Poor access and excessive wait times for specialist care is one of the most significant challenges of Canadian health systems [
15‐
18]. Poor access to specialists can lead to anxiety, pain, deterioration in health, delays in diagnostics, duplication of services and dissatisfaction of both patients and providers [
16,
19]. In a recent Commonwealth Survey, Canada was ranked the worst out of 11 countries for wait time to see a specialist (56% of Canadian patients waited at least 4 weeks). Within Canada, the situation was most dire in Newfoundland and Labrador, Manitoba, Quebec and Ontario with, respectively, 67%, 62%, 59% and 57% of patients waiting at least 4 weeks [
20].
One of the most promising innovations that has been piloted in Canada to improve access to specialist care is eConsult [
17,
21,
22]. eConsult is a model of asynchronous communication that allows primary care providers (e.g. family physicians, nurse practitioners) to electronically consult with specialists regarding their patients’ medical issues in a wide range of areas, including psychiatry, dermatology, geriatrics, paediatrics, cardiology, oncology, palliative care, sports medicine and clinical pharmacy. eConsult pilot projects have been shown to reduce wait times for specialist care, prevent unnecessary referrals, increase provider and patient satisfaction, and reduce health system costs [
15,
16,
21‐
23].
The model of eConsult first developed and piloted in the Champlain region in Ontario was the Building Access to Specialists through eConsult (BASE) model [
17]
. Given that the pilot projects were shown to be effective, efficient, acceptable and feasible, the spread and scale-up of eConsult has garnered increasing momentum across Canada [
24‐
26]. Between 2016 and 2018, teams in Manitoba, Quebec, Ontario, and Newfoundland and Labrador worked to spread eConsult to new clinics and regions as part of the Connected Medicine Initiative, supported by the Canadian Foundation for Health Improvement, in collaboration with the College of Family Physicians of Canada, the Royal College of Physicians and Surgeons of Canada, and Canada Health Infoway [
26]. In addition, three pan-Canadian symposiums have been held with providers, patients, researchers and policy-makers to reflect on the implementation, spread and scale-up of eConsult across the country [
27]. Key issues for scaling up eConsult identified during these symposiums include provider remuneration, patient privacy, delivery of care and interjurisdictional medical licensing [
27]. Scaling up eConsult has been identified as a priority by provincial governments of Ontario, Quebec, Manitoba and Newfoundland, and Labrador as well as by several professional associations, including the Quebec College of Family Physicians and the Association of Registered Nurses of Newfoundland and Labrador. Hence, it seems that there is a momentum in scaling up eConsult in Canada, with four provinces being actively involved and currently at different phases of the scale-up process (i.e. assessing, developing, preparing and implementing plans to do so). This offers a unique opportunity to conduct embedded research on the process of scaling up an innovation in real-world contexts, while contributing to cross-jurisdictional learning.