eReferral – Product Assessment and Recommendations

David Hutcheson

Business Analyst - FMPML

17 May 2013

CONTENTS PAGE NO.

(Click on headings to navigate to relevant section of the document)

1. Executive Summary 3

2. Background to eReferral Project 4a. The importance of eReferral in an evolving healthcare environment 4b. The benefits of a cohesive approach to eReferral adoption 4

3. Key Requirements 6a. Requirements gathering across the stakeholder community 6b. Formulation of key requirements for vendor assessment 7

4. Vendor Assessment 8a. Approach to Vendor Engagement 8b. Vendor Assessment Matrix 9c. Contextualising the Results 12

5. Environmental and Organisational Context 13a. The Barwon experience 13b. Partners in Recovery 14c. Miscellaneous considerations 15

6. Conclusions and Recommendations 16a. Key Recommendations 16b. Final Conclusions 17

Appendix 1 – Projected costs for recommended eReferral solutions 18

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1. Executive Summary

The establishment of the National E-Health Transition Authority (NEHTA) in 2005 was designed to encourage the adoption of a variety of eHealth initiatives by healthcare providers. One of the foundations of an effective eHealth environment is secure electronic messaging which enables the transfer of patient information, principally for the purposes of referrals between care providers. This process is commonly described as eReferral.

With NEHTA standards being adopted and tested by prospective vendors in recent times, Frankston Mornington Peninsula Primary Care Partnership (FMP PCP) were keen to explore this marketplace and recommend product options to their members to facilitate the growth of eReferral within their catchment. Frankston Mornington Peninsula Medicare Local (FMPML) were also quick to recognise the importance of facilitating the uptake of eReferral capability across the FMP region, and funded a business analyst resource to undertake the project activities described in this document.

This report outlines the three steps taken to identify one or more vendors who would be an appropriate fit for the specific requirements of FMP PCP and its members:

1) The gathering of key requirements from key users and stakeholders;2) Engagement with vendors on their product offerings and associated capabilities; and3) Recommendations on vendor suitability and proposed next steps.

A number of PCP members were consulted on their eReferral requirements, and all nine NEHTA-approved Secure Messaging vendors approached to be a part of the vendor assessment process. This was important to ensure that any product/vendor recommendation was in line with national eHealth standards (as outlined by NEHTA) to guarantee interoperability and sustainability.

The key recommendations and proposed next steps as outlined in this report are:

1) ReferralNet (Global Health) and AllTalk (LRS Health) are recommended as the products of choice for secure messaging/eReferral across the catchment.

2) The creation of a project management and system implementation function within FMP PCP and/or FMPML to co-ordinate the procurement and adoption of secure messaging across the catchment.

3) Global Health and LRS Health to be invited to respond to a selective tender on the rollout of their respective secure messaging capability across the FMP region, to include discussions on licensing/subscription options for a whole-of-catchment implementation.

4) The identification of ‘early adopters’ within all key care provider sectors (as appropriate) to enable a phased approach to implementation.

It should be noted that if FMP PCP/FMPML undertake to run and fund a co-ordinated procurement and rollout of the selected eReferral capability (as per the Barwon ML model and as recommended in this report), that steps 2) – 4) would be the foundation of this process. If this is not feasible, then the product recommendation would be ReferralNet as it can be adopted by individual care providers at low cost (AllTalk is only really suited to a larger procurement because of the nature of its server-based offering). It is, however, recommended that central procurement and co-ordinated rollout across the catchment is the approach taken because of the likely benefits it will provide.

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2. Background to eReferral Project

The facilitation of secure electronic messaging between healthcare providers was identified early by NEHTA as a core component of an effective eHealth environment. The increased use of specialist and community care, the growth of care co-ordination and the complex health journeys that many patients experience require timely, effective and secure exchange of information between healthcare professionals. FMP PCP recognised this and were keen to explore options for the recommendation and adoption of eReferral software that would dramatically enhance current eReferral systems and processes.

a. The importance of eReferral in an evolving healthcare environment

There are a number of practical and organisational benefits to the adoption of electronic referral through the use of secure messaging, principally in reducing costs and improving efficiency within any healthcare provider. There is no need to print, fax and/or post referrals and it eliminates the inefficiencies and time delays involved in the administration of paper-based processes. Many secure messaging products also promise seamless integration with existing client management systems (CMS), reducing the time the care provider needs to spend in generating and sending the referral in an appropriate format as well as improving how they receive referrals and how these are automatically attached to the patient record.

