly20131104cmaj109-4627fullpdf+html

RACE App

bull For iPhones and Androids bull No more listening to the

tedious VM bull To download - search

RACEconnect

Provincial Scale Up

RACE Process

Identify Needs Service requirements

Program management

Engage Marketplace

Collaboratively Decide

Identify Needs Providence Health

Care

Northern Partners in

Care

South Island Kootenay Boundary

Surrey North Delta

bull Held several team meetings bull Discussed options bull Need to make it

localregional bull Need to have some

consistency bull Need flexibility

Collaboratively Decide

Physicians Users

Providers

Partners Local Sites

bull We will need input from stakeholders

bull Need to select optimal strategy 1 vendor or multiple

bull Cost share bull Solution aligns with long term

plan bull Solution allows for integration

ldquo It is fantastic to be able to get answers immediately that I normally would either

bull refer to a specialist and have to wait months for an appointment

bull try and look up online but not be confident of the answer

bull play telephone tag or fax back and forth with a specialist regarding the clinical situation or

bull just take my best guess with the clinical situation

It has given me a level of professional satisfaction professional empowerment and improved patient carerdquo

Family practitioner frequent user of the RACE line

The Family Physician Perspective

ldquoI find myself educating pediatricians GPs and even other psychiatrists about more complicated psychiatric issues in children--- both sides of the conversation seem to enjoy the collaboration

I learn something about the types of patients and resources available to front-line clinicians and physicians and they learn something about child and adolescent psychiatryrdquo

Specialist provides service on the RACE line

The Specialist Perspective

Summary RACE has the potential to

bull Enhance the care experience by bull provide knowledge transfer bull improve the specialistprimary care interface through improved communication bull simplify the patient journey

bull Population health improved bull access to care is enhanced

bull Per capita cost of health care bull at least controlled

ndash avoidable consults and emergency visits

Online Resources on RACE bullhttpwwwRACEconnectca

bullhttpwwwyoutubecomwatchv=TQyKe0CKh_A

bullhttpswwwbcmaorgsuccess-stories

bullhttpblogsvancouversuncom20130918how-to-get-speedy-telephone-advice-from-medical-experts-the-race-program

bullhttpwwwcmajcacontentearly20131104cmaj109-4627fullpdf+html

Provincial Scale Up

RACE Process

Identify Needs Service requirements

Program management

Engage Marketplace

Collaboratively Decide

Identify Needs Providence Health

Care

Northern Partners in

Care

South Island Kootenay Boundary

Surrey North Delta

bull Held several team meetings bull Discussed options bull Need to make it

localregional bull Need to have some

consistency bull Need flexibility

Collaboratively Decide

Physicians Users

Providers

Partners Local Sites

bull We will need input from stakeholders

bull Need to select optimal strategy 1 vendor or multiple

bull Cost share bull Solution aligns with long term

plan bull Solution allows for integration

ldquo It is fantastic to be able to get answers immediately that I normally would either

bull refer to a specialist and have to wait months for an appointment

bull try and look up online but not be confident of the answer

bull play telephone tag or fax back and forth with a specialist regarding the clinical situation or

bull just take my best guess with the clinical situation

It has given me a level of professional satisfaction professional empowerment and improved patient carerdquo

Family practitioner frequent user of the RACE line

The Family Physician Perspective

ldquoI find myself educating pediatricians GPs and even other psychiatrists about more complicated psychiatric issues in children--- both sides of the conversation seem to enjoy the collaboration

I learn something about the types of patients and resources available to front-line clinicians and physicians and they learn something about child and adolescent psychiatryrdquo

Specialist provides service on the RACE line

The Specialist Perspective

Summary RACE has the potential to

bull Enhance the care experience by bull provide knowledge transfer bull improve the specialistprimary care interface through improved communication bull simplify the patient journey

bull Population health improved bull access to care is enhanced

bull Per capita cost of health care bull at least controlled

ndash avoidable consults and emergency visits

Online Resources on RACE bullhttpwwwRACEconnectca

bullhttpwwwyoutubecomwatchv=TQyKe0CKh_A

bullhttpswwwbcmaorgsuccess-stories

bullhttpblogsvancouversuncom20130918how-to-get-speedy-telephone-advice-from-medical-experts-the-race-program

bullhttpwwwcmajcacontentearly20131104cmaj109-4627fullpdf+html

RACE Process

Identify Needs Service requirements

Program management

Engage Marketplace

Collaboratively Decide

Identify Needs Providence Health

Care

Northern Partners in

Care

South Island Kootenay Boundary

Surrey North Delta

bull Held several team meetings bull Discussed options bull Need to make it

localregional bull Need to have some

consistency bull Need flexibility

Collaboratively Decide

Physicians Users

Providers

Partners Local Sites

bull We will need input from stakeholders

bull Need to select optimal strategy 1 vendor or multiple

bull Cost share bull Solution aligns with long term

plan bull Solution allows for integration

ldquo It is fantastic to be able to get answers immediately that I normally would either

bull refer to a specialist and have to wait months for an appointment

bull try and look up online but not be confident of the answer

bull play telephone tag or fax back and forth with a specialist regarding the clinical situation or

bull just take my best guess with the clinical situation

It has given me a level of professional satisfaction professional empowerment and improved patient carerdquo

