Overview of eConsults in Ontario

About eConsult

eConsult is a secure, web-based tool that allows physicians and nurse practitioners timely access to specialist advice through an online platform.

In Ontario, the Ontario eServices Program supports eConsult initiatives on three different platforms: the Ontario eConsult Service (OTNhub.ca); the Champlain BASE eConsult Service (on the HealthCareWorks platform); and the Ocean eReferral to eConsult Initiative (on the Ocean Platform). To learn more about the first two programs and technologies, please visit the Ontario eServices Program website.

Ocean eConsults in Ontario: The eReferral to eConsult Initiative

The Ocean Platform supports the following two workflows for eConsults:

  • Recipient-initiated: This involves sending an eReferral through the Ocean Healthmap. The  recipient can then choose to respond as an eConsult when it is deemed suitable to meet patient needs. 
  • Sender-initiated: This involves sending an eConsult from the Ocean Healthmap directly.

In Ontario, the eReferral to eConsult Initiative is testing the technical and clinical viability of providing the Recipient-initiated workflow to Ontario-based specialists. This initiative combines the eConsult and eReferral workflows, providing an opportunity to leverage existing solutions to potentially decrease the number of in-person referrals. 

Please Note: Ocean's Sender-initiated flow is not currently available in Ontario.

If you have received an eConsult response to your eReferral request and need support, please see the eConsult Fact Sheet for Primary Care Providers.

If you are a specialist who is interested in participating in the eReferral to eConsult Initiative please contact eReferral@eHealthCE.ca.


Ontario eServices Program - eConsult Fact Sheet for Primary Care Providers

What is an eConsult?

An eConsult allows for timely access to specialist advice and often eliminates the need for an in-person specialist visit.

Why am I receiving an eConsult response?

A subset of specialists are participating in a proof of concept that integrates a specialist-initiated eConsult response into the eReferral workflow. While triaging your recently submitted referral, the receiving specialist has opted to provide you timely advice for your patient via eConsult.

Where do I locate the eConsult reponse?

You can find the eConsult by looking in your ‘Needs Review’ or ‘eConsult in Progress’ folder within the Ocean Portal. The eConsult message will appear in the existing Ocean eReferral's messaging pane.

What do I do next?

You will have the option to communicate with the specialist via the messaging pane if you have any questions about the eConsult that has been provided.

After reviewing the eConsult, you can choose to click ‘Completed’ which will mark the consult as complete and no further action is required. Alternatively, you can choose to proceed with the in-person referral request by clicking ‘Proceed with eReferral’ and provide the reason for proceeding

For more information on the Ontario eServices Program contact eReferral@eHealthCE.ca.


Set Up eConsults (Ontario Only)

Please Note: Currently, Ocean's Sender-initiated flow is not available in Ontario. To enable Recipient-initiated eConsults, please follow the set up steps below.

1. Apply to respond to eReferrals as eConsults

Note: Only Ocean users with the Clinician Type of "Family Physician" or "Specialist" or "Nurse Practitioner" are eligible to apply to respond to eReferrals as eConsults. Please see how to update your Clinician Type if necessary before continuing.

Ocean users who would like to respond to eReferrals with an eConsult must first apply to their Regional Authority, which will review the eligibility of the applicant. To do this:

    • Log in to the Ocean Portal, click your name in the top right corner, and select "My Account".
    • Within your account settings, press the "Submit Application to Regional Authority" button, and select your appropriate Regional Authority site.
    • The Regional Authority site will review your application, and you will receive an email notification indicating the result.

2. Update Your eConsult Folder Visibility

If the Regional Authority accepts your application to respond to eReferrals as eConsults, you must ensure the proper folder visibility is configured in your eReferral settings area.

By default, the eReferrals area within the Ocean Portal does not display the eConsult folders which are used to organize the status of eConsults. To ensure that these folders are visible, please follow these steps:

    • Log in to the Ocean Portal, and navigate to the eReferrals area.
    • Within the eReferrals area, press the "Settings" button in the top right corner.
    • Press the "Configure eReferrals" button.
    • Under the "eConsult Management"" section, set the "Display eConsult Folder" dropdown to "Yes".
    • Ensure you press "Save" in the bottom left corner to save your changes.

eReferral to eConsult Workflow - Sending Sites

This article walks through the workflow for Ocean sites that are receiving an eConsult in response to a sent eReferral.

1. Receiving an eConsult in response to your eReferral

    • When an eConsult has been provided in response to an eReferral request, you will receive an email notification that an eConsult message has been provided.
    • Within the Ocean Portal, you can locate the eConsult response in the eReferrals "Sent" tab, under the folder named "eConsult in Progress", and within the "Needs Review" folder.
    • The eConsult will appear in blue font to differentiate it from an eReferral. Click on the patient name to open the eConsult.
    • Within the eConsult, you will see the consultation advice within the messaging pane with an "eConsult" header.

2. Actioning the eConsult Response

As the original eReferral sender, you have 4 options to proceed with:

Option 1: Marking as Reviewed

    • Once you have reviewed the message, you can select "Reviewed & Close" which will remove the eConsult from your "Needs Review" folder, but keep it in your "eConsult in Progress" folder.

      Note: If the eConsult has not been marked as "Reviewed" within 7 days, a reminder email will be sent notifying you that an eConsult has been provided and requires clinical attention.

    • The eConsult will remain in the "eConsult in Progress" folder until you decide to take further action. It is important that you take action in a timely manner, as the eConsult also remains "in-progress" for the original recipient.

