The Evolution of the Referral Process

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The Evolution of the Referral Process
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Case Study Providence Health System
E-Referral

Mike Reagin Director of Research and
Development michael.reagin_at_providence.org Provid
ence Health System Portland, Oregon USA
March 8, 2004
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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)

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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

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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

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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)

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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

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Consumer Driven HealthCare

• Providence Health System E-Health Vision

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Advanced Technology that supports the 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
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Expansion of SOA at PHS
Profile Manager Web Service
Physician Access Web Service
Patient Access Web Service
SOA Framework
PHS Web Access WS
Claims Access WS
Logician Access WS
ERP Access WS
McKesson Access WS
System Access WS
Claims
(SQL Cache)
(Lawson)
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Enterprise Messaging Architecture
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Oregon Primary Care Profile
Providence Medical Group

• 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 gt 15,000 specialist referrals annually
• 100 adoption of EHR by Primary Care Physicians
• Estimated 20 of Specialist referrals use an EHR

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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

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E-Referral Workflow Walkthrough
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Central Clinic Inbox
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Selecting a Patient
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Attaching documents
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Specialist Clinic Notification Message
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Received E-Referral Message
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Document Management Process
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View documents in GE Centricity EHR for completed
E-Referral.
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Potential Value of E-Referral Technology

• 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

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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

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The State of the Secure Messaging at PHS

• Krytpiqs 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

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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

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Questions?