# Presentation: 714444

## Meeting Referral Information Needs Electronically

- Carol L. Ireson RN, PhD
- College of Public Health
- Carol Steltenkamp MD, MBA
- College of Medicine
- University of Kentucky

## University of KentuckyChandler Medical Center(UKCMC)

**University of Kentucky****Chandler Medical Center****(UKCMC)**

_***Educational Mission:***_
**Six colleges:**
**Medicine, Nursing, Pharmacy, Dentistry, Allied Health Professions, and Public Health **
**600 medical faculty in 15 departments; 50 dentists **
**500 housestaff physicians**

## University of KentuckyChandler Medical Center(UKCMC)

**University of Kentucky****Chandler Medical Center****(UKCMC)**

_***Research Mission:***_
**Over $200,000,000 in Research Dollars**
**$104,000,000 Grants and Contracts Awarded**
**$80,000,000 Total Direct Expenses**

## University of KentuckyChandler Medical Center(UKCMC)

**University of Kentucky****Chandler Medical Center****(UKCMC)**

_***Clinical Mission:***_
**University of Kentucky Hospital**
**368 beds**
**Level 1 Trauma Center & Air Medical Service**
**Centers: Critical Care, Cancer, Women’s Health, Transplant, and Minimally Invasive Surgery**
**Magnet Recognition: 39****th**
**UK Children’s Hospital**
**106 beds**
**50 bed Level 3 Neonatal Intensive Care Unit**

## University of KentuckyChandler Medical Center(UKCMC)

**University of Kentucky****Chandler Medical Center****(UKCMC)**

_***Clinical Mission:***_
**A multi-specialty group practice **
**Kentucky Clinic with 14 on-site medical clinics, dental clinic, a Student Health Service **
**500,000 patient visits per year  **
**Multiple satellite facilities and regional clinics offer services throughout Lexington and the southern and eastern counties of Kentucky**

## Why we need to do this

- The quality of health care often hinges on coordination and continuity of care
- One of the most crucial interactions in the provision of care occurs when a primary care physician refers a patient to a specialist
- patients made over 756.7 million visits to a physician in 1999
- 40% of those were to a specialist provider
- 91 million specialists visits were a referral from another provider

## Goal of our HIT project

- Improve the quality and effectiveness of referrals between primary care physicians (PCP) in rural Kentucky and specialist providers (SPs) at the University of Kentucky Chandler Medical Center (UKCMC) using structured referral information templates.

## Where we began

**Commonwealth Fund Supported Study**** **
- Identified the gaps in the current process of information exchange between PCPs and SPs
- Developed a heuristic for referrals using principles of collaboration and user centered content generation resulting in information templates for five major chronic disease diagnoses
- Colon & Breast Cancer, CHF, COPD, Type II DM

## HIT Planning

- Identified 5 rural practice partners that frequently referred to UKCMC
- Conducted focus groups with rural PCPs
-  Shared Referral Study findings
- Determined desired format and timeframe for receiving information from the SP
- Completed a technology assessment

## Slide 10

## Surprise!

- Two of the five practice have EMRs
- Two more sites are purchasing EMRs

## HIT Planning

- Conducted focus groups with the four clinical specialty services: Endocrinology, Cardiology, Oncology, Pulmonary
- Shared Referral Study findings
- Validated the referral template information and revised templates
- Shared information from the referring practices about the format, content and timeframe for communicating patient information back to PCP

## What we did

- Performed a work flow analysis of the current process for clinical data exchange between the PCP and SP
- Identified the gaps in the clinical workflow process that could lead to patient errors
- Identified how the clinical workflow process could be supported by electronic information exchange

## HIT Plan

- Test paper version of the referral templates
- Develop web portal
- Implement secure server for electronic exchange

## Referral Source

**Contacts specialist clinic schedules visit**

**SP completes patient visit**

**Contacts SP office schedules &**
**collects pt info**

**Contacts UKMDs to schedule visit**

**SP sends patient visit summary to Referral Source**

- SP contacts PCP

- SP does not contact PCP

- UKMDs contacts SP who collects pt info

- Info not sent to clinic by office

- SP does not send patient information to referring source

- No Patient Information Sent

- SP Does not send info to clinic

- Visit not completed

- Dictates note and send by snail mail

- Phone Call

**  ****CURRENT PROCESS**

## Referral Source

**Contacts specialist clinic schedules visit**

**SP completes patient visit**

**SP Office schedules &**
**Receives fax of patient information**

**Contacts UKMDs to schedule visit**

**SP faxes patient visit summary to Referral Source**

- SP contacts PCP

- SP does not contact PCP

- UKMDs contacts SP & obtains **faxed **patient information from referral source sends to clinic

- Info not sent to clinic by office

- SP does not send patient information to referring source

- No Patient Information Sent

- SP does not send info to clinic

- Visit not completed

- Phone Call

**TEMPLATE TESTING**

## Referral Source

**Contacts specialist clinic schedules visit completes pt info template on web portal**

**SP accesses pt info & completes visit summary note template placed on web portal**

**Contacts SP Office schedules  visit & completes pt info template on web portal**

**SP accesses secure web portal for patient visit summary **

- SP does not contact PCP

- No Patient Information Sent

- Visit not completed

**Contacts UKMDs, schedules visit & completes pt info template on web portal**

**PROCESS FOR NON-EMR  SITES**

- UKMDs contacts SP

## Referral Source

**Contacts specialist clinic schedules visit**

**SP completes patient visit**

**Contacts SP office schedules &**
**collects pt info**

**Contacts UKMDs to schedule visit**

**SP sends patient visit summary to Referral Source**

- SP contacts PCP

- SP does not contact PCP

- UKMDs contacts SP who collects pt info

- Info not sent to clinic by office

- SP does not send patient information to referring source

- No Patient Information Sent

- SP Does not send info to clinic

- Visit not completed

- Dictates note and send by snail mail

- Phone Call

**  ****CURRENT PROCESS**

## Referral Source

**Contacts specialist clinic schedules visit & sends electronic pt info to secure server**

**SP clinic accesses pt info & completes patient visit & completes templated visit note that is sent to secure server**

**Contacts SP office schedules visit & sends electronic pt info to secure server**

**Contacts UKMDs, schedule visit & sends electronic pt info to secure server**

**Referral Source accesses patient visit summary from secure server**

- SP clinic sends no visit info  to secure server

- No Patient Information Sent

- Visit not completed

**PROCESS FOR EMRs**

## Expected Outcomes

-    Potential miscommunication between providers
-    Efficiency and effectiveness of referrals
- 	Patient and physician satisfaction
- 	Redundancy of tests and procedures & improve business outcomes
- 	Generalizable to many other settings, rural and urban