ereferrals a case study in innovation presentations · 2018. 4. 3. · ereferrals a case study in...

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  

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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.  

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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  

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• 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  

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2011: Partnership with Telus Health Solutions to build our Provider Portal

Referrals  at  WorkSafeBC  

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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  

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• 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 Daniela@stratahealth.com

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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  

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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