Healthcare access, specifically to specialist care, has remained a persistent challenge for rural communities worldwide. Countries like Canada and the United States experience significant disparities in the number of physicians and specialists per 100,000 residents compared to their urban counterparts. The resulting impact? Rural patients tend to experience higher rates of chronic diseases, preventable hospitalizations, and mortality rates. Virtual Hallway (VH) is a unique platform that uses technology to bridge the rural-urban healthcare divide.


While the struggle to provide patient care in rural areas is not new, it's fraught with an array of challenges. Patients often face a difficult choice between long waits for appointments at distant clinics or forgoing specialty care altogether. With internal medicine, surgical specialty services, and mental health services witnessing unpredictable coverage gaps, this lack of system redundancy in rural healthcare only amplifies the issue. These scenarios inevitably lead to an increase in complex and often costly patient transfers.


However, the solution to these challenges may lie in digital tools like Virtual Hallway. Designed to facilitate phone consultations between primary care providers and specialists, VH's aim is to dismantle geographical barriers in healthcare provision.


VH's impact is not just theoretical. Real-world data from VH users reveal an astounding 84% of phone consultations successfully avoided the need for an in-person referral. Think of it: near-instant access to a specialist, right within your rural community. This effectively eliminates long waits and reduces the need for lengthy travel to urban centres.


Recent user surveys indicate that around 95% of primary care respondents either "strongly agreed" or "agreed" that VH increases access to specialist consultation. In fact, 98% affirmed that VH enhances their capacity to manage care plans in their communities. Additionally, VH garnered high satisfaction rates, with 99.4% of users reporting they were "very satisfied" or "satisfied".


The introduction of VH offers hope in the quest to level the healthcare playing field between rural and urban communities. To uncover more about the potential of VH and its impact on rural healthcare, dive into our comprehensive white paper "Bridging the Rural-Urban Divide". Find out how VH is changing healthcare, one call at a time.

Expert Physician Advisor Delivers Insightful Lecture on Navigating the World of Virtual Care

The landscape of healthcare is rapidly evolving, and virtual care is becoming an integral part of modern medical practice. Dr. Shirley Lee, a renowned physician advisor at the Canadian Medical Protective Association, recently delivered a captivating lecture on the medicolegal considerations for virtual care and hallway consults. Hosted by Virtual Hallway in a hybrid format, both in person and online, the session sparked engaging discussions and raised thought-provoking questions.

Dr. Lee highlighted several key points during her talk:

  • The importance of obtaining verbal and explicit consent when conducting virtual care, ensuring that potential privacy risks and scope of practice issues are addressed and documented.
  • Acknowledging the limitations of technology, such as the inferiority of photos compared to in-person assessments.
  • Key virtual care considerations, including appropriate triaging, workflow and documentation, security of devices, accessibility and Wi-Fi, managing expectations and scope, addressing the needs of young, elderly, and vulnerable patients, and maintaining a consistent quality improvement process.
  • Emphasizing the need for thorough documentation, which should comprise the format of assessment, context, limitations, and safe discharge and follow-up advice.
  • The importance of documenting phone hallway consults between providers, including the name of the consultant, time of the call, advice received, patient safety concerns, and efforts made to contact the consultant.

Dr. Lee's insightful lecture not only provided valuable guidance for healthcare professionals navigating the world of virtual care but also sparked essential conversations on the topic. As a follow-up, Dr. Lee will be providing resources and articles that will be uploaded to the Virtual Hallway portal for further exploration.

Stay tuned for more updates on this crucial aspect of modern healthcare, and be sure not to miss future lectures and events hosted by the Virtual Hallway platform.

To view Dr. Lee’s lecture please login to your account under the Lectures Tab.

Coming up will be Dr. Phil Tibbo’s lecture on Management of Early Psychosis and Schizophrenia, date to be announced soon!

Our healthcare system is faced with a number of challenges, from overcrowded emergency departments to long wait times for specialist care. In order to improve access to care and reduce overuse of emergency departments, many healthcare providers are turning to a solutions that can make specialist consultation more effective. These innovative technologies offers a range of benefits, from connecting primary care providers with specialists in real-time to bringing specialist insights to patients. In this article, we'll explore how synchronous phone consultations can help reduce overuse of emergency departments and improve access to care.

Emergency departments are often overcrowded and overburdened, leading to long wait times and delayed care for patients who need it most. One solution to this problem is the use of synchronous phone consultations, which can help reduce overuse of emergency departments by improving access to primary care providers and specialists.