In addition, one of the main benefits of implementing eReferral capability within any healthcare environment is that of data security. Health records can contain particularly sensitive information about an individual and the removal of postal and/or fax communications from the referral process should eliminate a large element of risk around the inadvertent exposure of any personal details. Secure messaging systems can also provide confirmation of delivery of the referral – thereby satisfying the referrer that the documentation has been successfully received and should be acted upon promptly.

As the healthcare environment in the FMP region, and Australia as a whole, continues to evolve there is a strong probability that the demand for secure messaging will grow. Patients require increasingly specialised care plans in a variety of areas, from mental health to chronic disease to other conditions that require a joined-up approach to treatment. The volume of interactions and communications between healthcare providers will only increase, perhaps exponentially, as a result. This is not news to the vast majority of people operating within the healthcare arena, but the question is how to implement a capability that can turn a traditionally fragmented sector with multiple systems and processes into one where information can be exchanged rapidly, seamlessly and securely without wholesale change to its component parts.

b. The benefits of a cohesive approach to eReferral adoption

The use of secure messaging products for eReferrals is not a new phenomenon – indeed there are many regions of Australia (and beyond) that have successfully integrated this into their respective healthcare environments. Within the Frankston-Mornington Peninsula area there are already pockets of eReferral capability and some referrals (or similar messages) being sent using various secure messaging products.

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There are a number of reasons why this has not been extended significantly across the FMP region (and why various other regions are falling well short of full-scale eReferral). The principal reasons are:

i. The interoperability – or lack thereof - of secure messaging products (i.e. if one practice/organisation has a particular secure messaging product then they can only send eReferrals to other organisations who also have the same messaging product); and

ii. Negative experiences with current secure messaging capabilities (e.g. products can be unreliable and they aren’t integrated well with client management systems).

These issues were revealed during stakeholder discussions and are therefore explored in more detail in section 3 below.

As outlined above, one of the main challenges is to examine how best to facilitate and implement eReferral capability across a region with minimal effort required by the user community. Any minimisation of cost would also be welcome, while maintaining the primary aim of adopting a cohesive approach that enables healthcare providers to benefit from the new capability rapidly and easily.

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3. Key Requirements

a. Requirements gathering across the stakeholder community

In order to gather system and user requirements it was important to engage with as many key stakeholders within the FMP PCP community as possible. A number of PCP members were visited during this stage of the process, including:

Frankston City Council – Communities/Aged Care Peninsula Health Peninsula Health Community Health Frankston Mornington Peninsula Medicare Local Brotherhood of St Laurence Mind Peninsula Support Services Royal District Nursing Service Headspace Frankston

Project scope and time constraints prevented further stakeholder engagement, but these discussions revealed some key themes in relation to current referral processes that were relatively consistent across the PCP membership. These were:

Some eReferral processes are being used, including ConnectingCare and S2S, but there is a relative lack of consistency across the region – particularly in relation to ConnectingCare, which many users say they have little confidence in;

Care providers use different systems for client management, care co-ordination and other organisational requirements – they do not want to replace or amend these simply to enable eReferral;

These systems do not generally integrate well with their current eReferral capability (if they have one) – it is not a seamless process to refer electronically from a client management system, and there is often some manual data entry required that increases the time involved (as well as levels of frustration); and

Costs for any new system or capability should be kept to a minimum, as well as any time/effort needed to integrate it with current systems and processes.

In addition, a number of stakeholders expressed a desire to access ‘patient journey’ information – i.e. a summary record of the points of care that a client has accessed through the various referral processes operating across the care provider community. This is important to enable better understanding of the care journey that an individual has taken, including what referrals have already been made and perhaps additional information on patient response to the care provided. This would not only enhance information sharing across the healthcare community but it should also improve the patient’s experience, particularly as they would not need to repeat information they may have already been asked to share with one or more care providers.

With these high-level requirements gathered, a set of requirements and key criteria against which to measure all prospective vendors was formulated.

