MHC's Steve Spieker trains Deanna Rawlings, clinic manager, Creston Medical Center, (Grand Rapids, Mich.), to use the eReferral app. Photo: Michigan Health ConnectHow it WorksWithin an hour, a physician practice can be up and running on the eReferrals app; that includes both the time required to download the app and the hands-on staff training, Spieker says. The app runs from the MHC Command Center and is powered by the iNexx solution from Medicity (Salt Lake City, Utah). When the referrals app is first deployed in a practice, MHC asks for contact information for the three to five sites with which the practice exchanges the highest volume of referrals.When a primary care practice wants to make a referral, it looks up the provider or specialty in the app and chooses the appropriate office. Then it creates a referral for the patient, attaches any clinical documentation, and hits send. The app tracks all sent referrals and records when they are received, which Spieker notes is key from an accountability standpoint. On the specialist end, the office can either accept or decline the referral; but if it declines the referral, a reason has to be given. The specialist can also set up an announcement that can include information like if the practice is not admitting any new patients or provide mandatory questions like insurance information to be filled out by the PCP.Successful PilotsThe eReferral app evolved out of a problem that an MHC anchor hospital, Saint Mary’s Health Care in Grand Rapids (owned by the 47-hospital Trinity Health system based in the Detroit suburb of Novi, Mich.), had been having in coordinating dental referrals with the local federally qualified health center (FQHC), Cherry Street Health Center. The eReferral app replaced a very time-consuming process involving inputting referrals and payment arrangements manually onto a spreadsheet. Four Trinity Health primary care practices—Trinity Sparta Health Center, Trinity Clinica Santa Maria, Trinity Browning Claytor Health Center, Trinity Heartside Clinic—piloted the app in October 2010.Feedback from the pilot spurred such additional functionality as the ability to print referrals and import all referrals onto a spreadsheet. Also the tool now allows the user to move a scheduled appointment, cancel a referral, and show the history of changes. Another enhancement allows referrals to be assigned to alternate staff members, like for example if someone goes on vacation. “They can be reassigned and show up on someone else’s work list to make sure that nothing falls through the cracks,” says Dietzman.On the heels of the success of the pilot, MHC has been leveraging its member organizations and using those relationships to further deploy the eReferral app throughout its physician population, including primary care providers, specialists, a medical equipment supplier, home care providers, behavioral health organizations, and long-term care facilities. “We’ve signed up a couple of large physician organizations in Southeast Michigan with the intent on their part to tie their physicians together using this referral capability to manage the transitions and care outside their organization,” says Dietzman. MHC also builds awareness for the app through webinar training.So far, MHC has deployed the app to at 220 sites across 159 specialties, in 58 cities and 27 counties statewide. Soon, more than 1,000 physicians in Michigan will be using the technology, and the list of interested practices continues to grow. The quick spread of the technology is due not only to the ease of implementing the app and MHC’s streamlined processes, but also to word of mouth among providers, says MHC.Freeing up Providers' TimeMHC is able to offer the app free to providers, as the HIE sustains itself on revenue from electronic results delivery. Reed City Hospital, a 25-bed hospital in Grand Rapids, Mich. affiliated with the eight-hospital Spectrum Health, started using the app in Spring 2011, and now has nine referral specialists sending at least 100 referrals a week via the app, across three family practices and three specialist practices. Mindy Fewless, operations manager, family practice, Reed City Hospital, says the app has proven to be a huge time-saver for her office. She adds that communication is much better now between the specialty offices, and the ability to track the sending and receiving of referrals has really cut down on the number of phone calls.Klausing sees the efficiencies gained from this app really freeing up time for providers to focus more on patient care. “This app is allowing PCPs and specialists to connect in a way they’ve never been connected before,” she says. “It’s allowing this electronic conversation to easily track referrals, so there are no more black holes with the fax.”