The Evolution of the Referral Process

Case Study: Providence Health System E-Referral Mike Reagin Director of Research and Development michael.reagin@providence.org Providence Health System Portland, Oregon USA March 8, 2004

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)

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

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

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)

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

Consumer Driven HealthCare Providence Health System E-Health Vision

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

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)

Enterprise Messaging Architecture

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

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

E-Referral Workflow Walkthrough:

Central Clinic Inbox

Selecting a Patient

Attaching documents

Specialist Clinic Notification Message

Received E-Referral Message

Document Management Process

View documents in GE Centricity EHR for completed E-Referral.

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

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 E-Mail 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

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

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

Questions?