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b. Formulation of key requirements for vendor assessment

As outlined above, there were some key requirements elicited from the stakeholder community that could be directly translated into vendor assessment criteria – which were framed as follows:

Integration with clinical systems (to ensure interoperability with the variety of systems across the PCP community)

Automation of generate/send/receive referral (to reduce/eliminate the manual element of preparing referrals)

Flexibility to meet future needs (particularly the development of the patient journey capability)

Costs (Initial/Future)

Additional considerations included whether or not the vendor has experience in this region before (local and state), which were translated into the following requirements:

Regional experience and knowledge (experience of implementing their product within Victoria)

Footprint across the catchment (are any care providers within the FMP region using their eReferral products already)

Finally, a set of criteria was designed to ensure confidence in the vendor as a provider of quality products and services that the FMP PCP would be comfortable in recommending to its members. There was then direct engagement with all key vendors during this process (as outlined in more detail in section 4 below), who were measured against the following criteria to complete the assessment phase.

Verbal presentations/web demonstrations (how convincing were they during product demonstrations and related discussions specific to FMP PCP requirements).

Past performance and related engagements (what is their history in providing products and services related to eReferral, and do they have strong references).

User/system support arrangements (how comprehensive and effective does this appear to be).

Breadth of offerings (do they have additional products that users/stakeholders could benefit from adopting should they desire).

Customer engagement and transparent approach to service provision (how comfortable are we with their view of how any future client/vendor relationship may work, and whether or not pricing models are sustainable or susceptible to change).

Training and knowledge transfer (what training is required, and how good are their knowledge transfer processes).

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4. Vendor Assessment

At the core of this project was an exploration of the secure messaging marketplace, as redefined under NEHTA guidelines and standards. This section describes the approach taken (and why), and includes an assessment matrix designed to measure how well current vendor products and services match up to the current (and future) requirements of the catchment. The results from the vendor assessment matrix are then contextualised in an attempt to inform final recommendations.

a. Approach to Vendor Engagement

NEHTA manages a national eHealth Product Register on behalf of the Australia healthcare community, which provides a register of medical software products and organisations that meet the requirements of the Practice Incentives Program (PIP). Secure Message Delivery is one of the core components of eHealth and has a dedicated product register, the introduction to which states:

“The Secure Message Delivery (SMD) Australian Technical Specification published by Standards Australia defines a set of interfaces and associated applications ensuring that health information exchanged by healthcare providers is protected against malicious interference. Health messaging software systems listed here have been independently assessed for conformance to the SMD specifications. The assessment was performed by testing laboratories accredited to perform SMD conformance testing.”1

It is important that any software vendor recommended for FMP PCP operates in line with SMD standards, and is therefore an approved vendor under this part of the product register. This formed the initial list of vendors that were approached to engage with this assessment process, who were (secure messaging products are in brackets):

Database Consultants Australia (Argus) HTR Business and Technology Services Pty. Ltd. (HTR Telhealth) CSC Healthcare Group - iSOFT Aust Pty Ltd (PractiX) HealthLink International Limited (HealthLink Messaging System) Medical-Objects Pty Ltd (Medical-Objects Capricorn) Global Health (ReferralNet Agent) University of Western Australia (MMEx) LRS Health (AllTALK) Alcidion (Miya Platform)

It should be noted that ConnectingCare and S2S, two current referral products being used by selected PCP members, do not appear on this list. Neither solution is a true secure messaging products (they operate by users logging in to a separate system rather than sending directly) and are therefore not capable of delivering a message directly to another provider as stipulated under SMD

1 SMD should not be confused with SMX – Secure Messaging Exchange. This is an initiative by three of the main secure messaging vendors (Healthlink, DCA and Global Health) that was intended to enable secure messages to be sent and received by each of their respective products in advance of SMD being used by the approved vendors. SMX has not been implemented as yet, and there are doubts that the three vendors will actually be able to come to an agreement in relation to costing models. It is therefore recommended that the focus remains on SMD approved vendors, which includes the SMX consortium members anyway, but with no requirement for the recommended solution to be SMX-compliant.

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protocols. They are both capable of providing a type of electronic referral, but not one that complies with NEHTA standards and are therefore not considered as part of this assessment.