Family practitioner frequent user of the RACE line

The Family Physician Perspective

ldquoI find myself educating pediatricians GPs and even other psychiatrists about more complicated psychiatric issues in children--- both sides of the conversation seem to enjoy the collaboration

I learn something about the types of patients and resources available to front-line clinicians and physicians and they learn something about child and adolescent psychiatryrdquo

Specialist provides service on the RACE line

The Specialist Perspective

Summary RACE has the potential to

bull Enhance the care experience by bull provide knowledge transfer bull improve the specialistprimary care interface through improved communication bull simplify the patient journey

bull Population health improved bull access to care is enhanced

bull Per capita cost of health care bull at least controlled

ndash avoidable consults and emergency visits

Online Resources on RACE bullhttpwwwRACEconnectca

bullhttpwwwyoutubecomwatchv=TQyKe0CKh_A

bullhttpswwwbcmaorgsuccess-stories

bullhttpblogsvancouversuncom20130918how-to-get-speedy-telephone-advice-from-medical-experts-the-race-program

bullhttpwwwcmajcacontentearly20131104cmaj109-4627fullpdf+html

Identify Needs Providence Health

Care

Northern Partners in

Care

South Island Kootenay Boundary

Surrey North Delta

bull Held several team meetings bull Discussed options bull Need to make it

localregional bull Need to have some

consistency bull Need flexibility

Collaboratively Decide

Physicians Users

Providers

Partners Local Sites

bull We will need input from stakeholders

bull Need to select optimal strategy 1 vendor or multiple

bull Cost share bull Solution aligns with long term

plan bull Solution allows for integration

ldquo It is fantastic to be able to get answers immediately that I normally would either

bull refer to a specialist and have to wait months for an appointment

bull try and look up online but not be confident of the answer

bull play telephone tag or fax back and forth with a specialist regarding the clinical situation or

bull just take my best guess with the clinical situation

It has given me a level of professional satisfaction professional empowerment and improved patient carerdquo

Family practitioner frequent user of the RACE line

The Family Physician Perspective

ldquoI find myself educating pediatricians GPs and even other psychiatrists about more complicated psychiatric issues in children--- both sides of the conversation seem to enjoy the collaboration

I learn something about the types of patients and resources available to front-line clinicians and physicians and they learn something about child and adolescent psychiatryrdquo

Specialist provides service on the RACE line

The Specialist Perspective

Summary RACE has the potential to

bull Enhance the care experience by bull provide knowledge transfer bull improve the specialistprimary care interface through improved communication bull simplify the patient journey

bull Population health improved bull access to care is enhanced

bull Per capita cost of health care bull at least controlled

ndash avoidable consults and emergency visits

Online Resources on RACE bullhttpwwwRACEconnectca

bullhttpwwwyoutubecomwatchv=TQyKe0CKh_A

bullhttpswwwbcmaorgsuccess-stories

bullhttpblogsvancouversuncom20130918how-to-get-speedy-telephone-advice-from-medical-experts-the-race-program

bullhttpwwwcmajcacontentearly20131104cmaj109-4627fullpdf+html

Collaboratively Decide

Physicians Users

Providers

Partners Local Sites

bull We will need input from stakeholders

bull Need to select optimal strategy 1 vendor or multiple

bull Cost share bull Solution aligns with long term

plan bull Solution allows for integration

ldquo It is fantastic to be able to get answers immediately that I normally would either

bull refer to a specialist and have to wait months for an appointment

bull try and look up online but not be confident of the answer

bull play telephone tag or fax back and forth with a specialist regarding the clinical situation or

bull just take my best guess with the clinical situation

It has given me a level of professional satisfaction professional empowerment and improved patient carerdquo

Family practitioner frequent user of the RACE line

The Family Physician Perspective

ldquoI find myself educating pediatricians GPs and even other psychiatrists about more complicated psychiatric issues in children--- both sides of the conversation seem to enjoy the collaboration

