Northwest pilots GP to specialist e-referrals

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Resource Matching and Referral system speeds referrals between hospitals, CCAC, long-term care, family docs and specialists

Fax machines aren’t quite obsolete yet, but they’re seeing a lot less use as both the North East and North West LHINs transition to computer-based Resource Matching and Referral (RM&R) systems.

The journey began in March 2010 in the northwest with the implementation of a Strata Health solution at Thunder Bay Regional Health Sciences Centre for referring patients to St. Joseph’s Care Group for rehab and complex continuing care. Two years later, the system was expanded to accommodate referrals to the North West CCAC and from the CCAC to long-term care.

By March of this year, all 14 hospitals in the northwest and long-term care homes in Thunder Bay, as well as those east of the city, were on the system. And in July, two family health teams began electronically referring patients to pediatricians.

Resource Matching and Referral technology offers a number of advantages, says North West Health Alliance project manager Krista Wilson.

Electronic transmission on standardized forms ensures that the referral has all of the required information and is legible. It eliminates phoning back and forth for follow-up and updates, and is more secure than faxed referrals, which can get lost or sent to the wrong number.

With all of the referrals date stamped and captured electronically, health care planners can track the number and type of referrals and the time it takes for patients to be seen.

The next step is to expand the system to all primary care providers in the northwest, and slowly begin to add additional specialties, said Wilson.

Adding specialties takes time because each one requires a standardized form that is developed with input from the specialists.

For example, the form for pediatrics requires primary care providers to identify the reason for the referral and automatically directs the referral to a pediatrician specializing in that area – for example, allergies or behaviour problems. Built-in logic also checks the patient’s date of birth and rejects a referral if the patient is older than 17.

The system gives referring providers the option of selecting the first available pediatrician, but also lists each specialist next to a green, yellow or red circle to depict the estimated wait time for an appointment.

Upon receipt, the specialist office enters the date of the appointment, allowing the primary care provider to go into the system to track the progress of the referral and update any information as required.

Primary care providers can upload files from their EMR, but because the application – Strata PathWays – is not integrated with electronic medical record systems, a patient’s demographic data has to be rekeyed.

Of the two family health teams currently plugged in, one has opted for centralized processing of referrals by the clinic manager, while the other chose to have individual docs and nurse practitioners fill out the forms.

The latter isn’t working as well “because re-entering the demographic data – name, date of birth, address, phone number, etc. – takes time,” said Wilson.

OntarioMD is working on an integration solution for Strata Pathways, but it will take time because of the number of EMRs certified for use in Ontario. Integrations with Meditech, which is used by all hospitals in the northwest, and with CHRIS, the CCAC’s patient management system, were much easier.

Ultimately, the vision is to accommodate all health-care related referrals, including referrals to community support agencies such as Meals-on-Wheels and mental health services.

The 2016-2017 projected cost for RM&R in the northwest totals $458,000. The LHIN picks up $78,000 of that, leaving the North West CCAC and 14 hospitals cost sharing the balance.

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