Attempts to engage with University of Western Australia and Alcidion were unsuccessful, and initial analysis of open source material indicated that their solutions may not have been an ideal fit. CSC Healthcare did respond to an initial query, but confirmed that their secure messaging solution only integrated with their own clinical software – making it unsuitable for this catchment.

The prospective vendor list was therefore amended to contain six vendors, each of whom were approached individually to arrange for in-depth discussions on their product and service offerings. Telephone discussions, web demonstrations and/or face-to-face meetings were then conducted depending on availability, and information compiled to allow for measurement against the criteria described previously.

b. Vendor Assessment Matrix

Typically, if an organisation is looking to procure a software product to solve a problem it would first assess the basic requirement – can this product do what we need it to? In this case, the products have been extensively tested and are generally in operation across parts of Australia doing exactly what is required – delivering eReferrals through the use of secure messaging.

The focus of the assessment was therefore the requirements outlined in section 3 above, namely:

Integration with clinical systems Automation of generate/send/receive referral Flexibility to meet future needs Costs Regional experience and knowledge Footprint across the catchment Verbal presentations/web demonstrations Past performance and related engagements User/system support arrangements Breadth of offerings Customer engagement and transparent approach to service provision Training and knowledge transfer

Weightings were then attached to each of these criteria based on their importance to an effective implementation of eReferral capability across the region, as follows:

2.5 – Essential (poor capability in this area would prevent success) 2 – Important (poor capability in this area would impact significantly) 1.5 – Desirable (poor capability in this area would have some negative impact)

These weightings are based on requirements gathered from PCP members and key stakeholders as well as an understanding of the broader business and system requirements appropriate to an IT implementation of this type. In a larger project with less restrictive timescales there would have been more scope for testing and ratifying the matrix criteria and particularly the allocation of weightings. It is, however, unlikely that any amendment to the weightings would fundamentally alter

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the conclusions reached through the assessment process given the relative strengths of each vendor/product.

Finally, each vendor was assessed against the criteria and assigned a score from 1 to 4, as follows:

4 – Strong capability in this area 3 – Good capability in this area 2 – Fair capability in this area 1 – Poor capability in this area

The unweighted score is multiplied by the weighting to produce the weighted score, with scores totalled for each vendor across the 12 criteria to produce a final score out of 100. Figure 1 is the completed vendor assessment matrix showing these scores in full.

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AllTalk Argus HealthlinkHTR

TelhealthMedical Objects ReferralNet AllTalk Argus Healthlink

HTR Telhealth

Medical Objects ReferralNet

Integration with existing clinical systems

2.5 4 4 4 2 4 4 10 10 10 5 10 10Flexibility to meet future needs - particularly patient journey

2.5 4 2 1 1 2 3 10 5 2.5 2.5 5 7.5Costs (Initial/Future) 2.5 4 3 2 2 3 3 10 7.5 5 5 7.5 7.5Verbal presentations/web demonstrations

2.5 3 3 1 1 3 4 7.5 7.5 2.5 2.5 7.5 10Automation of generate/send/receive referral

2.5 4 4 4 1 3 4 10 10 10 2.5 7.5 10Regional experience and knowledge 2 2 3 3 1 2 3 4 6 6 2 4 6Past performance and related engagements

2 3 1 2 1 3 3 6 2 4 2 6 6User/system support arrangements 2 3 3 3 2 3 3 6 6 6 4 6 6Customer engagement and transparent approach to service

2 4 3 1 3 3 3 8 6 2 6 6 6Breadth of offerings 1.5 2 4 2 2 2 4 3 6 3 3 3 6Footprint across the catchment 1.5 1 4 4 1 2 2 1.5 6 6 1.5 3 3Training and knowledge transfer 1.5 4 3 3 3 3 3 6 4.5 4.5 4.5 4.5 4.5

82 76.5 61.5 40.5 70 82.5

Vendor Assessment Matrix - Secure Messaging Software

TOTALS (OUT OF 100)

CriteriaUnweighted Score Weighted Score

Weighting

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Figure 1 – Vendor Assessment Matrix for eReferral products

c. Contextualising the Results

It is obvious from the matrix scoring that HTR Telhealth (40.5) would not be an appropriate product at this stage. The product has potential, but there were too many gaps in HTR’s capability and their general response during engagement means they would be too much of a gamble.

