EDMONTON – Now in its second year, the Alberta Netcare eReferral program has shown promising results.

A notable feature is the addition of an “advice request” referral rather than a full in-person referral.

“We were told that about 30 percent of the time for non-urgent patients, specialists feel that they could have given an opinion without seeing the patient,” says Dr. Allen Ausford, a family physician and proponent of the eReferral solution.

“Adding a feature where care providers could simply seek advice, rather than delaying a patient’s care with an unnecessary visit, could fix a lot of the gaps in care and increase in-person referral capacity to see more urgent patients.”

Dr. Ausford is also an expert in clinical information systems, and recently participated in an Orion Health webinar outlining the Alberta experience with eReferral. Orion Health, a leading provider of population health and integration systems, has partnered with the province in building the Alberta Netcare eReferral solution.

Alberta aimed for an electronic system which would be user-friendly, requiring only three minutes for GPs to complete a referral, on average, along with the ability to track a referral’s progress through the system.

They also wanted it to connect to the Alberta Netcare system, a healthcare network that reaches tens of thousands of clinicians throughout Alberta. Moreover, the designers sought to include analytics capabilities so they could identify workflow and information bottlenecks. They achieved all this, which can be called the infrastructure of the system. On top of it, they’ve been building the workflow features, which are helping general practitioners make faster and more meaningful referrals to specialists.

The addition of the ‘advice request’ feature, mentioned above, is an example of how workflow – and patient flow – has been streamlined.

Another new feature involves blocking the submission of a referral unless all the information a specialist needs has been included. Traditionally, when doctors used faxes to communicate, up to 30 percent of referrals were incomplete. “The main complaint we’ve heard was that care providers don’t receive enough information. So they have to send the referral back to the primary care physician with questions,” commented Dr. Ausford.

This led to a lot of back and forth, resulting in longer waits for patients to see specialists. Some of Alberta’s hip and knee replacement clinics have reported that an incomplete referral results in the patient waiting an additional six weeks for an appointment. But by converting from faxes to computerized referrals, many of the delays can be avoided and the risk of losing referrals is reduced. Another feature of eReferral allows users to update an active referral as a patient’s condition changes, so the patient can be further moved up the waiting list.

Dr. Ausford recounted a story of one of his patients who was dealing with a sore hip for some time as a result of arthritis. A referral for a hip replacement was done by eReferral.

The patient initially started as a low priority for hip replacement, but when his pain increased to the point of needing daily narcotics, his situation was updated in the electronic system. The referral’s status was changed to a higher priority, resulting in a reduced wait for consultation.

There are few who disagree that more can be done to improve the state of referrals within Canada. While much of the finger pointing is aimed at fax machines and the unreliable and unsecure state of older technology, there are other considerations that are at risk of being overlooked as healthcare jurisdictions develop their eReferral solutions.

These issues have included incomplete information in the patient file, lost referrals and the need to change a patient’s place in the queue as his or her condition changes. As the Alberta experience indicates, these challenges can be quickly resolved using electronic solutions.

In Alberta, the eReferral system is being steadily accepted by GPs and specialists across the province. It is now servicing referrals for medical/radiation oncology, (breast and lung cancer), hip and knee joint replacement and nephrology (advice request only).

Dr. Ausford said that his personal ‘eureka moment’ with eReferral came during a recent patient visit: “I was sitting in an exam room with a patient I had referred three months earlier, and he asked about the status of his referral. The fact that with two pushes of a button I was able to deliver this information was very positive both for me and the patient. Just think how this will improve care when all of our referrals are done this way.”

This article originally appeared in the Canadian Healthcare Technology February 2017 issue which can be accessed via the canhealth website.