In May 2009 Boston Medical Center (BMC), a 508-bed academic medical center, implemented an automated eReferral management system from the Scottsdale, Ariz.-based Carefx Corp. to fund its community information exchange and solve a key problem of lack of system-wide referral standardization. The eReferral management system has been so successful for BMC and its community health centers that it has generated $7.4 million in referrals and reduced operating costs.In 2008 BMC started building its community information exchange that shares continuity of care documents (CCDs) and clinical information like medications, problems, allergies, lab results, specialty notes, discharge summaries, and ED notes between BMC and 12 of its community health centers. Increasing and automating referrals would be key to ensuring its sustainability, so the eReferral system went live a few months after the exchange’s go-live in April 2009.The eReferral system operates by the referring doctor inputting the referral into the EHR, which is part of the CCD output that is then sent to the community information exchange. The exchange alerts a referral coordinator through the portal, who then checks for authorizations and any missing data. Afterwards, the referral is processed and the patient is notified. The management system also tracks referral volume, efficiency, outcomes, leakage, and compliance.The problem at Boston Medical Center, and a lot of academic hospitals, is that every department has its own workflow for referrals, says Daniel Newman, M.D., chief medical information officer and practicing internal medicine specialist at BMC. “Everyone had their own rules: some wanted faxes, some wanted phone calls, some wanted emails; so it was really complicated,” says Newman. “So we went from a really confusing, multi-step process that was different for every individual specialty to a single standardized process across all the specialty clinics at Boston Medical Center.”
Daniel, Newman, M.D.The eReferral management system implementation started with the department of medicine at BMC and became so popular that other surgical specialties and departments began clamoring for the system. The eReferral system was then rolled out across other hospital specialties and the 12 affiliated health centers over the course of a year.BMC has seen many improvements from its eReferral system including increasing scheduled referrals from 30 percent to 60 to 80 percent and reducing no-shows by 2 percent to 23 percent. Also, turnaround time for patients has markedly improved from an average of about 33 days to get a specialist appointment to now six to eight days.When first released, the new system received some negative flak for changing workflows. “One of the challenges at the health centers was the concern about how much can we trust this new fangled method,” says Newman. “They were very content with their horrible method, and they were worried it was going to get worse and not better. From the administrator side of things, they were worried that this would increase the amount of staff they would need to monitor the referrals.”It took a year, says Newman, for people to appreciate the new efficiencies and be able to monitor in real-time how many referrals are put in the system and how many are made. Next steps are to implement the eReferral system for the BMC primary care physicians, deploy the system between BMC departments, and offer the system via the BMC website for use by non-network, referring providers.