Healthlink (61.5) is in operation across parts of the catchment already, so in certain circumstances their weaknesses in other areas could be overlooked. There are, however, some issues with their costing model for secure messaging - sender pays, with no plan to charge GPs, is unsustainable – and those who had some experience of how they operate were generally not positive. Allied to their relatively low score, this would remove them from consideration as a viable/appropriate vendor.

Medical Objects (70) are based in Queensland and, although they do have some organisations using their secure messaging in our catchment and Victoria more widely, there would be some concerns in relation to regional footprint and their capability to respond to future needs in a timely and cost-effective way.

The engagement with DCA on Argus (76.5) was probably the most interesting one as they painted a picture of good product integration, an already-established presence within the region, that they were driving national standards and could also provide a comprehensive set of products that would benefit the wider care provider community. In isolation this would make them one of the front-runners but they would bring significant challenges for this catchment because of the negative experiences that multiple stakeholders have had with their products. Change management and generating an appetite for adoption across the provider community would be particularly difficult with DCA as the vendor of choice.

AllTalk (82) was of particular interest, as LRS Health traditionally works with clients in pathology and radiology environments but have developed a relatively simple, email-like secure messaging product that has wider application. They were particularly pleasant to engage with and inspired confidence that their offering was an effective but also inexpensive way to enable secure messaging across a catchment. Their model is a one-off server software purchase (approximately $20,000) and then $100 per ‘inbox’ required – there are minimal future costs (training and customisation aside) and therefore no ongoing subscription costs. There are some concerns around their wider offerings being more focused towards their traditional customer set, but this would definitely be a viable option if there were an appetite amongst the FMP community to have a co-ordinated software purchase and rollout to enable eReferral across the catchment.

ReferralNet (82.5) came out marginally on top in the matrix scoring, and recommending the Global Health offering would bring some distinct advantages. It has strengths across the board, with no real weaknesses apart from footprint across the catchment – which should not be a significant issue as its integration with other systems appears to be the best in the market. Their product offering is wide and varied, and targeted at community care providers in particular.

The key recommendation here is that there are two potentially viable options for eReferral – AllTalk and ReferralNet. There are strengths and weaknesses to both, so a final consideration of environmental/organisational context will help in framing recommendations.

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5. Environmental and Organisational Context

While objective vendor assessment against key system requirements is the foundation of recommendations under this project, it is also important to consider any environmental and organisational factors that could impact on the choice of vendor and successful implementation of any eReferral capability across the catchment. Key areas for consideration are outlined in subsections a, b and c below.

a. The Barwon experience

Barwon Medicare Local embarked on an eReferral project in 2009, with an aim of achieving saturation of one particular eReferral software product across their catchment so that there were minimal barriers to change. They have now successfully implemented eReferral in approximately 360 GPs, 120 specialists and 150 Allied Health providers across their catchment.

Barwon ML chose ReferralNet as their secure messaging product primarily because of its interoperability with the majority of clinical software as well as their ability to deal with other systems at work in Allied Health and specialist arenas. Overall, the project has been a success based principally on two key factors in relation to the system implementation:

1) Barwon ML procured and paid for all provider licences for year 1 as a catalyst for ReferralNet adoption; and

2) They carried responsibility for project management, software implementation and system maintenance – including co-ordinating installation, providing change management capability and generally managing all aspects of the rollout of ReferralNet across the catchment. Once implemented, they provided first-line support to users, investigated errors and any unsent/unretrieved messages and provided a testing environment for any new adopters of the software.

Barwon ML’s eHealth Manager, who led the project, felt this was the best way to ensure success, as not only would all care providers receive the software at no cost initially but there was no real burden on them from a system adoption perspective. They would also benefit from having local support from their ML on a day-to-day basis, as opposed to vendor support which can be variable in quality and accessibility. There was also minimal resistance to paying for ReferralNet once the initial, ML-funded period had expired – the majority recognised that their savings (actual costs plus efficiencies) far outstripped the relatively low cost of maintaining their product subscription.

As with any project that breaks new ground, Barwon ML would no doubt do some things differently now they have gone through the experience of rolling out secure messaging software to their catchment. They may even have gone with a different software vendor, as there have been some differences between them and Global Health in relation to customer/user engagement and the actual support of the software product. Despite some of these issues, Barwon ML would stand by their decision to choose ReferralNet because of a simple fact – the product works, and it works well.

