Communication about a patient can range from asking for a specialist assessment on a patient currently unknown to a specific speciality, to asking for quick advice about a patient who is known on how to better manage the patient within primary care and their home or aged-care facility.
Historically, GPs would send referrals by fax or post, but despite the best intentions and systems, paper can and does get lost on its journey to the DHB.
What are we trying to achieve?
The implementation of electronic referrals will help to:
- eliminate paper and communications not reaching the intended DHB hospital specialist
- speed up communication between the parties
- improve the support for the general practitioners so they can better manage patients and not have them attend hospital visits unnecessarily
The ultimate aim of the eReferrals project is to ensure patients in the Auckland region are referred to the right service, with the right information, for the right reasons, at the right time, and receive the right response – in a timely manner.
What have we done?
eReferrals is a regional collaborative project between the three Auckland DHBs, healthAlliance, and the software vendor partners Healthlink™ and Orion Health™. To date the project has achieved the following:
End-to-end electronic referral
Previous electronic referral systems were basically electronic forms, which still had to be manually processed by DHB staff. This has now been replaced by an end-to-end electronic referral process which also provides:
- an audit trail for each referral
- an immediate message to the GP from the relevant DHB about their referral
The GP can also submit more information or further communication regarding their referral within the system, and any questions or conversations are retained with the rest of the information about that patient. This ensures that a more timely and better quality response can be provided by the specialist.
An important benefit of standardising referral processes is that referrals are handled in a consistent manner and all referrals can be tracked to ensure they were managed in a timely and clinically appropriate manner.
Standardised processes and systems
We have developed a number of standardised templates, processes and systems to ensure consistency of practice across the Auckland region. For example we have created:
- standard templates for referral to specialist care
- referral process standards
- quality reporting standards
- referral management dashboard
These developments have led to improvements in process quality, time to process, and overall productivity resulting in less confusion, rework, and duplication, and achieving better patient outcomes. We also now have information about referrals and the outcome of clinical reviews that was not available previously in electronic format.
eReferrals - GP referral options
eReferrals example - skin cancer form
eReferrals example - skin cancer grading
Did we make a difference?
- Increasing uptake
The eReferrals system is very well used by GP practices in the Waitemata region, with over 85% of referrals from GPs to specialists now coming via eReferrals
- Faster referral process
Previously paper referrals could take up to 10 days to reach and be reviewed by a specialist clinician. In the eReferral system, the referral is received by the hospital as soon as the GP presses “Submit referral”.
- Improved GP-Specialist communication
The eReferral system makes it possible for a specialist to communicate back to the GP to ask for more information or to provide advice for treatment if specialist care is not required. This is providing a better outcome for patients to receive specialist input into their care while still under the care of their GP, and without having to attend outpatient appointments
Snapshot of eReferral results at February 2015
Where to from here?
The eReferral development to date has concentrated on making it possible for GPs to send referrals electronically. In early 2016 we will launch a Web Portal which will enable other external healthcare providers in the region (eg private specialists, optometrists, midwives) to securely send eReferrals to hospital specialists.
The final stage of this project is for internal referrals (within the DHB) to go electronic which will take place over the next 1-2 years. To find out more about eReferrals visit the project website at www.eReferrals.co.nz.