Transforming Alberta’s Referral ExperienceConnecting Healthcare Professionals

Allen AusfordMD FCFP Clinical Professor

Referrals Affect the Entire Health Ecosystem

Referral

Community

Long term care

Acute 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? “

7

Stages of Referral Evolution

Referral Evolution

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 StandardsAlberta QuRE project

Referral StandardsCollege of Physicians and Surgeons

In an “Ideal” World

• Single area for referrals and tracking

• Health Services Catalogue enabled

• Real time access times posted

• Supports “standard referral” and “referral for advice”

• Standardized forms for both Generic and Custom referrals

• Triage automation/scoring capability

• Known information does not need to be duplicated

• Supports providers and patients electronic communication

• Analytics embedded with optimization feedback

Efficient referral generation

Triage automation

Standardized process and forms

Health Services

Catalogue

Analytics Needed to Track Referrals

Patient books

primary care appt

Patient sees primary care

provider

Decide on service

Referral ReceivedReferral Information

Complete Appt booked

Attend appt

Ready for service

Booked for service Attend service

Communicate outcome to referral

source

Alberta Netcare (HIE) Orion Health Suite

• Provider Portal

• EMR context launch

• Case management

• Pharmaceutical Information Network

• PAC system / Viewer

• Population Health dashboard

• List capabilities– ADT generated

– Provider generated

• Messaging

• Resources and links

• Data integrity

• 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