The Online Collaborative Care Study

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• The Online Collaborative Care Study

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Overview

• Summary
• History and Background
• The Study
• Future Implications

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Summary

• Physician communication surrounding the patient
  referral process is fragmented
• Online tool to enable convenient physician
  collaboration prior to referral visit
• Improved quality
• Improved cost savings

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Background

• 43 million provider to provider referrals per
  year in US
• Substantial problems exist in the referral
  process Ghandi, et. al.
• 63 of PCPs, 35 of specialists dissatisfied
• 68 of specialists report no information from PCP
  prior to referral visits
• 25 of PCPs do not have information from the
  specialist 4 weeks after referral visit

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History

• OKC circa 1999
• University of Oklahoma
• State of Oklahoma Dept of Corrections
• OCAST

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Medunison

• Based in OKC
• Physician owned and lead
• Small and growing
• Developed and support the study application
  Docsynergy

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The Study

• Cluster-randomized, controlled trial
• 16-20 PCP offices
• As many specialist offices as possible
• Targeting 1500 referrals
• Physicians reimbursed based on number of
  referrals thru system

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Phased Approach

• First phase clerk to clerk
• Second phase physicians involved

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Outcome Measures

• Quality Metrics
• Assignment of medically appropriate wait times
• Improved access to distant specialists
• Correct preliminary work-up
• Specialist guided changes to management plan
• Satisfaction of patients, physicians, staff

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Outcome Measures

• Cost
• Unnecessary specialists avoided
• Unnecessary/duplicate lab and imaging studies
  avoided

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Outcome Measures

• Sustainability
• Physician expectations of reimbursement for
  participation and completing online collaboration
• Identification of diagnoses and patient types
  that are best suited to asynchronous
  collaboration

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Examples

• The following examples are actual online
  consultations taken from the Doc2Doc system.
  Patient identities have been masked.

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Where are we now?

• Clerk to clerk 8,750 referrals
• Pediatrics 4,800
• Adult 3,950
• Radiology 2,100
• Doc2Doc Consults in progress
• Response times lt24 hours on average
• Do not need to see 39

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Whats next?

• Patient populations
• Indigent/uninsured
• Soonercare

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Whats next?

• Patient populations
• Indigent/uninsured
• Soonercare
• Applications of the system
• Clerk to clerk- complete
• Doc to Doc- complete
• ER to Clerk- next

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These diagrams show the flow of indigent/Medicaid
patients through various sites of care. Arrow
thickness corresponds to volume of patient flow.
Green color indicates an increase in patient flow
and blue indicates a decrease.
Home
Specialist/ Labs/Imaging/ Ancillary Services
Emergency Department
PCP
Inpatient
Current state
Home
Home
Specialist/ Labs/Imaging/ Ancillary Services
Specialist/ Labs/Imaging/ Ancillary Services
Emergency Department
Emergency Department
PCP
PCP
Inpatient
Inpatient
Doc2Doc implementation Short term
Doc2Doc implementation Long term
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Summary

• Collaborative healthcare delivery model works
• Decreased visits for specialty care
• Improved access to specialty care
• Very short time to specialist opinion
• Improved timeliness of face to face visits
• Improved PCP performance through active learning
• System transparency enables continuous quality
  improvement
• System is live and positioned for rapid network
  growth

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Thanks!www.doc2docstudy.orgjohn-studebaker_at_ou
hsc.edu