The benefit for any future health organisation looking to implement a similar whole-of-catchment rollout of ReferralNet is that the key players at Global Health have no doubt learned from the Barwon experience. Their approach to client engagement and user support should have been

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shaped by this, which would enable a smoother implementation. In addition, there would be less concern about risk in attempting a whole-of-catchment rollout as it has already been done successfully in a region within Victoria.

b. Partners in Recovery

Partners in Recovery (PIR) is described by the Department of Health and Ageing (DoHA) as follows:

“The PIR initiative is a new and innovative program that aims to facilitate better coordination of and more streamlined access to the clinical and other services and supports needed by people in the target group who require a response from multiple agencies.”

At the heart of this is an objective to “improve the system response to, and outcomes for, people with severe and persistent mental illness who have complex needs by:

facilitating better coordination of clinical and other supports and services to deliver 'wrap around' care individually tailored to the person's needs;

strengthening partnerships and building better links between various clinical and community support organisations responsible for delivering services to the PIR target group;

improving referral pathways that facilitate access to the range of services and supports needed by the PIR target group; and

promoting a community based recovery model to underpin all clinical and community support services delivered to people experiencing severe and persistent mental illness with complex needs.”

The italicised sentence on referrals (emphasis added) is important as funding is being released in the immediate future to implement PIR programs across multiple Medicare Local regions – including the FMPML region (and, by extension, the FMP PCP catchment). Part of this funding is allocated to the procurement of whatever system or software is required to effectively link the PIR partners within the region, and will include a secure messaging capability to facilitate referrals and sharing of client information across the PIR community.

FMPML have decided to partner with South East Melbourne Medicare Local (SEMML) to prepare an Expression of Interest (EOI)/Invitation to Tender (ITT) document to invite proposals from software vendors on the implementation of a PIR system. Selected vendors who were assessed during this eReferral project are likely to tender for the PIR system, and Global Health in particular may be in a strong position to do so given the strength of their offering from a mental health perspective.

It is difficult to say with any certainty how the PIR tender process will turn out, but within the next few months a vendor will be selected and their proposal will include a secure messaging product to facilitate the transfer of referrals within the PIR community – many of whom are members of the FMP PCP. It will be important to align any decision on the recommendation and/or rollout of an eReferral capability across the catchment with the implementation of the new PIR system.

FMPML is the lead organisation for PIR within the FMP area and can ensure the PCP is kept abreast of developments in relation to this project. There would also be an opportunity to invest responsibility for co-ordination of any eReferral procurement and rollout within the FMPML, given

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they will be providing similar system implementation support to PIR and could have the structures and personnel already in place to manage this process.

c. Miscellaneous considerations

All FMP PCP members that have been engaged throughout this process have been supportive of the need for an effective eReferral system and understand the potential benefits. There is, however, no doubt that many within the healthcare community have had negative experiences in relation to IT and the implementation of new databases and products. This can create ‘system fatigue’, which will typically manifest itself as reluctance or even an overt resistance to changing any elements of their current working arrangements. This is completely understandable, but is a challenge for implementing change – particularly when any prospective change will encompass a large number of individuals and organisations. It is vital to examine how best to overcome this challenge, as the success of eReferral adoption will be based largely on how much of the healthcare community sign up to it and actually use it within their day-to-day operations.

Selected requirements within the vendor assessment were designed to mitigate against this, with particular importance on any eReferral product seamlessly integrating with the raft of existing clinical systems being used across the catchment. Minimisation of cost is also vital, as this can often be used as a reason to disengage even if the projected return on investment makes it a sound financial decision. If any healthcare provider within the catchment can see that adoption of this eReferral capability will be i) easy, ii) inexpensive and iii) guaranteed to provide them secure messaging access to the vast majority of the healthcare community, then it will look like an attractive proposition. If one of these elements is missing, it is likely that there will be more fragmented adoption and less success from a whole-of-catchment perspective.

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6. Conclusions and Recommendations

a. Key Recommendations

The vendor assessment process as outlined in this document has revealed two potential and viable products – ReferralNet (Global Health) and AllTalk (LRS Health). Both products have their strengths and weaknesses in selected areas of the vendor assessment matrix, but there are no major concerns with either. The first recommendation from this report is therefore that:

1) ReferralNet and AllTalk are recommended as the products of choice for secure messaging/eReferral across the catchment.