The Problem

Emergency departments are overcrowded, leading to long wait times and delayed care for patients who need it most. Patients stuck on specialist waitlists are ER admissions in the making. The longer a person waits, the more likely they are to require urgent or emergent care. High frequency ER patients are often a result of inability to manage complex comorbidities. With growing specialist waitlists, the percentage of patients going untreated increases, and as a result so will potentially avoidable admissions. Are increasing ER admissions in part caused by increasing waitlists?

The Solution

Synchronous provider-to-provider phone consultations can reduce overuse of emergency departments by improving access to specialists. In traditional healthcare systems, primary care providers often have to refer patients to specialists for further evaluation and treatment. However, this process can be slow and cumbersome, and patients may have to wait months or even years to see a specialist. This wait time can lead to patients showing up in the emergency department with complex, chronic conditions that could have been managed earlier with specialist input.

The Benefits

Synchronous phone consultations offer a number of benefits. By allowing primary care providers and specialists to have a synchronous dialogue, it helps ensure that all parties are on the same page when discussing patient care. This can lead to better collaboration and more effective treatment plans, which can reduce the need for emergency department visits. Direct collaborative communication between providers can take efficiency to the next level. By exchanging information directly, doctors can avoid the time-consuming process of reviewing patient files, scheduling appointments, and waiting for specialist feedback. This direct communication not only saves time but also increases the likelihood of the advice being actioned.

Asynchronous Solutions

Asynchronous solutions like e-consults can also be part of the solution. E-consults allow primary care providers to send a secure message to a specialist, who can then review the patient's case and provide recommendations. This can help reduce the need for in-person specialist referrals, which can be unnecessary and time-consuming. This is particularly important for patients who are stuck on waitlists and may not be able to see a specialist in person for months.

Case Ilustration

Let's consider the case of a patient with borderline personality disorder and a substance use disorder, who had longstanding difficulty stabilizing their condition. This patient was previously a frequent visitor to the emergency department of a regional hospital in a rural area, staffed mainly by family doctors. Unfortunately, there were no psychiatrists in the area, and even though this patient had a family doctor, they were unable to get the patient to be seen by a psychiatrist in the closest urban centre (a 4-hour drive away).

Without psychiatric advice and support, the family doctor was limited in their ability to help the patient manage their conditions effectively. The result was that this patient frequently visited the emergency department for symptoms related to their mental health and substance use disorders.

However, after implementing phone consultations between primary care providers and psychiatrists, the family doctor was able to collaborate with specialists in real-time to develop more effective treatment plans for this particular patient. With ongoing support from these specialists via synchronous phone consultations, the family doctor was able to better manage this complex case.

As a result of these consults, this patient is no longer frequenting the emergency department unnecessarily. Thanks to improved access to expert advice and collaborative communication between providers involved in their care through these efficient consults, this patient is now receiving adequate care without having to travel long distances or wait months for specialist appointments. This demonstrates how powerful synchronous phone consultations can be in improving access to care and reducing overuse of emergency departments for patients with complex comorbidities living in rural areas where specialist resources may be scarce.

Summary

Phone consultations are a promising solution to the challenges facing our healthcare system today. By connecting primary care providers with specialists in real-time, phone consultations can help address issues before complications arise, reducing the need for emergency department visits. Additionally, asynchronous solutions like e-consults can also be part of the solution by reducing the need for in-person specialist referrals. Overall, phone consultations are powerful tools for improving access to care and reducing overuse of emergency departments. By reducing the number of potentially avoidable admissions, we can help alleviate the burden on emergency departments and improve patient outcomes.

Take control of your call flow

Imagine being more available to help your primary care colleagues with challenging cases while eliminating interruptions throughout your day.

After getting set up on Virtual Hallway, your primary care colleagues can book phone calls with you… at times that work for you. That means both you and your colleague are in the right headspace to share your expertise.

Triage your consults

Use your appointments for the most pressing cases, while still being able to support patients with lower acuity problems. Have the peace of mind knowing that if a primary care colleague needs your advice on a case, that they have a mechanism to reach you.

Help manage your waitlists.

Use Virtual Hallway to regularly consult with a family doc about a patient with a complex issue. Specialists have found that the primary care provider is able to effectively care for that patient with their guided insights on Virtual Hallway, rather than have that patient referred to their waitlist.

Save time with an easy and quick platform.

We have heard the laments of cumbersome and time-consuming solutions, and are proud to boast a 4.9/5 satisfaction rating from specialist physicians. Easy, smooth, quick, and friendly are the words we hear when we ask specialists about using Virtual Hallway. By connecting with a primary care provider over the phone, you avoid the back-and forth than often comes with asynchronous solutions.

Grow your network.

Make yourself available to primary care clinicians outside of your network for compensated consults. Our team assists and executes promoting your availability on Virtual Hallway to any area or network you are interested in accepting VH consults from. We facilitate e-faxing, OMA related advertisements, and other means of informing clinicians on how to access your support.

