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e-Referral enabled collaborative health careOpportunities and considerations

Presented by:

Sasha Bojicic

Emerging Technology Group

Canada Health Infoway Inc

The goal of the presentation• Position e-Referral as a core component of e-

Health• Describe what is an e-Referral

• Business drivers and expected benefits• Architecture pattern • Functional enablers

• Implementation considerations• Implications for collaborative health care

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The “e”-ing of Things

Indicates business conduct where business objectives are achieved by electronic exchange of informatione-Mail

e-Banking

e-Commerce

e-Health

e

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- ing things is not simple

It is much more then just using a technology

It requires configurable processes patterns and data

It requires governance of resources (people , processes and technologies)

e

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What is an e-Referral?

e-Referral - common misperception

Digitize

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e-Referral represents holistic implementation of the clinical process that uses information technology with goal to

all stages of the patient referral across multiple organizations and health care settings

automate

expedite

improve

monitor

qualify

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Information Technology Assisted

Care Model

Efficiency and Quality Improvements

Patient Centric Care Delivery

Continuity of Care

Business Drivers

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The e-Referral Process PatternReferring Provider

2. Determine Referral Recipient: The Referring Provider uses an online Services/Provider directory to help determine with the patient the appropriate referral recipient based upon services/ providers, priority, location and availability.

3. Referral Template:

The Service-specific referral template is accessed and patient demographic and health information pre-populates from the provider’s EMR. Referral data is validated including the patient priority.

4. Send Referral:

The completed electronic referral is sent electronically to the Referral Recipient.

1. Initiate Referral:

The Referring Provider can task an administrator with arranging the referral or the provider proceeds to Step #2.

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The e-Referral Process PatternConsulting Service / Provider

8. Consultation:

The Consulting Service/ Provider assesses/treats patient completing a consultation template pre-populated with information from the Service’s/Provider’s electronic record.

6. Review Request:

The Consulting Service/ Provider reviews and accepts, rejects or requests additional information from the Referring Provider.

5. Receive Referral:

The Services/Provider Referral Recipient receives the referral request electronically.

A receipt of request acknowledgment is sent.

7. Appt. Scheduled:

Appointment is placed in EHR, confirmation sent to referring clinician and patient.

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e-Referral represents patient-centric health care delivery pattern which allows

• Timely provision of information to assist the requested

provider to determine if they can meet the patient’s needs

• The booking and confirmation of the patient’s appointment with the requested provider

• Managing of the encounter between the patient and the

consulting provider

• The consultation report back to the referring provider

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What are the anticipated benefits

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Collaborative management of the e-Referral process• Patient prioritization• Status tracking• Reporting

Accurate and timely access to services• Resource availability• Event scheduling• Clinical content provision

Real time clinical decision support and dynamic business intelligence• Access to clinical guidelines and best practices• Patient safety clinical validation• Wait time analytics

Functional Enablers

Scheduling

Decision Support

Health Service

Discovery

Content Provision

Status Tracking

Notification

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Health Service Discovery

Query the list of relevant health care organizations and providersIncreased resource visibility and wait time availability

Filter search results based on the provider and / or patient preferences /criteriaEnables patient preferences (proximity, wait time, language preference, etc.)

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Content Provisioning

Authoring and publishing of the clinical content (templates, orders sets, guidelines)Consolidated management of standardized clinical content

Subscription to and distribution of the clinical contentEnables access to clinical content

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Status Tracking

Capture, monitor and report the status of the prospective eventCommunicate referral progress inside the circle of care

Status change managementTriggers other system processes (alerts, notifications, etc.) according to the business rules

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Notification

Configure preferred notification channels Enable individual preferences for notification

Event driven notification / alert broadcastIncreases service provider and health care team accessibility and ability to timely respond

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Event Scheduling

Access to resource availability and booking of the prospective eventProactive management of service and resource capacity

Input for wait times analyticsProactive wait time management

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Decision Support

Access to decision support resources (best practices, clinical guidelines)Support for evidence based decision making

Systemic enforcement of the business rules Avoid redundant procedures, check for adverse reaction to medication, etc.

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EHRS Architecture Considerations

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Unleashing the potential – scaling optionsLocal Regional Jurisdictional

• Simple updating of lists (eReferral providers, care settings, locations, services, care plans)

• Stand –alone forms & templates

• Local decision support resources

• Create linkages to regional registries and source systems to automatically maintain ‘eReferral lists’ (ie. LDAP and regional shared databases)

• Potentially use a regional shared content management system for the creation and management of forms/templates

• Use EHR infrastructure eg. Registries/databases for automatically maintaining lists

• Use EHR distribution mechanisms like HIAL, Web Services, Publish/Subscribe, etc.. For communication between providers, care settings, etc..

• Use EHR repositories like SHR for storing documents and encounter information

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Implications for health care sectorIncreased use of the existing EHRS infrastructure

Development of new system capabilities and services

Accelerated IT enabled health care practice• Cost reduction• New reimbursement model

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Implications for participantsContent harmonization• Fewer data capturing variances• Improved evidence based CDS

Quality management with process monitoring and notification• Increased efficiency• Improved patient safety• Reduced wait times

Increased visibility and accessibility to health care providers

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Thank you

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