Implementation Science Workshop: Implementation of an Electronic Referral System in a Large Academic Medical Center

Barnett, Michael L.; Mehrotra, Ateev; Frolkis, Joseph P.; Spinks, Melissa; Steiger, Casey; Hehir, Brandon; Greenberg, Jack J.; Singh, Hardeep

doi:10.1007/s11606-015-3516-y

Cited by 8 publications

(11 citation statements)

References 42 publications

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“…32 Further exploration of eConsult programs and more objective measures of their impact in different settings for various clinical conditions can help to encourage the adoption of payment models to cover this service. 2,32,33 Nephrology is ideally suited for an eConsult model since timely nephrology referral is crucial for patients with highrisk chronic kidney disease (CKD), and yet many new patients referred to nephrology have low-risk CKD and do not require in-person specialist visits. 14,15 Within a large, integrated, fee-for-service health system, we developed a nephrology eConsult pilot program to address challenges to specialty care access.…”

Section: Introductionmentioning

confidence: 99%

“…1 In the US, the movement away from fee-for-service payment and towards value-based reimbursement and accountable care organizations creates financial incentives to improve patient care coordination and to keep specialty referrals within health systems. 2 Methods to ensure that referrals are tracked and completed – a concept known as closing the referral loop – support the Quadruple Aim of Healthcare Reform by improving provider-to-provider communication, patient experience, population health, and cost reduction. 3,4 In order to realize these aims, strategies must be adopted that support treatment within the primary care setting and optimize coordination between primary care and specialty services.…”

Section: Introductionmentioning

confidence: 99%

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Keeping care connected: e-Consultation program improves access to nephrology care

et al. 2017

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Introduction Health systems are seeking innovative solutions to improve specialty care access. Electronic consultations (eConsults) allow specialists to provide formal clinical recommendations to primary care providers (PCPs) based on patient chart review, without a face-to-face visit. Methods We implemented a nephrology eConsult pilot program within a large, academic primary care practice to facilitate timely communication between nephrologists and PCPs. We used primary care referral data to compare wait times and completion rates between traditional referrals and eConsults. We surveyed PCPs to assess satisfaction with the program. Results For traditional nephrology referrals placed during the study period (July 2016-March 2017), there was a 51-day median appointment wait time and a 40.9% referral completion rate. For eConsults, there was a median nephrologist response time of one day and a 100% completion rate; 67.5% of eConsults did not require a subsequent face-to-face specialty appointment. For eConsults that were converted to an in-person visit, the median wait time and completion rate were 40 days and 73.1%, respectively. Compared to traditional referrals placed during the study period, eConsults converted to in-person visits were more likely to be completed ( p = 0.001). Survey responses revealed that PCPs were highly satisfied with the program and consider the quick turnaround time as the greatest benefit. Discussion Our eConsult pilot program reduced nephrology wait times and significantly increased referral completion rates. In large integrated health systems, eConsults have considerable potential to improve access to specialty care, reduce unnecessary appointments, and optimize the patient population being seen by specialists.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Keeping care connected: e-Consultation program improves access to nephrology care

et al. 2017

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“…69 The fifth intervention is to optimize order entry design. Order sets could be redesigned to provide helpful, noninterruptive decision support and automatically pull in required information 75 and screen designs that are difficult to use. 76,77 Evidence of order entry problems, diagnostic information that is difficult to find, information overload, and limited physician time to process EHR notifications has emerged from other health systems.…”

Section: Failure Of a System To Track Test Resultsmentioning

confidence: 99%

Assessment of Health Information Technology–Related Outpatient Diagnostic Delays in the US Veterans Affairs Health Care System

et al. 2020

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IMPORTANCE Diagnostic delay in the outpatient setting is an emerging safety priority that health information technology (HIT) should help address. However, diagnostic delays have persisted, and new safety concerns associated with the use of HIT have emerged. OBJECTIVE To analyze HIT-related outpatient diagnostic delays within a large, integrated health care system. DESIGN, SETTING, AND PARTICIPANTS This cohort study involved qualitative content analysis of safety concerns identified in aggregated root cause analysis (RCA) data related to HIT and outpatient diagnostic delays. The setting was the US Department of Veterans Affairs using all RCAs submitted to the Veterans Affairs (VA)

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“…One proposed method of improving scheduling issues is electronically transmitted referral order systems in which PCPs electronically transmit referral orders to subspecialists. 12 Implementation of electronically transmitted referrals has been associated with improved satisfaction among PCPs of adult patients. 12 Of note, electronically transmitted referrals are distinct from electronic consultations (e-consults), which facilitate iterative communication between PCP and specialists regarding clinical questions (or electronic “curbsides”) through a store-and-forward platform.…”

mentioning

confidence: 99%

“…12 Implementation of electronically transmitted referrals has been associated with improved satisfaction among PCPs of adult patients. 12 Of note, electronically transmitted referrals are distinct from electronic consultations (e-consults), which facilitate iterative communication between PCP and specialists regarding clinical questions (or electronic “curbsides”) through a store-and-forward platform. 13,14 e-Consult systems require significant changes in referral processes, information transfer, and clinician expectations.…”

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confidence: 99%

Impact of Implementation of Electronically Transmitted Referrals on Pediatric Subspecialty Visit Attendance

Ray

Drnach

Mehrotra

et al. 2018

Academic Pediatrics

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Implementation Science Workshop: Implementation of an Electronic Referral System in a Large Academic Medical Center

Cited by 8 publications

References 42 publications

Keeping care connected: e-Consultation program improves access to nephrology care

Keeping care connected: e-Consultation program improves access to nephrology care

Assessment of Health Information Technology–Related Outpatient Diagnostic Delays in the US Veterans Affairs Health Care System

Impact of Implementation of Electronically Transmitted Referrals on Pediatric Subspecialty Visit Attendance

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