Share your expertise widely.

With one of the fastest growing CME Lecture series in the country, we handle all accreditation, sponsorship, hosting and outreach about CME lectures. Just let us know you’re interested in participating as a speaker, and we’ll handle the rest. Learn more about our CMEs.

Earning opportunity

Consulting on cases is work, and being fairly compensated for providing patient care is important. With Virtual Hallway phone consults, we ensure that all eligible fee for service physicians get reimbursed for their work.

For Family Doctors and Nurse Practitioners in Ontario who need access to specialists, asynchronous eConsults and synchronous phone-based Virtual Hallway are both secure and free-to-use solutions.

Most importantly, each tool helps primary care providers keep patients off the wait list and deliver better, faster and often life-saving outcomes to patients.

When considering which tool to best suited for each case, it's helpful to consider the ways in which they are unique. This will help primary care providers determine which one might be the best fit for their working preferences and patient needs.

Email-based consults

E-consultations are a long-standing and widely adopted solution that recreates some aspects of a live, hallway-style consultation. The asynchronous nature of emails is helpful in many contexts and many clinics and hospitals have integrated it into their standard workflows.

Benefits of email-based consultation through eConsult include:

  • Familiarity. Many people already understand how to use it. This is helpful for those who aren't as tech-savvy or interested in trying out a new tool.
  • Choice. At the moment, it may be easier to find a specific type of specialist or sub-specialist through well-established eConsult networks. Is there a specific speciality or specialist you'd like to see on Virtual Hallway? Let us know at [email protected]
  • Convenience for less complex, less time-specific cases. Some questions are relatively straightforward, routine or do not require certainty around when a response might arrive. These cases are asked and answered fairly easily through email.

Did you know: in Ontario, 40% of eConsults avoided an unnecessary referral and 60% do not require an in-person followup visit. Source.

Phone-based consults

Discussing a patient’s case with a colleague in a clinic or hospital hallway is the original gold-standard in patient-specific medical consultation and knowledge sharing. Phone-based consultations allow primary care providers to experience the benefits of a “hallway”-style conversation outside the confines of their immediate network, clinic or hospital.

Virtual Hallway brings ease and convenience to this approach with technology aligned to CMPA guidelines, modern clinic workflow and billing criteria.

Benefits of phone-based consultations through Virtual Hallway include:

  • In-depth answers. Live conversations offer detailed insights in a short amount of time. This is especially useful for more complex, less routine cases.
  • Simple consult requests. Communicating detailed context in a live conversation is easy, reducing the need to write it all out in the consult request.
  • Personal and collegial. The engaging nature of a live, problem-solving discussion is energizing and can help foster new, meaningful professional relationships.
  • Answers on a schedule. Primary care providers choose the time of the consultation so they know when they will have their answer. This can help plan follow up next steps with a patient. One family doctor in Ontario described this as, “I pick up the call [from the specialist] with a question and hang up with an answer.”
  • Easy billing and documentation. For qualifying primary care providers, OHIP reimburses phone consultations at $31.25, nearly twice the rate of email-based consultations. Virtual Hallway bills on behalf of the primary care provider. When the specialist submits consult documentation via the Virtual Hallway platform the primary care provider has the option to have that report automatically faxed or emails to their office.

Did you know: in Nova Scotia, 84% of phone consultation through Virtual Hallway helped a patient avoid a specialist waitlist entirely. Source.

Conclusion

Email and phone-based consultations are both important tools that help primary care providers provide better, faster often life-saving patient care. Consider your patient case and personal preferences when determining which tool is the best fit:

  • eConsult is a familiar email-based tool in Ontario. It offers more speciality choice at the moment and can work well for more routine consultations with less complexity.
  • Virtual Hallway phone-based consultations consultations are personal, offer worry-free billing and documentation and can work well for less routine consultations.

Meet Liz, 24. She has a hard time focusing at work.

Liz visited her family doctor for this reason. While assessing Liz, they found she had a fast heartbeat and an abnormal ECG, causing hesitancy about prescribing ADHD medication to improve her attention. With Liz's best interest in mind, she was referred to an internist for an in-person appointment.

3 months passed; Liz heard nothing. Still having trouble focusing, she called her family doctor's office for an update. She was told that the referral was sent and to keep waiting.

Another 3 months passed; Liz’s troubles continued. Her performance at work was suffering and her trouble focusing was interpreted by her manager as lack of interest in her role. Liz had several write-ups due to lack of productivity and missed deadlines.

Liz was frustrated and concerned; but kept waiting.

3 more months; Liz visited an internist. The internist interpreted the ECG and created a treatment plan that allowed Liz to best manage her condition and improve her performance at work.  

