The Evolution of the Referral Process

Transcription

1 The Evolution of the Referral Process

2 Case Study: Providence Health System E-Referral Mike Reagin Director of Research and Development Providence Health System Portland, Oregon USA March 8, 2004

3 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)

4 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

5 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

6 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)

7 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

8 Consumer Driven HealthCare Providence Health System E-Health Vision

9 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 Proprietary SOA Implementation Framework Proprietary Proprietary Open Standards Open Standards

10 Expansion of SOA at PHS Client Register Patient Info Portal Doctor Info Portal WS WS client client M2M connection.... Web Application Server Farm Profile Manager Web Service Patient Access Web Service Physician Access Web Service Web Applications Registration Web Service Authentication Index Person SOA Framework Physician Appointment Billing Diagnostics. SAML LDAP Active Directory P a t I e n t s P h y s I c I a n s U s e r s PHS Web Access WS Claims Access WS HIS McKesson Access Access WS WS ERP Access WS EHR/ Logician EMR Access WS System Access WS PHS Web Claims McKesson HIS ERP EHR/EMR Logician EAI... bus. (ASMX) (SQL Cache) (CORBA) (Lawson) (SQL)

11 Enterprise Messaging Architecture HIS Billing Clinical Doc. EMR Hospital Lab EMR Ambulatory External Web Site DB DB DB DB DB Application DB DB Application SMTP Application HL7 Application HL7 Custom Developed Web Services HL7 HL7 Direct Database Access / Exchange Interface Engine SOAP SMTP HL7 XML Enterprise Secure Messaging IMR IMR IMS

12 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 > 15,000 specialist referrals annually 100% adoption of EHR by Primary Care Physicians Estimated 20% of Specialist referrals use an EHR

13 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

14 E-Referral Workflow Walkthrough:

15 Central Clinic Inbox

16 Selecting a Patient

17 Attaching documents

18 Specialist Clinic Notification Message

19 Received E-Referral Message

20 Document Management Process

21 View documents in GE Centricity EHR for completed E-Referral.

22 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

23 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 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

24 The State of the Secure Messaging at PHS Krytpiq s 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

25 Next steps E-Visit Q 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

26 Questions?