CareAware. Improving Workflow — Improving Outcomes.

Cerner's CareAware® connects devices to the clinical record to enhance workflow and improve care.
This connectivity architecture places the EMR at the center of all information created and stored
for the patient, creating a single source of truth™.

Boston Medical Center streamlines work flow and interoperability — and sees a huge return on investment — using Carefx eReferral portal.

The primary care physician (PCP) refers a patient to a specialist; the specialist treats the patient and then sends the patient and a report back to the PCP. It's a simple process, but for most organizations it actually comprises a number of steps that make for a complex work flow for facilities, clinicians and patients.

Because of this complex and manual system, patients were often not receiving timely care, the hospital was not achieving optimal patient volume and simplified work flow, revenues were not where they could and should be and physicians were frustrated.

After looking at our own paper-based referral process in the fall of 2009, Boston Medical Center (a private, not-for-profit, 626-bed academic medical center) and its neighboring 15 community health centers (CHCs) recognized the need for the automation of referrals and the exchange of information and collaboration to benefit patient care throughout our system. We decided to integrate an electronic referral management solution into our community information exchange (CIE), where simplified work flow, interoperability, service and usability could flourish.

workflow2With an electronic referral management solution, BMC has been able to simplify and optimize the referral process, enhance collaboration among community providers, improve patient access to care and coordinate that care efficiently.

Manual system multiplies complexity
With the current, complex referral process, many times our patients would receive less-than-optimal care, and clinicians would grow increasingly frustrated over the lack of complete and timely information. Also, an enormous amount of revenue was lost due to missed appointments and inefficient work-flow procedures.

Prior to the use of an electronic referral management solution, BMC, like most other hospitals and networks across the country, used a manual, cumbersome system to process referrals from within referring providers, and much of it was dependent on fax machines or phone calls. The limitations were enormous, with the process being difficult, inefficient and confusing for both clinicians and patients.

Being awarded a 12-month federal grant for innovative technology development and implementation from the Health Resources and Services Administration's (HRSA) High Impact HIT Innovations Grant Program, we were given the opportunity to conduct a search for a vendor that could assist us with automating our referral process. We considered multiple vendors based on health information exchange (HIE) experience, vision, innovation, focus and track record.

portalAfter evaluation, BMC selected Carefx, an interoperable work-flow solution provider whose solutions aligned with our core strategies and our need to improve work flow and close the communication loop in referrals. Our non-automated referral process often left clinicians with inadequate patient information, minimal feedback and insufficient tracking abilities. In just eight months, Carefx was able to develop a referring physician dashboard on our CIE framework to address the inefficient referral process.

With an electronic referral management solution, BMC has been able to simplify and optimize the referral process, enhance collaboration among community providers, improve patient access to care and coordinate that care efficiently by utilizing a portal-based solution, which has significantly improved the referral work flow for clinicians and their staff. In addition, the ability to track patients through the referral lifecycle within BMC has enabled our organization to continue to improve its service level to referring providers by reporting on our response rates to them, and it has ensured that we are optimizing access to care for our patients as the demand for our services calls for it. This, of course, also provides us with the ability to monitor our referral throughput and best practices for referral management among our specialty clinics.

Tips for implementing an automated referral solution

  • Invest in clinical automation, balancing the benefits of safer, more efficient care delivery with IT's priorities regarding privacy, security, performance and availability.
  • Shift to process-centric thinking, reducing reliance on functional silos to improve quality and operational performance.
  • Focus on business intelligence, leveraging currently available data toward performance improvement and strategic decision-making.
  • Integrate wireless devices and applications into clinical work flows.
  • Strengthen physician productivity and retention through remote access, but offer stronger authentication to satisfy compliance requirements.

Portal to information control
Through the implementation of the Carefx eReferral portal, BMC is able to offer more than 1,500 clinicians composite views of relevant patient information housed in varied systems to facilitate and standardize collaboration, improve patient care quality, promote access to care and increase referral volume and revenues across the entire community. Among some of our key results:

  • Of referrals submitted by community providers, we have seen an improvement in the percentage of referrals scheduled by our BMC clinics from 30 percent to around 80 percent. Our goal is, of course, scheduling 100 percent of referrals ordered.
  • We have decreased the number of days it takes to schedule an appointment from an average of 33 days to around five days.
  • No-shows have been reduced from 25 percent to less than 23 percent.
  • The total number of incoming referrals has increased by 10 percent (about 100 per day).
  • When fully functional, it's estimated the portal system will generate an additional $6.5 million for BMC over a three-year period.

Without the ability of eReferral to interoperate with multiple information systems, BMC would not have been able to streamline work flows, improve patient experiences and see such tangible results in a very short period of time.

Electronic referral management has generated an impressive projected return on investment (ROI) for BMC. Using grant funding of $543,535 and in-kind personnel worth $90,905, BMC made an electronic referral investment totaling $769,520. However, financial benefits totaled $7,384,482 for a 553.09 percent ROI. The total includes $6,476,022 generated through increased referral follow-through and $908,460 in reduced operating costs, as well as non-ROI benefits such as expedited operations, faster scheduling, enhanced quality and safety and improved participant satisfaction.

Joel L. Vengco is the director and chief applications officer at Boston Medical Center.
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