The Evolution of the Referral Process
Mike ReaginDirector of Research and [email protected]
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?
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