SEAMO is excited to announce the introduction of a new eConsult pathways group in Gastroenterologyphysician working with a liver accepting eConsults now! Dr. Melissa Kelley is one of the specialists who can answer your eConsult and she says the eConsult service provides another method for primary care to contact GI specialists with questions or clarifications as they are working through one of the GI primary care pathways. “It’s a way to reach out for a timely response without having to wait for a call back from a specialist pager. It allows primary care to send their question when they have time to do it and review the response from the eConsult when it fits into their schedule,” she explains. “It hopefully will make our service more open and accessible to support our primary care partners in use of the clinical pathways.”

This is part of a Kingston Health Sciences Centre-wide innovation initiative to reduce wait times for specialty access and a number of evidence-based projects have been undertaken to reduce demand/need for new referrals as well as increase capacity to manage referrals across specialty groups.

One of these projects has focused on the introduction and implementation of an increasing number of “primary care management pathways” for common, non-urgent conditions for which long wait times exist. A working group, comprised of specialists, primary care physicians, as well as patient experience advisors, is overseeing the development of these primary care pathways at KHSC. Gastroenterology is one of these pathway groups.


Pathways are clinical algorithms, formatted as a flow diagram that provide primary care physicians with advice and resources to manage non-urgent conditions within the primary care home – and are to be used instead of making a specialist referral. Each pathway provides information on:

  • red flag/referral findings necessitating an urgent referral to a specialist;
  • how to make rapid telephone contact with a specialist should the primary care physician have questions about a patient following a pathway; and
  • how to leverage eConsults where appropriate

The pathway is also accompanied by relevant resources, such as a patient conversation guide should patients express interest in knowing more about the pathway.


For examples of primary care management pathways developed by KHSC, please visit: KHSC Referral Information. Pathways are available by specialty page.

Dr. Kelley provides five examples of questions that can be answered by this new Gastroenterology eConsult pathways service: 

  1. NAFLD pathway—A patient has a positive smooth muscle Ab but other autoimmune markers are negative—does this patient require a consult to assess for autoimmune hepatitis?
  2. NAFLD pathway—A patient has a positive HCV Ab—should this patient be referred for consult or should other tests be done?
  3. Diarrhea, IBS or Dyspepsia pathways—I checked the celiac serology and the TTG is normal but IgA is low. How can we assess for celiac disease?
  4. Dyspepsia pathway—I treated H. Pylori with quadruple therapy for 14 days but follow up urea breath test is still positive. What are the next steps?
  5. IBS Pathway—my patient couldn’t tolerate amitriptyline as it caused constipation. Is there another option to help the abdominal pain?

Dr. Kelley’s hope for the future of this program is for it to provide patients and primary care access to specialist advice for common conditions that can be managed in the primary care home and also to help identify those who do require specialist referral. “Our goal in the longer term is for this to decrease wait times to see specialists so those that require specialist care can access it in a timely fashion. The eConsult group is a way to help support our busy primary care partners in patient care and hopefully add a communication method that is less time-consuming and flexible for their schedules.”