The Evolution of the Referral Process

Mike ReaginDirector of Research and Developmentmichael.reagin@providence.org

Providence Health SystemPortland, Oregon USA

March 8, 2004

Case Study: Providence Health System E-Referral

The Program

Background / Health System Profile Developing an Enterprise Communication

Strategy Technology overview of E-Referral Integration of E-Referral Technology with

business processes Factors for consideration in planning E-

Referral Measuring value of Secure Communications Your questions (and hopefully some useful

responses)

Providence Health System

•Alaska•Washington•Oregon•Southern California(Western Coast of the US)

•20+ Acute Care Hospitals• 9 Long-term Care Facilities• 18 Low Income and Assisted Living Facilities• 40+ Primary Care Clinics• EAP, Emergency Clinics• Home Healthcare and Hospice Services•Research,• 700,000 Health Plan members• 33,000 employees

IT Strategy and Business Drivers

Clinical Transformation Offer comprehensive clinical

suite of applications for staff Growth

Meet expectations of 25% business growth in the next five years

Service Excellence Develop World Class Customer

Service Information at the Time of Care

Deliver real-time information for clinical decisions

Proposed Secure Messaging Projects:

E-Referral Enhanced Rehab Request Process Patient E-Visits Patient Lab Results (E-Lab) Online Bill Payment Physician to Physician Messaging (PHI) E-Prescribing Professional Health Record

Communications E-Commerce (PHI)

Developing and Enterprise Communications Strategy

Physician Adoption is the key to success of this technology

Meets HIPAA Security Requirements Integration into Patient Portal Strategy Integration into EHR / Clinical Applications Supports Open Standards (Web Services,

SOAP, SOA) Leverage Technology Platform at an

Enterprise Level Supports B2B and B2C Communication

Channels

Consumer Driven HealthCare

Providence Health System E-Health Vision

Why Web Services?

-Web services are particularly good at three key functions

Integration – Break the application silos

Flexibility – Machine to machine communication

Access – Provide multiple access methods

Advanced Technology that supports the Vision

Open

Standards

SOA Implementation Framework

Open Standards

Expansion of SOA at PHS

ProfileManager

Web Service

ProfileManager

Web Service

PhysicianAccess

Web Service

PhysicianAccess

Web Service

ClientRegister

Patient Info

Portal

Web Applications

Web Application Server Farm

. . . .Doctor

Info Portal

WS client

IndexAuthentication

SAML

LDAP

Active Directory

PhysIcIans

PatIents

Registration Web Service

Users

PatientAccess

Web Service

PatientAccess

Web Service

Claims

(SQL Cache) (SQL)

Logician

. . . .

(CORBA)

McKessonPHS Web

(ASMX)

ERP

(Lawson)

Person

PHS WebAccess WSPHS Web

Access WSClaims

Access WSClaims

Access WSLogician

Access WSLogician

Access WSERP Access

WSERP Access

WSMcKesson Access WSMcKesson Access WS

System Access WS

System Access WS

Physician Appointment ….Billing

Doctor Info

Portal

PhysicianAccess

Web Service

PhysicianAccess

Web Service

Patient Info

Portal

PatientAccess

Web Service

PatientAccess

Web Service

(CORBA)

HIS

ERP Access WS

ERP Access WS

HIS Access WS

HIS Access WS

Physician Appointment

ERP

(Lawson)

M2Mconnection

WS client

Web Applications

. . . .

(SQL)

EHR/EMR

EAI bus

EHR/ EMR Access WSEHR/ EMR Access WS

System Access WS

System Access WS

DiagnosticsBilling

M2Mconnection

SOA Framework

Enterprise Messaging Architecture

HIS

DB

Clinical Doc.

DB

Billing

DB

EMR Hospital

DB

Lab

DB

EMRAmbulatory

DB

External Web Site

DB

Application

SMTP Email

Application

HL7 HL7

CustomDeveloped

WebServices

HL7

Application

HL7

InterfaceEngine

Application

SOAP

IMR IMR

IMS

Email / Exchange

Enterprise Secure Messaging

SMTP

DirectDatabase

Access

HL7 XML

Oregon Primary Care Profile

• 40+ Primary Care Clinics in the Oregon Market

• 130+ Employed Primary Care Physicians (Expected growth by more than 20% in the next three years)

• 800+ Office and Administrative Staff

•350,000+ office Visits per year

•Estimated > 15,000 specialist referrals annually

•100% adoption of EHR by Primary Care Physicians

•Estimated 20% of Specialist referrals use an EHR

Providence Providence Medical Group Group

Deployment and Process Business Process Re-Design Process before E-Referral (i.e. Faxing and Scanning)

Referral process was managed on exception basis (Estimated one error in every five transactions)

Improved Access to Information Structured Information vs. Scanned Images

Business Process Map for clinic workflow revealed 55 step process for a completed Referral --- New E-Referral Process is 18 steps ----

Pilot project with large local specialist clinic (10+ specialties) to design standard workflow

Process designed to work for Clinics without EHR Training and rollout process was 1 week per clinic

Specialist Clinics trained and implemented in 4-8 hours Address book and Account Creation 2 Days

Process design resulted in reduction of scanned documents

E-Referral Workflow Walkthrough:

Central Clinic Inbox

Selecting a Patient

Attaching documents

Specialist Clinic Notification Message

Received E-Referral Message

Document Management Process

View documents in GE Centricity EHR for completed E-Referral.

Reduced overall cost of Referral by $4.97 per referral

Improved Access and timeliness of information for Physician

Reduced process Time for Referral from 1 Week to 1 Hour (or less)

Reduction of errors in transferring information between Primary Care and Specialist Clinics

Improved Staff Efficiency

Improved Patient Satisfaction

Improved Physician Satisfaction

Improved Security of PHI

Reduction in Scanned Documents and outsourced labor

Potential Value of E-Referral Technology

Factors for your Consideration

Selecting a Solution that supports a wide variety of Secure Messaging Projects

Effective Auditing and Dictionary Capabilities in Secure Messaging platform (Discovery of Existing E-Mail Issues)

Developing a scalable Secure E- Mail process for business communications

Organizational Governance of Messaging Projects Sponsorship Technical and business skill sets

PHS used 2 Project Managers 1 Application Analyst and 1 Developer to implement solution

Required Active business participation by Clinic staff

Interface options for scanned documents Explore the different opportunities for creating an integrated solution

Develop Policy and Procedures for communication of acceptable uses of Secure Messaging Technology

The State of the Secure Messaging at PHS…

Krytpiq’s Secure Messaging Solution has been operational for 6 months

PHS has completed more that 6000 Referrals with pilot clinics and is in process of rolling out the platform to all physicians ( 6 clinics live – all clinics will be live before Q3)

Online Bill Payment Ecommerce Notification in pilot Increased capabilities in data sharing with B2B market

space E-Visit Pilot begins Q2 (In Development) Continued deployment of “My Providence” and SOA

Next steps

E-Visit Q2 2005 Physician-to Physician

Messaging (context sensitive) 2005

Patient Portal Messaging 2005

E-Prescribing 2005 Q4 PHS Expansion of Secure

Messaging to CA, AK, WA 2005

E-Lab 2006 Professional Health

Record 2006

Questions?