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eReferral System Boosts Medical Center Bookings

A portal-based referral system from Carefx and a clinical information exchange from GE Healthcare increase appointments and reduce patient no-shows.

By Marianne Kolbasuk McGee,  InformationWeek
Nov. 5, 2009

Boston Medical Center, plus its 15 community healthcare centers, which together make up Boston HealthNet, provides outpatient care to more than 1 million patients a year. The majority of those patients are "underserved," meaning they are low income, disabled, or elderly and qualify for Medicaid or Medicare, or sometimes don't have insurance at all.

Boston HealthNet patients seen by primary care doctors at community health centers need referrals to see specialists, like orthopedic or cardiologists, at the medical center.

But until recently, only about 30% of those referrals ended up with patients actually seeing a Boston Medical Center specialist. That's because the referral process, which involved paper, faxes, phone calls or other mostly manual steps handled by office coordinators, often fell through the cracks. Specialists did not always receive a referred patient's medical information in time, appointments didn't always get set up, and patients didn't always show up.

But a new portal-based eReferral system provided by Carefx Corp., along with a new clinical information exchange, recently deployed at Boston HealthNet by GE Healthcare, has already doubled the percentage of referred patients booked by coordinators and seen by Boston Medical Center specialists.

The new system is projected to save Boston Medical Center about $7 million over the next five years through improved efficiencies. Revenue is expected to grow via a dramatic increase in the number of patients who actually follow-through with their specialist visits.

The new portal provides coordinators at the community health center and specialty departments at the medical center with a standardized workflow for setting up patient appointments, as well as making sure those specialists are provided with the patient's pertinent electronic medical record information at the time of the appointment. The portal also helps coordinators contact patients to remind them about scheduled appointments.

In the past, referrals often took 30 days to process. Now referrals take only two days. The eReferral portal presents coordinators with a workspace that includes a list of tasks that need to be completed in a set amount of time for each patient referral. Among the tasks is sending electronic packages of key patient medical information to specialists before patients' scheduled appointments.

"If information doesn't get to the specialist by the time of care, the specialists don't know why the patient is there, what tests have been done, etc.," said Joel Vengco, executive director of clinical information systems at Boston Medical Center. "The process of doing this is cumbersome," he said. In addition, on the back end of patient visits with specialists, there was difficulty in providing primary care doctors with the new information and updates about the individuals.

That information dearth has been addressed with the eReferral portal and a new clinical information exchange (CIE) launched in June by Boston HealthNet.

Over the last nine years, Boston HealthNet has been rolling out a mix of e-medical record systems at each of its 15 community healthcare centers. Those EMR systems include GE Centricity, Epic, and NexGen. Yet, at the medical center, another mix of EMR systems are used, including GE Centricity for outpatient visits, Eclipsys for inpatients, and Picis for emergency department care.

That lack of software consistency and interconnectivity made it difficult for patient data to be exchanged among doctors at the community centers and the medical center, adding to the frustrations in referrals.

So in June, with help from GE, Boston Medical Center finished developing its new CIE, which now allows doctors at the community centers and medical center to easily and securely access patient's data from the diverse mix of EMR systems used at Boston HealthNet.

The exchange was built using industry health information exchange specifications, including those from HITSP (Health Information Technology Standards Panel) and IHE International, said Vengco. The CIE allows doctors to access patient data through local federated repositories as well as through central repositories of data, Vengco said.

"The beauty of the [eReferral ] portal is that it plugs into the CIE," which allows the appointment coordinators to send out to specialists electronic packages of "links" to pertinent patient data prior to the visit, including information about allergies, medications, symptoms, and clinical notes.

Since launching the eReferral portal on the CIE, Boston HealthNet has reduced the number of patient-no shows for referred specialist appointments and has increased successful referral bookings from 30% to 50%. Further improvements are anticipated, Vengco said. "This boosts revenue and satisfaction levels" among physicians and patients alike, he said.

The boost in revenue related patient referrals is important for Boston HealthNet especially now, said Vengco. That's because state subsidies for the care provided to low income patients has been reduced in recent years related to Massachusetts' recent healthcare reform. At the same time, while there are now fewer uninsured patients in Massachusetts, state payments for healthcare services and other various state subsidies have been reduced, said Vengco.

Finally, in addition to the new eReferral portal that's improving appointment bookings, the medical center is also using the CIE and Carefx portal technology to track patients who receive seasonal and H1N1 flu vaccinations from Boston HealthNet providers.

"The CDC has raised guidelines for flu vaccination patients," including sequencing of when seasonal and H1N1 shots should be given, said Vengco. The portal helps caregivers record when patients or Boston HealthNet employees receive their vaccinations, as well as track any flu-related symptoms or side effects they report.

"The portal makes vaccination tracking easier, too," he said.