e-Referral enabled collaborative health care Opportunities and considerations Presented by: Sasha Bojicic Emerging Technology Group Canada Health Infoway Inc 1

The goal of the presentation Position e-Referral as a core component of e- Health Describe what is an e-Referral Business drivers and expected benefits Architecture pattern Functional enablers Implementation considerations Implications for collaborative health care 2

The “e”-ing of Things 3

Indicates business conduct where business objectives are achieved by electronic exchange of information e 4

- ing things is not simple It is much more then just using a technology It requires configurable processes patterns and data It requires governance of resources (people, processes and technologies)e 5

What is an e-Referral? 6

e-Referral - common misperception Digitize Digitize 7

e-Referral represents holistic implementation of the clinical process that uses information technology with goal to all stages of the patient referral across multiple organizations and health care settings automateexpediteimprovemonitorqualify 8

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The e-Referral Process Pattern Referring Provider 2. Determine Referral Recipient: The Referring Provider uses an online Services/Provider directory to help determine with the patient the appropriate referral recipient based upon services/ providers, priority, location and availability. 3. Referral Template: The Service-specific referral template is accessed and patient demographic and health information pre- populates from the provider’s EMR. Referral data is validated including the patient priority. 4. Send Referral: The completed electronic referral is sent electronically to the Referral Recipient. 1. Initiate Referral: The Referring Provider can task an administrator with arranging the referral or the provider proceeds to Step #2. 10

The e-Referral Process Pattern Consulting Service / Provider 8. Consultation: The Consulting Service/ Provider assesses/treats patient completing a consultation template pre- populated with information from the Service’s/Provider’s electronic record. 6. Review Request: The Consulting Service/ Provider reviews and accepts, rejects or requests additional information from the Referring Provider. 5. Receive Referral: The Services/Provider Referral Recipient receives the referral request electronically. A receipt of request acknowledgment is sent. 7. Appt. Scheduled: Appointment is placed in EHR, confirmation sent to referring clinician and patient. 11

e-Referral represents patient-centric health care delivery pattern which allows 12

What are the anticipated benefits 13 Collaborative management of the e-Referral process Patient prioritization Status tracking Reporting Accurate and timely access to services Resource availability Event scheduling Clinical content provision Real time clinical decision support and dynamic business intelligence Access to clinical guidelines and best practices Patient safety clinical validation Wait time analytics

Functional Enablers Scheduling Decision Support Health Service Discovery Content Provision Status Tracking Notification 14

Health Service Discovery Query the list of relevant health care organizations and providers Increased resource visibility and wait time availability Filter search results based on the provider and / or patient preferences /criteria Enables patient preferences (proximity, wait time, language preference, etc.) 15

Content Provisioning Authoring and publishing of the clinical content (templates, orders sets, guidelines) Consolidated management of standardized clinical content Subscription to and distribution of the clinical content Enables access to clinical content 16

Status Tracking Capture, monitor and report the status of the prospective event Communicate referral progress inside the circle of care Status change management Triggers other system processes (alerts, notifications, etc.) according to the business rules 17

Notification Configure preferred notification channels Enable individual preferences for notification Event driven notification / alert broadcast Increases service provider and health care team accessibility and ability to timely respond 18

Event Scheduling Access to resource availability and booking of the prospective event Proactive management of service and resource capacity Input for wait times analytics Proactive wait time management 19

Decision Support Access to decision support resources (best practices, clinical guidelines) Support for evidence based decision making Systemic enforcement of the business rules Avoid redundant procedures, check for adverse reaction to medication, etc. 20

EHRS Architecture Considerations 21

Unleashing the potential – scaling options LocalRegionalJurisdictional Simple updating of lists (eReferral providers, care settings, locations, services, care plans) Stand –alone forms & templates Local decision support resources Create linkages to regional registries and source systems to automatically maintain ‘eReferral lists’ (ie. LDAP and regional shared databases) Potentially use a regional shared content management system for the creation and management of forms/templates Use EHR infrastructure eg. Registries/databases for automatically maintaining lists Use EHR distribution mechanisms like HIAL, Web Services, Publish/Subscribe, etc.. For communication between providers, care settings, etc.. Use EHR repositories like SHR for storing documents and encounter information 22

Implications for health care sector Increased use of the existing EHRS infrastructure Development of new system capabilities and services Accelerated IT enabled health care practice Cost reduction New reimbursement model 23

Implications for participants Content harmonization Fewer data capturing variances Improved evidence based CDS Quality management with process monitoring and notification Increased efficiency Improved patient safety Reduced wait times Increased visibility and accessibility to health care providers 24

Thank you 25