Transforming Alberta’s Referral Experience Connecting Healthcare Professionals Allen Ausford MD FCFP Clinical Professor
Referrals Affect the Entire Health Ecosystem Community Referral Acute Long care term care
Steps in Completing a Referral (Sending Referral Perspective) 1. Patient primary care appointment received 2. Patient seen and initial assessment done 3. Additional tests/workup received 4. Review of results with patient and decision to refer 5. Referral letter composed and forwarded to staff 6. Staff receives, attaches additional information and sends referral 7. Staff tracks if reply received - often pings consultants office about referral status 8. Referral date and time received 9. Staff fields ongoing complaints from patients about long waiting period 10. Patient seen and treated by consultant 11. Referral letter received back
Typical Referral Workflow Challenges • Letter arrives significantly later than date posted • Incorrect patient contact information provided • Letter sent to inappropriate provider • Does not see that type of problem • Patient already has specialist in that area • Specialist is not available in a timely fashion • Letter is incomplete – Reason for referral is unclear – Required information is missing – Faxed or scanned referral letter is illegible • Patient does not actually need to been seen in person - the referring provider simply need’s “advice”
Incomplete / Inappropriate Referrals Lead to • Delayed patient care • Poorer outcomes • Decreased referral capacity • Exasperated Triage Providers • Rushed Support Staff • Frustrated Physicians • Angry Patients
The Patient Experience ”It’s been 5 weeks since my Doctor referred me? You don’t know the status of my referral?” “Seriously, you don’t have my information? They did labs and x-rays. I assumed you had that all to view and it was sent with my referral!” “I can’t remember ‘Who I saw’ ...‘When’... for ‘What reason’ and you want me to recall all my past history and plan of care? “
Referral Evolution Stages of Referral Evolution 7
Workflow Issues • Simple vs complex triage systems • Duplicating known information • Incomplete information (send or not send?) • Sending to incorrect person/place/service • Referral status tracking • Draft • Waiting for triage • Triage in progress • Appointment booked • Waitlisted • Waiting for appointment • Appointment attended • Completed
Referral Standards Alberta QuRE project
Referral Standards College of Physicians and Surgeons
In an “Ideal” World Health Standardize Services d process Catalogue and forms • Single area for referrals and tracking • Health Services Catalogue enabled Triage automation • Real time access times posted • Supports “standard referral” and “referral for advice” • Standardized forms for both Generic and Custom referrals Efficient referral generation • Triage automation/scoring capability • Known information does not need to be duplicated • Supports providers and patients electronic communication • Analytics embedded with optimization feedback
Analytics Needed to Track Referrals Patient sees primary care provider Patient books primary care appt Referral Information Referral Received Appt booked Complete Attend appt Decide on service Communicate outcome to referral source Ready for service Booked for service Attend service
Alberta Netcare (HIE) Orion Health Suite • Provider Portal • List capabilities – ADT generated • EMR context launch – Provider generated • Case management • Messaging • Pharmaceutical Information Network • Resources and links • PAC system / Viewer • Data integrity • Population Health dashboard • Enhancement request • eReferral
Alberta Netcare Statistics Utilisation stats as of March 31, 2017 • Number of clinical screens viewed since 2006: 418,207,392 • Total number of unique users in last 6 months: 53,186 • Total number of physicians user accounts: 10,990 Data stats (Provincial) – 96% of all dispensed medications – 92% of all laboratory test reports – 92% of all diagnostic images and reports
“Full Consult”
Best Choices Made at the Onset
Best Choices Made at the Onset
Wait times
Ensure required info is included
Embedded Scoring / Triage Tools
Triage Dashboard
Scheduled appointment targets
“Advice Request”
Launch Netcare from your EMR
Click on eReferral button
Select referral type
Post referral service/specialist
Type in Question/Add documents
Workflow Issues resolved with eReferral • Simple vs complex triage systems • Duplicating known information • Incomplete information (send or not send?) • Sending to incorrect person/place/service • Referral status tracking • Draft • Waiting for triage • Triage in progress • Appointment booked • Waitlisted • Waiting for appointment • Appointment attended • Completed
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