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eReferrals a Case Study in Innovation
Dr. Allen Ausford - Meadowlark Health Centre Stefan Fletcher - CEO, RebalanceMD
Gary Folker, SVP, Orion Health Daniela Lockhard, VP Business Development, Strata Health Solutions
Andrew Montgomerie , Director, Financial Services & Health Care Programs, WorkSafeBC
Penny Rae, Chief Information Officer, Alberta Health Services (Moderator)
Healthcare Summit eReferral Value Proposi5on Gary Folker, SVP, Orion Health
SVP, Orion
“Obstacles are those frigh@ul things you see when you take your eyes off the goal”
Page 4 • Copyright © 2012 Orion Health™ group of companies • All rights reserved
As is Situa)on: Care Complexity Drives Waste and Inefficiency
Experiences – Referring clinicians
• You don’t know the waitlist or the people to whom you are referring pa5ents
• Specialists complain about the informa5on you send with a referral
• You don’t hear back from a specialist aQer a consulta5on
• Your pa5ent complains that the specialist didn’t seem to know why s/he was there
• A referral doesn’t answer your ques5on
• Your pa5ent doesn’t come back to see you aQer a consulta5on
• A specialist duplicates tests you have already performed
• You are unaware that your pa5ent’s other referrals and results
Experiences – Receiving providers
• You don’t offer the services being requested
• You don’t know why the pa5ent is in to see you
• The referral is incomplete, not legible, or inappropriate
• It’s not clear what tests have already been done
• Pre-‐request informa5on and results are not available
• Your unaware of the pa5ent’s other referrals
Qualita)ve Benefits by Stakeholder Group For The Pa)ent
• More choice -‐ aware of op5ons for referrals (referral based on loca5on, availability, wait lists)
• More informed -‐ aware of pre-‐requisites upfront
• Improved customer services -‐ status inquires are responded to much quicker
• More confident -‐ less likely to receiving conflic5ng info from clinicians
For Referring Clinician • More choice -‐ aware of all specialists that provide desired services
• Less )me – referrals are auto-‐populated with pa5ent informa5on and guide provider through mandatory fields, referrals can’t be lost or miss-‐directed
• Know what informa)on to send – automated forms include specialty
• Improved referral responses – the results answer the ini5al intent of the referral
For Receiving Providers • BeOer access to marketplace – able to clearly publicize service special5es, loca5ons, availability
• Improved efficiencies – less 5me spent dealing with in-‐complete, inappropriate, illegible, and duplicate referrals
• BeOer informed – access to pa5ent electronic file
• Less duplica)ons – aware of tests already conducted by another provider
For Healthcare Managers • Improved performance repor)ng on referral volumes, specialty, and nature of referral
• Improved efficiency resul5ng in increased capacity
• Improved service for the money spent.
• Ability to forecast demand and supply and jus5fy requests for more resources
• Improved clinical outcomes as a result of improved processes, and use of structured data and templates
Achievements
Time efficiency for clinicians and patients
Reduces the high cost of referrals
Information sharing and ‘the conversation’
Patient safety increased; risk reduced
Innova5ve change …..done by physicians that has drama5cally improved pa5ent wait 5mes and pa5ent experience
Who Are We?
Located in Victoria, BC, RebalanceMD is a physician-owned and operated interdisciplinary clinic specialized in musculoskeletal care
Our Team 14,000 square foot state of the art facility hosts: • 18 orthopedic surgeons • 3 physical and rehabilitation medicine specialists • 5 sports medicine physicians • 4 registered nurses • 1 occupational therapist • 10 physiotherapists • 3 internal medicine specialists • 3 physician extenders • 1 osteoporosis internist • Pre-operative
optimization physician team • Post-operative
rehabilitation team • Anesthesia consulting team
Exceptional patient and practitioner satisfaction
75% reduction in wait times
Best diagnostic
technology
Seamless access to
specialists
Simplified patient
experience
Convenient one stop access to all related health care needs
Fair and transparent
referral process
Complete transparency and knowledge throughout the system
What We Do
First Available Appropriate
Specialist Triage (FAAST)
Standardized Physician Referral Form
http://rebalancemd.com/downloads/Rebalance-MSK-referralform.pdf
The Impact We Are Having – Reducing Wait Time for Consulta)on
Wait time for consultations for all patients has been dramatically reduced. In only two years a steady
decrease of 50 to 75% occurred.
The Impact We Are Having – Adop)on of FAAST
On average, 38% of all referrals received by the clinic are now addressed to the FAAST model
What Makes Us Different?