Option 2: Communicating with the Recipient

    • You can respond to the provided consultation advice by sending a message in the messaging pane, and pressing "Send".
    • The recipient can then provide further information, and the conversation can continue for as long as necessary until the eConsult is either marked as "Completed", or it is decided to proceed with an eReferral.

Option 3: Marking as Complete

    • If you are satisfied with the consultation and would like to complete the eConsult, select the "Completed" button at the bottom.
    • A message will be stamped into the messaging pane indicating that the eConsult has been marked as complete, and the recipient will receive an email notification that the eConsult was completed.
    • Once marked as completed, the eConsult will move from the "eConsult in Progress" folder to the "Completed" folder.
    • After marking as completed, you will also be prompted with the option to download and import the consultation note into your EMR to maintain a permanent record of the interaction.

Option 4: Proceeding with an eReferral

    • If you would like to proceed with an eReferral at any point following the initial eConsult response, you can select the "Proceed with eReferral" button at the bottom.
    • You will be prompted to choose the reason for proceeding with an eReferral, and include a message for the recipient.
    • The recipient will receive an email notification of the decision to proceed with an eReferral, and will have the option to either Accept or Decline the eReferral.
    • If the recipient accepts the eReferral, it will be moved to your "Pending Booking" folder. If the recipient declines the eReferral, you will receive an email notification of the declination and it will be moved to your "Declined" folder.

eReferral to eConsult Workflow - Receiving Sites

This article walks through the workflow for Ocean sites that are responding to incoming eReferrals with an eConsult.

1. Reviewing New eReferrals

    • Log into the Ocean Portal. Click the "Menu" button in the top left corner and select "eReferrals".
    • Locate the eReferral. New referral requests will be in the "New" folder. Click on the eReferral to open it.

2. Responding to an eReferral as an eConsult

Accepting as an eConsult

    • With the eReferral opened, you will have the option to "Accept as eConsult" by selecting the arrow beside the "Accept" button at the bottom of the page, or by selecting the "Respond as eConsult" check-box beneath the messaging pane.
    • If the "Accept as eConsult" button is selected, it will move to the "Accepted as eConsult" folder until further action is taken. The eConsult is marked in blue font to differentiate it from eReferrals.

Sending the eConsult Response

    • When you are ready to respond with an eConsult, navigate to the "Accepted as eConsult" folder and click the patient name to pull up the referral view.
    • Since the eReferral was initially marked as an eConsult, the "Respond as eConsult" checkbox is automatically checked off.

      To provide the consultation, type the consult advice in the messaging pane, and select your billing time. Note that the maximum billing time is 60 minutes. Ensure that the "Respond as eConsult" box is checked, and press "Send" when complete.

      The original eReferral sender will receive an email notification that you have responded to their referral with an eConsult.

    • Once the eConsult has been provided, the eConsult is moved from the "Accepted as eConsult" folder to the "eConsult in Progress" folder.

3. Sender-Receiver Communication

Original Sender Responds to your eConsult

    • Once the original sender reviews and responds to your eConsult, you will receive an email notification indicating that they have responded.
    • The outstanding response from the original sender also places the eConsult into the "Needs Review" folder.
    • Opening the eConsult will show your initial consult advice and the sender's response to your advice in the messaging pane. Selecting "Reviewed & Close" removes the eConsult from the "Needs Review" folder. It can then be found in your "eConsult in Progress" folder.

Additional Sender-Receiver Communication

  • Both senders and receivers can correspond back and forth using the messaging pane until the original sender marks the eConsult as "completed", or they choose to proceed with an eReferral.

4. Sender Marks eConsult as Completed

    • When the original sender marks the eConsult as "Completed", you will receive an email notification.
    • The eConsult will be moved to your "Needs Review" folder, with a stamped completion message added to the conversation in the messaging pane. Once you have reviewed it, select "Reviewed & Close".
    • You will be prompted with the option to download and import the consultation note into your EMR to maintain a permanent record of the interaction.
    • After reviewing the completed eConsult, it can be found within the "Completed" folder.

5. Recipient Chooses to Accept as an eReferral following an eConsult Response (Optional)

At any point, recipients can decide to turn the eConsult back into an eReferral if it is more suitable. If you would like to provide both an eConsult and accept the eReferral, the eConsult must be provided first, followed by the change to an eReferral.

Accepting an eConsult in Progress as an eReferral

    • Within the eConsult, select the "Accept as eReferral" button. This moves the patient into the "Pending Booking" folder.

Accepting a Completed eConsult as an eReferral

    • Within the completed eConsult, select the "Mark Incomplete" button. This moves the patient back into the "eConsult in Progress" folder.
    • Select the "Accept eReferral" button. This moves the patient into "Pending Booking" folder.

6. Sender Chooses to Proceed with an eReferral following an eConsult Response (Optional)

If you provide an eConsult in response to a sender's eReferral, the sender has ability to proceed with an eReferral at any point during the back and forth consultation conversation.

    • If the original sender chooses to proceed with an eReferral following your initial eConsult response, you will receive an email notification, and the eConsult will appear in your "Needs Review" folder.
    • Within the request, a stamped message is shown indicating the sender's reasoning for requesting to proceed with an eReferral.
    • You can decide to either "Decline" or "Accept eReferral" using the buttons near the bottom. Declining moves the patient into the "Declined" folder, while accepting moves the patient into the "Pending Booking" folder.