ReferralNet could be considered to have an edge as it has already been proven across a whole-of-catchment implementation, as described in section 5.a above, when it was rolled out across hundreds of care providers within the Barwon Medicare Local region. However, the lessons learned from that process are important to consider here, principally that successful eReferral adoption will almost certainly require a cohesive approach across the catchment and potentially also be funded (wholly or partly) by a co-ordinating body such as the PCP or ML to initiate and maintain uptake across the provider community. This is critical to an effective rollout of eReferral capability no matter what product is ultimately selected.

There are a number of areas that will need to be managed to ensure successful adoption of eReferral software across the catchment. The relationship with the vendor is critical and often needs a co-ordinating presence, as does any change management and implementation support across the stakeholder community. The actual procurement of the software – if undertaken centrally by the PCP or ML - may require a more formalised tendering process given the scale of the undertaking. Although this could probably be satisfied by a relatively simple expression of interest or selective tender to the two vendors mentioned, it would require some dedicated resources to manage the procurement. The second recommendation is therefore:

2) The creation of a project management and system implementation function within FMP PCP and/or FMPML to co-ordinate the procurement and adoption of secure messaging across the catchment.

The Barwon experience provides a guide to the conditions required to effect substantive change in the eReferral environment, the cornerstone of which is a central co-ordinating and funding body managing a whole-of-catchment procurement and adoption of the relevant secure messaging product. If this approach is taken, the level of cost involved (likely to be in the tens of thousands) would require a formal tendering process but would also provide scope to get significant reductions on initial costs and ongoing subscriptions (if applicable) given the bulk nature of the purchase. The third recommendation is therefore:

3) Global Health and LRS Health to be invited to respond to a selective tender on the rollout of their respective secure messaging capability across the FMP region, to include discussions on licensing/subscription options for a whole-of-catchment implementation.

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Finally, any successful implementation of this type would typically be built on a phased approach to rollout. This has a number of benefits, including:

Client and vendor resources can target a smaller, more manageable group of users and ensure that any issues with the solution are ironed out early;

The capability can be up and running quickly, with early benefits and ‘quick wins’ identified; Users who are more willing to adopt the new capability can be utilised during this process,

mitigating against any general resistance to change during the critical early period; and Future users (including any resistant to the process) can benefit from seeing the capability in

action within actual healthcare providers across real world data.

The fourth and final recommendation is therefore:

4) The identification of ‘early adopters’ within all key care provider sectors (as appropriate) to enable a phased approach to implementation.

b. Final Conclusions

The original aim of this assessment process was to identify a recommended provider of eReferral software for the FMP PCP and its members – it has revealed two viable products, ReferralNet and AllTalk. The nature of AllTalk’s solution means that a centralised procurement and rollout would be required, so if there is little appetite to embark on a project of this nature then the recommended product would be ReferralNet. Having gone through this process, however, it has become apparent that a simple recommendation to the provider community may not achieve maximum success and that a more co-ordinated approach to eReferral adoption and rollout would be more effective.

It is difficult to predict exact costs for a whole-of-catchment procurement of the type recommended here, particularly given the different nature of the solutions and the prospective discounts that could be achieved due to the strategic benefits that would be gained by the chosen vendor. However, estimates of initial set-up and ongoing costs that could be attached to the implementation and maintenance of each platform are articulated in Appendix 1 below.

To fund (wholly or partly) the rollout of eReferral capability across a whole catchment would be a significant undertaking. It is, however, important to consider how effective eReferral processes will be if left to individual care providers to procure their own capability. By managing and funding a PCP/ML-led procurement (for year 1 at least) the majority of obstacles to cohesive adoption of eReferral capability will be removed, and benefits will be felt across all sections of the healthcare community. A more passive approach would require minimal capital outlay and would be less resource-intensive, but would likely deliver a more fragmented and protracted uptake of eReferral capability.

The above recommendations would provide a framework to enable successful implementation of a sophisticated eReferral capability across the catchment, and it is hoped that they could be built upon to improve care co-ordination and also generate multiple associated benefits for the FMP PCP and its members.