Liz was still frustrated; it took 9 months of waiting to get the treatment she needed. She asked herself ‘isn't there a better way?’

Long story, short solution - a Virtual Hallway consult.

Virtual Hallway phone consults are available within 1-2 days, enabling specialist input earlier on in the course of a patient’s illness. The platform facilitates knowledge sharing between specialists and primary care providers, in turn, motivating more timely and effective care.

A Virtual Hallway consult in the case of Liz?

9 months of waiting, worsening and wondering – avoided.  

Professional knowledge and confidence – shared. 

Specialist waitlist – one patient shorter.

“Can I get your thoughts on this?”

“Can I run something by you?”

These are familiar questions asked by primary care providers to specialists. Questions like these are part of the daily discourse of medicine, coined hallway consults.

Let’s take a look back

Traditionally, hallway consults occurred in elevators, lunch rooms or hospital corridors (earning their name). These brief clinical interactions were localized, casual, undocumented and aimed at solving a particular question on the spot. Such interactions relied on chance encounters with a colleague – bumping into someone or finding shared free time – an unreliable method for gaining advice. Given that Canada is geographically vast and not densely populated in some areas, oftentimes there are few or no specialist colleagues to consult with.

Entering the digital era, hallway consults have shifted to take place by way of email, phone or video. In turn, reducing the traditional reliance on chance encounters with a colleague. These new means of connecting have caused a shift in how we consult, increasing access to specialists both in and outside of one’s institution.

Hallways are not what they used to be.

Current day, how do we connect and gain advice on patient care?

Both traditional and digital consults are tried-and-true methods for gaining advice from a specialist, though they are plagued with challenges.

  • Finding the right colleague to consult with. 
  • Phone tag and missed emails. 
  • Administrative burden. 
  • Absence of record keeping or follow-up. 
  • Medico-legal risks. 
  • Not getting paid. 

We haven't reinvented the wheel; we’ve just made it better. Like a traditional hallway consult, after a few minutes of collegial discussion you can confidently deliver the highest quality of care based on actionable advice.

It’s a hallway consult, several a day are a-ok.

Streamlined and simple – book, consult via phone, receive report, receive payment.

Virtual Hallway doesn’t take time away from you, it gives it back.


…to teach them this Art, if they shall wish to learn it, without fee or stipulation; and that by precept, lecture, and every other mode of instruction, I will impart a knowledge of the Art to my own sons, and those of my teachers, and to disciples …

Hippocrates 

Being a specialist on Virtual Hallway means you are now part of a solution to efficiently provide rapid, effective care to hundreds of thousands of patients who would otherwise be without specialist care, or sit for months on waitlists.

Joining Virtual Hallway means now being part of a community where family physicians and specialists can work together in real time for the best of large numbers of patients.

Block off availability

 The first step is to log into your calendar and block off times where family physicians and nurse practitioners can book phone consults with you. You can choose as much or as little time as you’d like. There are some strategies to consider to maximize the number of consults you receive. It takes a bit of time to really build up a big consult base, but with sticking to the basic principles it will happen.

Wait for your first consult request

It’ll come by text message and email. Make note of it, review the consult within your portal and ensure that it is a request that will work for a phone consult.

Make the call

At the time of the scheduled request, call the family physician. Discuss the case, ask lots of questions, get a sense of the family doctor’s impression of the problem. Come up with a plan together.

Document the call

Write up the call in the consult report form. It can be as short or as long as you wish, though we recommend you include a brief summary include any suggestions made. Record the provisional diagnosis and submit the report.

Billings

After you submit your consult report, we will bill provincial phone consult codes on your behalf. Then, once a month we will transfer you your billings along with a statement.

Your consult request form

Your consult request form is customizable. This form can ask family physicians to include as much or as little information as you would like to have. Some specialists would like to have a lot of information up front in the consult request form so that they can focus on recommendations during the call. Other specialists prefer to have a more basic form because they want the conversation to be more free flowing. It is up to you.

Duty of Care

The division of care within Virtual Hallway is clear: the Specialist is providing advice to the family physician based on the information provided in the consult request form and the call. However, the family physician is aware that the Specialist is not taking over care of the patient. Virtual Hallway is just that, a hallway consult. Except it can be done anywhere. And is documented. And reimbursed.

Reconsults

Family physicians can re-consult on patients with the same specialist. It is recommended that this not be done more frequently than 14 days because some jurisdictions do not permit billing more frequently for a given patient Than 14 days. However, reconsults can be an excellent way to ensure some continuity of care and follow up on recommendations made.

Office staff

Virtual Hallway accounts can be converted to Practice Group accounts. These accounts allow for a physicians office staff to access documentation for imporatation to EMRs, complete consult request forms, or complete consult reports.

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