Volume 6 | January 2021
HITS eHealth Office
eConsult Insider
Thank you to the Hamilton Niagara Haldimand Brant (HNHB) eConsult community for continuing to use eConsult to improve access to specialist advice across our region.

  • With the recent push for virtual care adoption due to the COVID-19 pandemic, HNHB welcomed 61 new specialists across our region to provide eConsults over the last year.
  • With 215 primary care providers actively using eConsult, more than 6000 eConsults were sent on behalf of HNHB patients in the last year – a 46% increase over the previous 12 months.
  • 149 specialists actively provided eConsults over the last 12 months, and despite the increased case volumes, these specialists maintained a median response time of less than 1 day.
eConsult Impact in 2020:
Hamilton Niagara Haldimand Brant
Data as of November, 2020. This data has been reproduced with permission from the Ontario eConsult Centre of Excellence. For more information, please contact eConsult@toh.ca.
Learn How to Submit Your First eConsult
eConsult for Primary Care Providers in HNHB Webinar
Date: Friday, January 22 from 4:00-4:30pm

This short webinar will provide you with everything you need to know about how to send eConsults to specialists, both across the province or locally in the HNHB region.

We'll cover:
  • How to submit an eConsult directly to a specialist
  • How to submit an eConsult to an HNHB Regional Specialty Group
  • How to utilize a delegate to save time
HNHB Specialist Spotlight
Dr. Siraj Mithoowani
Dr. Siraj Mithoowani obtained his MD degree and completed Internal Medicine and Hematology residency as well as a fellowship in Benign Hematology and Thromboembolism at McMaster University. He is a clinical hematologist at St. Joseph's Healthcare Hamilton specializing in the care of non-malignant and thrombotic blood disorders and a specialist available on eConsult.
Here's an example of an eConsult Dr. Mithoowani received and his response!
Question
Patient is a 67-year-old female with rheumatoid arthritis who was recently diagnosed with an unprovoked right-sided greater saphenous vein clot measuring 21cm. A repeat US is pending. She was started on Apixaban out of the emergency department. She has no personal or family history of DVT or PE. My question to you is, is the Apixaban necessary given that this is not a true DVT, and if so, how long should she be on it for? Thank you.
Answer
Thank you for your eConsult! Basically, the key is to ensure there is no concomitant DVT in the same leg. If there is, then she requires a minimum of three months of full dose anticoagulation. Otherwise, the typical management for extensive SVT (>5 cm in length) would be 45 days of low-intensity anticoagulation with either: rivaroxaban 10 mg once daily, fondaparinux 2.5mg subcut once daily, or prophylactic-intermediate dose LMWH. Apixaban at a prophylactic dose (2.5mg BID) might work equally well, but unfortunately has not been studied in this context. I hope that helps. Please let me know if I can be of any more assistance.

– Dr. Siraj Mithoowani

"OTN eConsult is a great platform for primary care providers to get answers to specific clinical questions in Hematology that might otherwise require a 3-6 month (or longer) wait time for patients to see a specialist in-person. The platform encourages consultants not only to answer the clinical question at hand, but also to provide education, attach supporting literature, and engage in back-and-forth dialogue with the primary care provider. In many cases, consultants can provide reassurance about benign findings on routine lab-work, help primary care physicians broaden their differential diagnosis, or recommend a change in management - all virtually and without the need for a face-to-face visit!”

– Dr. Siraj Mithoowani, clinical hematologist at St. Joseph's Healthcare Hamilton
specializing in the care of non-malignant and thrombotic blood disorders.

What Specialties are Available to Me?

Both primary care providers and specialists can send eConsults through OTNHub. You can connect directly with a specialist by searching their name in the OTNHub Directory, or you can access a provincial or regional BASETM Managed Specialty Group.
If you'd like to connect with a local specialist, try using an HNHB BASETM Managed Specialty Group. There are 30 available!
New HNHB Regional Geriatric Psychiatry Group

The HITS eHealth Office is thrilled to announce the launch of the HNHB Regional Geriatric Psychiatry Group on eConsult.

This group of local specialists can answer eConsults that address severe mental illness (e.g. depression, mania, anxiety, psychosis, progressive cognitive disorder etc.) that develops in late life, dementia (e.g. Alzheimer Disease), addiction and/or behavioural complications.

How to Access a Regional Managed Group on eConsult:

  1. Use the OTNHub Directory and search for 'HNHB Regional Geriatric Psychiatry Group'
  2. With your 'Priority Region' already set to Hamilton Niagara Haldimand Brant (Read how to set your Priority Region here), select 'BASETM Managed Specialty Group' after initiating an eConsult, then select 'Psychiatry' from the dropdown menu, then select 'Geriatric' in the next dropdown menu.
  3. Proceed as normal with your eConsult.
Why Set Your eConsult Priority Regions?

  • Setting your Priority Region to HNHB gives access to local specialists within the HNHB Regional BASETM Managed Specialty Groups automatically
  • Without setting Priority Regions, cases can only be sent to Provincial Groups

Did You Know a COVID-19
Managed Speciality Group Exists?


As a result of the current COVID-19 pandemic, OTN and the eConsult Centre of Excellence have created a COVID-19 BASETM Managed eConsult Specialty Group.

This group enables physicians and nurse practitioners to ask clinical questions to infectious disease specialists electronically and receive a response within days. This is the only group that allows for population-based, non-patient specific clinical questions. 
For non-patient specific questions please enter the patient information as follows:
  • First Name: COVID19
  • Last Name: COVID19
  • Date of Birth: 1900-01-01
  • Select OHIP number not available
Need a refresher or assistance logging onto OTNHub?

Watch a short video or contact us at eConsult@HITSeHealth.ca to set up a quick training session.
Contact Us
For more information on anything in this email, or to schedule a follow-up appointment with our team, please contact us at the email listed below.