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Appendix 1 – Projected costs for recommended eReferral solutions

The projected costs for a co-ordinated procurement and rollout of both eReferral solution options are outlined below. It is important to understand that these are based on knowledge of the pricing structure employed by each vendor along with the potential for bulk discount based on the scope of this prospective rollout and the strategic benefit gained by the successful capability. They have also been based on an example 500-user rollout, which is a rudimentary estimate of requirement given the care provider footprint across the catchment. The actual user requirement is likely to be more complex, but this gives us an indication of scale which should not be significantly off the mark.

It should be noted that the figures below are for the reader’s consumption only and should not be discussed externally. They are high-level, indicative figures that have not been fully discussed and negotiated with the potential vendors – more rigorous discussions would take place during a selective vendor process when the scale and nature of the solution has been confirmed.

a. Resource Costs

It is recommended that a full-time resource is allocated to co-ordinate the procurement and implementation of the full eReferral capability, including the development and execution of a cohesive and holistic change management and adoption strategy to accompany the technical elements of the project. This could be a new employee who would manage this as well as any other key IT/change projects as they are identified, or a contractor engaged specifically for the period of the eReferral rollout. However this person is identified and engaged, it is anticipated that there would be a requirement for 1 FTE for the period of the implementation – at least 6 months, and potentially 9-12 months depending on the evolution of the project. As an indication of the costs that would apply, current salaries for change managers range between $90,000 and $140,000 (approximately) and contractor rates are typically between $80 and $120 per hour.

There will also be some technical support required as the project moves towards testing and implementation and, although it is unlikely to require a full-time resource, it should be factored in to calculations of resourcing and funding requirements. The requirements for technical oversight may also be different depending on the solution purchased, but would be in the order of 0.6-0.8 FTE during the key implementation phases which are likely to cover approximately 6-12 weeks across the life of the project. This would likely decrease to 0.2 to 0.5 FTE as the system becomes embedded within day-to-day processes, again depending on the solution chosen.

b. ReferralNet (Global Health solution)

As ReferralNet is subscription based, the proposed funding model for this solution would be for the first year to be funded centrally (by FMP PCP/FMPML), including subscriptions for all interested care provider organisations and any set-up costs involved in the initial implementation. Subscriptions for year 2 (and beyond) would then revert to each individual provider/organisation, with the PCP/ML only responsible for any project management or technical support costs they would like to retain responsibility for beyond this period.

Individual subscriptions for ReferralNet are priced at $300 each, with discounts given for practices/ organisations who require additional licences. There would be minimal set-up and training costs, and

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first-line support could be provided by the vendor. It is difficult to accurately predict what type of discounts we would get for a proposed whole-of-catchment rollout, but I would imagine it to be at least 50% of year 1 costs given the future revenue that Global Health would be achieving through this model.

Year 1 costs would therefore be approximately $150,000 (500 users @ $300), but in all likelihood would be closer to $75,000 with a 50% discount achieved. It is anticipated that any additional implementation and training costs would be minimal, with the possibility of obtaining an even greater discount and reducing costs further.

c. AllTalk (LRS Health solution)

AllTalk is a different type of eReferral product, with LRS Health selling a server-based platform that requires one-off costs in relation to the server software, the number of inboxes (i.e. – users) required, and training in relation to managing the solution within the host organisation. Strengths here are that the initial funding would cover perpetual ownership of the solution with no ongoing subscription, so there would be no requirement for practices/organisations to pay a yearly sum to keep using the capability. However, because responsibility for managing the server-based system would not be held by the vendor, it would require a more sustainable system support function to be developed centrally (at PCP/ML).

The server software is a one-off cost of $20,000, with individual inboxes costing $100 each. There would be a higher training cost initially (to train whoever would have responsibility for managing the system), which is anticipated to be in the region of $10,000-$15,000, and there would likely be some residual support costs payable to LRS Health.

Year 1 costs would therefore be approximately $85,000 ($20,000 for server software plus $50,000 for 500 inboxes plus $15,000 for training/support), with additional costs bearable by the central body (PCP/ML) for second line support ongoing into year 2 and beyond. It is likely that we could negotiate a discount, potentially to $70,000-$75,000, but this is likely to be less drastic because there is minimal future revenue for the vendor for this type of solution.

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