I can't help but reflect: is there another Health Information Management strategy out there that has the same broad appeal and value as eReferral?
Canada's Alberta Health Services recently announced the rollout of a new province-wide, eReferral solution that seamlessly integrates with its EHR (a province-wide electronic health records system similar to an HIE). See Alberta Netcare for further details, videos and orientation material.
A Cornerstone for Healthcare Service Delivery
By way of background, almost all specialty services provided in healthcare organisations around the world are managed through a complex system of referrals. A referral is used to safely transfer patient care and service delivery across a variety of departments and care settings; such as referring to a specialist, conducting assessments, enlisting opinions, conducting treatments, enabling specialised clinical workflow (e.g. cancer care) and coordinating services for complex patients. Knowing this, the referral can be viewed as a strategic enabler – if you can improve the referral process, you can significantly improve the healthcare system.
Fax Machines and the Referral
The fact is that healthcare is one of the few remaining industries today that still relies on fax machines. This presents challenges since the majority of referrals are often handwritten on pre-printed forms that are then faxed or mailed. The inconsistency in this process opens the door to a litany of issues including:
- Lost or misdirected referrals
- Illegible referrals, resulting in mistakes and patient safety issues
- Inappropriate referrals
- Incomplete or missing pre-requisites
- Requesting tests/procedures that have recently been completed
- Wasteful re-work, call-backs, and confirmations
- Manual status updates
- Delays in receive results of referrals
- Patients lost in transition, no follow-up
- Lack of visibility to the referral status by the referring clinician
This list, while not comprehensive, clearly shows that there are dangers, waste, and barriers associated with manually sharing patient information throughout the referral process.
Putting the "e" in eReferral
Fundamentally, eReferral enables the end-to-end management and tracking of referrals through electronic means across a defined healthcare system. The “e” allows for the closed-loop process of a referral: creation, submission, acceptance, and closure of service requests between clinicians. It sounds simple enough; however, eReferral includes some very sophisticated capabilities:
Health Services/Provider Directory:
This enables the selection of the most appropriate service to meet patients needs including: service specialty, availability, location, and in-network referrals. Too many doctors today, restrict patient-referrals to the same personal network of people and services that they are aware of.
Integration with Electronic Health Records (EMPI, EMR, EHR and HIEs):
This enables auto-population of both patient demographic and health information in the referral, saving clinicians significant time and reducing errors made through data entry.
Auto Generation of Continuity of Care Documentation (CCD/CDA):
Similar to the integration with Electronic Medical Records (EMR) above, this enables the auto-generation of required patient contextual information as part of a referral and/or transition of patient care across care settings. This capability would also satisfy CCD/CDA Meaningful Use requirements in the US.
Standardised Referral Forms by Specialty:
This enables standard forms by specialty that includes mandatory fields, pre-requisites, and associated clinical workflow or care pathways. It also means that patients and their data are transitioned together from one care setting to another within a closed-loop process. The receiving specialist understands why a patient is being referred to them and has the relevant information to initiate care, which in turn saves significant time and reduces re-work. This capability also impacts clinical outcomes by reducing re-admissions or acute episodes and ensuring appropriate care is provided while reducing the wait-time associated with patient transition across care settings.
Automated and Secured Processing:
Automated send/receive/acknowledgment messages mean no more lost referrals. Automated scheduling allows the patient to leave their doctor's office with a booked appointment to meet a specialist. Real-time referral updates, ensure that the status of the referral is available to all parties involved throughout the entire process, significantly improving both clinician and patient inquires regarding status and allowing appropriate follow-ups from the referring clinician. Wait list and priority setting controls also allow service providers to manage their referrals more effectively.
Yes, But What About Adoption?
Some of the very early health IT initiatives of the past required clinicians to enter information they collected on paper, into electronic files, often for someone else's benefit. However, assuming comprehensive electronic records (EMR, EHR, or HIE) already exist, eReferral provides a strong value proposition for clinicians who are sending as well as those receiving electronic referrals. Both sender and receiver enjoy more choice and control, significantly less administrative work through auto-population and workflow, fewer incomplete transactions, increased capacity, and improved financials.
The solution also allows clinicians to improve customer service to their patients as well as reduce the number of patients “lost in transition.” Properly designed and implemented, the eReferral is an example of a Health IT solution that appeals to almost all stakeholders and users of the system. The adoption challenge for eReferral will not be getting clinicians to use the technology, but rather having clinicians agree on the standardised clinical pathways and forms to be automated.
eReferral as a Strategic Enabler
A number of studies have pointed out that up to 30 percent of healthcare services in the U.S. are wasteful. eReferrals could have a significant impact on many of these wasteful activities.
From a strategic perspective, the eReferral also provides healthcare managers and policy makers with a fundamental decision-making tool which they don't have currently. Although information on healthcare claims have been available for decades, imagine for the first time, having a clear picture of healthcare medical transactions for analysis, as well as providing a better understanding of the daily operations of healthcare service delivery.
There are no easy “silver bullets” in healthcare; however it's hard to see how the healthcare system can address waste without region-wide, process-automation solutions like eReferral. Additionally, given the broad appeal of the solution to clinicians, as well as healthcare managers and policy makers alike, eReferrals should have a place in every Health IT organisations' strategic plan.