I learn something about the types of patients and resources available to front-line clinicians and physicians and they learn something about child and adolescent psychiatryrdquo

Specialist provides service on the RACE line

The Specialist Perspective

Summary RACE has the potential to

bull Enhance the care experience by bull provide knowledge transfer bull improve the specialistprimary care interface through improved communication bull simplify the patient journey

bull Population health improved bull access to care is enhanced

bull Per capita cost of health care bull at least controlled

ndash avoidable consults and emergency visits

Online Resources on RACE bullhttpwwwRACEconnectca

bullhttpwwwyoutubecomwatchv=TQyKe0CKh_A

bullhttpswwwbcmaorgsuccess-stories

bullhttpblogsvancouversuncom20130918how-to-get-speedy-telephone-advice-from-medical-experts-the-race-program

bullhttpwwwcmajcacontentearly20131104cmaj109-4627fullpdf+html

ldquo It is fantastic to be able to get answers immediately that I normally would either

bull refer to a specialist and have to wait months for an appointment

bull try and look up online but not be confident of the answer

bull play telephone tag or fax back and forth with a specialist regarding the clinical situation or

bull just take my best guess with the clinical situation

It has given me a level of professional satisfaction professional empowerment and improved patient carerdquo

Family practitioner frequent user of the RACE line

The Family Physician Perspective

ldquoI find myself educating pediatricians GPs and even other psychiatrists about more complicated psychiatric issues in children--- both sides of the conversation seem to enjoy the collaboration

I learn something about the types of patients and resources available to front-line clinicians and physicians and they learn something about child and adolescent psychiatryrdquo

Specialist provides service on the RACE line

The Specialist Perspective

Summary RACE has the potential to

bull Enhance the care experience by bull provide knowledge transfer bull improve the specialistprimary care interface through improved communication bull simplify the patient journey

bull Population health improved bull access to care is enhanced

bull Per capita cost of health care bull at least controlled

ndash avoidable consults and emergency visits

Online Resources on RACE bullhttpwwwRACEconnectca

bullhttpwwwyoutubecomwatchv=TQyKe0CKh_A

bullhttpswwwbcmaorgsuccess-stories

bullhttpblogsvancouversuncom20130918how-to-get-speedy-telephone-advice-from-medical-experts-the-race-program

bullhttpwwwcmajcacontentearly20131104cmaj109-4627fullpdf+html

ldquoI find myself educating pediatricians GPs and even other psychiatrists about more complicated psychiatric issues in children--- both sides of the conversation seem to enjoy the collaboration

I learn something about the types of patients and resources available to front-line clinicians and physicians and they learn something about child and adolescent psychiatryrdquo

Specialist provides service on the RACE line

The Specialist Perspective

Summary RACE has the potential to

bull Enhance the care experience by bull provide knowledge transfer bull improve the specialistprimary care interface through improved communication bull simplify the patient journey

bull Population health improved bull access to care is enhanced

bull Per capita cost of health care bull at least controlled

ndash avoidable consults and emergency visits

Online Resources on RACE bullhttpwwwRACEconnectca

bullhttpwwwyoutubecomwatchv=TQyKe0CKh_A

bullhttpswwwbcmaorgsuccess-stories

bullhttpblogsvancouversuncom20130918how-to-get-speedy-telephone-advice-from-medical-experts-the-race-program

bullhttpwwwcmajcacontentearly20131104cmaj109-4627fullpdf+html

Summary RACE has the potential to

bull Enhance the care experience by bull provide knowledge transfer bull improve the specialistprimary care interface through improved communication bull simplify the patient journey

bull Population health improved bull access to care is enhanced

bull Per capita cost of health care bull at least controlled

ndash avoidable consults and emergency visits

Online Resources on RACE bullhttpwwwRACEconnectca

bullhttpwwwyoutubecomwatchv=TQyKe0CKh_A

bullhttpswwwbcmaorgsuccess-stories

bullhttpblogsvancouversuncom20130918how-to-get-speedy-telephone-advice-from-medical-experts-the-race-program

bullhttpwwwcmajcacontentearly20131104cmaj109-4627fullpdf+html

Online Resources on RACE bullhttpwwwRACEconnectca

bullhttpwwwyoutubecomwatchv=TQyKe0CKh_A

bullhttpswwwbcmaorgsuccess-stories

bullhttpblogsvancouversuncom20130918how-to-get-speedy-telephone-advice-from-medical-experts-the-race-program

bullhttpwwwcmajcacontentearly20131104cmaj109-4627fullpdf+html

wwwRACEconnectca

Margot Wilson mwilsonprovidencehealthbcca