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Bridging the Referral Divide

January 19, 2012
by Jennifer Prestigiacomo
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A Michigan HIE finds an innovative, cost-effective way to link transitions between primary and specialty care

Michigan Health Connect (MHC), a Grand Rapids-based health information exchange (HIE) founded by leading Michigan health systems, developed a free eReferrals app for community physicians. The value and ease of use of that app spurred rapid adoption and made this project well-qualified for the Healthcare Informatics Innovator Award. What really is impressive is how this app can not only be used to transform communication between primary and specialty care, but how it can be applied to other areas of healthcare.

Bridging the Referral Divide
The eReferrals app was designed to solve a major practice pain point—specialist referrals—and eliminate a workflow bottleneck. Julie Klausing, senior program manager at MHC, says that her organization’s strategy has been to really assess their business processes and figure out where the greatest need to enhance efficiency in patient care is needed, instead of simply throwing technology at physician practices. “As [we thought about this], we looked at it as an HIE; so instead of building Mecca and trying to get everything done, [we said] let’s deal with the pain points; they’re not pretty or flashy, but it’s these things that make a difference,” adds Steve Spieker, senior solution specialist, MHC.

Doug Dietzman, MHC’s executive director, adds that the HIE was formed with the specific intent of trying to solve real problems in healthcare, rather than attempting to implement the theory of HIE. “One of the big components that is often talked about is patient care transitions and moving from one setting to another and how to eliminate some of those hand-off and quality issues,” he says.

The manual process of referring patients to other practices involves filling out and faxing paper forms, followed by numerous phone calls between practices to ensure all of the information is passed from the referring provider to the receiving provider. This process is repeated in reverse if the referring provider wants to follow up on the results of the referral. Since gaps in the care record frequently occur at care transition points, MHC asserted that providing electronic referral functionality would not only ease administrative processes in the practices, but also significantly improve care coordination and quality across the community.

MHC's Steve Spieker trains Deanna Rawlings, clinic manager, Creston Medical Center, (Grand Rapids, Mich.), to use the eReferral app. Photo: Michigan Health Connect

How it Works
Within an hour, a physician practice can be up and running on the eReferrals app; that includes both the time required to download the app and the hands-on staff training, Spieker says. The app runs from the MHC Command Center and is powered by the iNexx solution from Medicity (Salt Lake City, Utah). When the referrals app is first deployed in a practice, MHC asks for contact information for the three to five sites with which the practice exchanges the highest volume of referrals.

When a primary care practice wants to make a referral, it looks up the provider or specialty in the app and chooses the appropriate office. Then it creates a referral for the patient, attaches any clinical documentation, and hits send. The app tracks all sent referrals and records when they are received, which Spieker notes is key from an accountability standpoint. On the specialist end, the office can either accept or decline the referral; but if it declines the referral, a reason has to be given. The specialist can also set up an announcement that can include information like if the practice is not admitting any new patients or provide mandatory questions like insurance information to be filled out by the PCP.

Successful Pilots
The eReferral app evolved out of a problem that an MHC anchor hospital, Saint Mary’s Health Care in Grand Rapids (owned by the 47-hospital Trinity Health system based in the Detroit suburb of Novi, Mich.), had been having in coordinating dental referrals with the local federally qualified health center (FQHC), Cherry Street Health Center. The eReferral app replaced a very time-consuming process involving inputting referrals and payment arrangements manually onto a spreadsheet. Four Trinity Health primary care practices—Trinity Sparta Health Center, Trinity Clinica Santa Maria, Trinity Browning Claytor Health Center, Trinity Heartside Clinic—piloted the app in October 2010.

Feedback from the pilot spurred such additional functionality as the ability to print referrals and import all referrals onto a spreadsheet. Also the tool now allows the user to move a scheduled appointment, cancel a referral, and show the history of changes. Another enhancement allows referrals to be assigned to alternate staff members, like for example if someone goes on vacation. “They can be reassigned and show up on someone else’s work list to make sure that nothing falls through the cracks,” says Dietzman.