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

Background Canada has been referred to as the land of ‘perpetual pilot projects’. Effective innovations often remain small in scale, with limited impact on health systems. Several innovations have been developed in Canada to tackle important challenges such as poor access to services and excessive wait times – one of the most promising innovations that has been piloted is eConsult, which is a model of asynchronous communicationthat allows primary care providers to electronically consultwith specialists regarding their patients’ medical issues. eConsult pilot projects have been shown to reduce wait times for specialist care, prevent unnecessary referrals and reduce health system costs. eConsult has been spread throughout Ontario as well as to certain regions in Manitoba, Quebec, and Newfoundland and Labrador. Our aim is to understand and support the scale-upprocess of eConsult in Ontario, Quebec, Manitoba, and Newfoundland and Labrador. Our specific objectives are to (1) describe the main components of eConsult relevant to the scale-upprocess in each province; (2) understand the eConsult scale-upprocess in each province and compare across provinces; (3) identify policy issues and strategies to scaling upeConsult in each province; and (4) foster cross-level and cross-jurisdictional learning on scaling upeConsult.