Michigan HIE finds an innovative, cost-effective way to link transitions between primary, specialty care | Healthcare Informatics Magazine | Health IT | Information Technology Skip to content Skip to navigation

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.

On the heels of the success of the pilot, MHC has been leveraging its member organizations and using those relationships to further deploy the eReferral app throughout its physician population, including primary care providers, specialists, a medical equipment supplier, home care providers, behavioral health organizations, and long-term care facilities. “We’ve signed up a couple of large physician organizations in Southeast Michigan with the intent on their part to tie their physicians together using this referral capability to manage the transitions and care outside their organization,” says Dietzman. MHC also builds awareness for the app through webinar training.

So far, MHC has deployed the app to at 220 sites across 159 specialties, in 58 cities and 27 counties statewide. Soon, more than 1,000 physicians in Michigan will be using the technology, and the list of interested practices continues to grow. The quick spread of the technology is due not only to the ease of implementing the app and MHC’s streamlined processes, but also to word of mouth among providers, says MHC.

Freeing up Providers' Time
MHC is able to offer the app free to providers, as the HIE sustains itself on revenue from electronic results delivery. Reed City Hospital, a 25-bed hospital in Grand Rapids, Mich.  affiliated with the eight-hospital Spectrum Health, started using the app in Spring 2011, and now has nine referral specialists sending at least 100 referrals a week via the app, across three family practices and three specialist practices. Mindy Fewless, operations manager, family practice, Reed City Hospital, says the app has proven to be a huge time-saver for her office. She adds that communication is much better now between the specialty offices, and the ability to track the sending and receiving of referrals has really cut down on the number of phone calls.

Klausing sees the efficiencies gained from this app really freeing up time for providers to focus more on patient care. “This app is allowing PCPs and specialists to connect in a way they’ve never been connected before,” she says. “It’s allowing this electronic conversation to easily track referrals, so there are no more black holes with the fax.”


Julie Klausing

When a referral is made for a patient, those offices are now connected and become a virtual care team, says Dietzman. “The ability of both offices to stay in sync with the scheduled appointment time, and if the office changes that scheduled appointment, it automatically lets the primary care office know that that appointment has been changed,” says Dietzman. He foresees patients will be seeing quicker times to get an appointment because of this tool.

Dietzman says the app helps facilitate meaningful use requirements. An image or a CCD can be attached to the eReferral to create a smooth care transition. He also sees this tool as a favorable way for PCPs to coordinate with mental health providers without sharing certain sensitive data that cannot be shared in a medical home scenario.

As the industry is figuring out the next steps toward forming accountable care organizations, Dietzman says that more practices will be working in an environment with multiple vendors and providers that aren’t owned by the same system, which will make communication all the more challenging. That’s why a simple, web-based app could be a good connector for those communications, he says.

Klausing notes that the tool gives specialists a competitive advantage. “Say they’re a cardiologist and they’re listed in a particular area and their competitors aren’t; guess who’s going to get the referral?”

Enhancements, Different Use Cases
In the future, MHC’s leaders would like to interface the eReferral app with practices’ EHRs, and build encounter triggers for sending CCDs. But Dietzman says vendors need to become more mature to allow for this functionality. Klausing also wants to get insurers involved in order to develop an enhancement to automate health plan authorizations.

Further functional development, Dietzman says, will be “not so much massive changes to the tool, but rather, [enhancements] where the tool can be applied to solve more problems in the community.” One application that Spieker is really excited about is for Child Protective Services teams to use the messaging and tracking capability for receiving referrals on children they care for. The State of Michigan started a pilot in Kent County in January 2012, and hope to roll the app out to all CPS workers in the state. “Child Protective Services realizes how this could really impact helping children, being able to track if they’ve been referred in the past and pulling all information into one spot so when they go to court, so everything is in one area,” Spieker says.


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