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
SOA Implementation Framework
Open Standards
Open Standards

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

11. Enterprise Messaging Architecture

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 Q2 2005
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?