Traditional Model RebalanceMD Model
Multiple points of access to practitioners Patient’s role is passive Fragmented patient information Long wait times to see specialist Silo’ed health care streams between allied health professionals
Single point of access for all related health issues Patient’s role is active Real-time patient information gathering and sharing Reduced wait times to see specialist Complete care from all allied health professionals
FAAST Model
Streamlined patient in-take
Patients directed to correct specialist
Coordination of allied health professionals
Consultation process actively managed
Alternative to traditional referral process
Dramatic wait 1 improvements
June 23, 2015 Kelowna, BC
E-‐Referrals a Case Study in Innova)on
Allen Ausford MD FCFP Clinical Professor
23
Stages of Referral Evolu5on Referral Evolu)on
What is Path to Care A provincial program aimed at improving the way we manage referrals and patient wait times.
Right Care Right Place Right Time
Patient books primary care
appt
Patient sees primary care provider
Decide on service
Referral Received
Referral Information Complete
Appt booked
Attend appt
Ready for service
Booked for service Attend service
Communicate outcome to referral source
Pa)ent Centric EMR’s/EHR
GP
Notes
Meds
Reports
Care Plan
DI
Lab
DM
Notes
Meds
Reports
Care Plan
DI
Lab
CDM Nurse
Notes
Meds
Reports
Care Plan
DI
Lab
ED
Notes
Meds
Reports
Care Plan
DI
Lab
Pa)ent
Alberta Netcare (EHR) Orion Health Suite >36,000 ac)ve users
Func)ons • Provider Portal • EMR context launch • Case management • Pharmaceu5cal Informa5on
Network • PAC system / Viewer • Popula5on Health dashboard • List capabili5es • Messaging • Resources and links • eReferral
Province Wide Sta)s)cs • 96% of all dispensed medica5ons • 92% of all laboratory test reports • 92% of all diagnos5c images and
reports • >200 million screens of
informa5on accessed by Alberta Health professionals
eReferral Clinical Requirements
– Province wide – Leverage current Netcare data/pla@orm – User Friendly / Team based – Health Services Catalogue enabled – Standardized form tools / Time efficient – Tracking /Triaging
• Referrals • Wait 5mes
Referral processing at WorkSafeBC
Suppor5ng Injured Workers in accessing health care Andrew Montgomerie, Director Financial Services & Health Care Programs
June 23, 2015
Objec)ve: Provide expedited access to necessary health care in support of the injured worker’s 5mely recovery and durable, safe return to work.
29
Referrals at WorkSafeBC
Referrals at WorkSafeBC
• ~150,000 Injuries reported per year • ~60,000 claims that result in 5me lost from work • ~30,000 referrals to specialized health care programs
• Developed contracted networks of health care providers: • Occupa5onal Rehabilita5on • FCE
30
• Psycholog
y
• Home
Care
• Etc…
Referrals at WorkSafeBC
• Manual effort to process = delays for injured worker • Paper, phone calls, faxes, folders on desks…
= 24-‐72 hours to book appointment
31
2011: Partnership with Telus Health Solutions to build our Provider Portal
Referrals at WorkSafeBC
32
0
5,000
10,000
15,000
20,000
25,000
30,000
35,000
40,000
2009 2010 2011 2012 2013 2014
Total Annual Referrals
Referrals -‐ Portal
Referrals -‐ Manual
Referrals at WorkSafeBC
Benefits …for the injured worker:
• Faster access to required health care • Access to care in local community
…for WorkSafeBC
33
• Process time reduced
by 1 day
• Easier for case
managers
• No more paper
• Better data
• Scalability
• Less manual effort
Global eReferral Innova5ons & Lessons Learned
6/23/15 34
Panel D: eReferral – A Case Study in Innovation 15th Annual Healthcare Summit - Disruptive Forces in Healthcare
June 23rd, 2015
Panelist: Daniela Lockhard, VP Business Development [email protected]
6/23/15 35
Intelligent eReferral
Population Health
Management
Care Coordination
Social Determinants of
Health
Prevention Health & Wellness
Citizen Engagement
Improved Health and Wellness for all System Efficiency and Optimization
Quality of Care
6/23/15 36
Cumbria Clinical Care Group eReferral Outcomes
6/23/15 37
6/23/15 38
Leadership System-‐wide eReferral ini2a2ves require strong system leadership and sustainable funding to
succeed.
Shared Leadership Transforma2on of our health care system to improve the pa2ent
experience starts with me. Everyone is accountable
and engaged. MacLeod & Closson (2013)
6/23/15 39
