INTEGRATION OF REFERRAL INFORMATION AND PATIENT FLOWS: THE

1
INTEGRATION OF REFERRAL INFORMATION AND PATIENT
FLOWS THE ROLE OF REFERRAL MANAGEMENTIN TAYSIDE

• Linda Fox/Rebecca Locke

2
A History Lesson

• Implementation of locally developed system
  Electronic Referral Service (ERS) for electronic
  referrals to all provider units across Tayside
  excluding Community Services
• Live within 7 pilot practices in May 2001
• Receipt by Medical Record Departments across
  Tayside printed off
• SIGN guideline compatibility for all specialties
• 5 protocol referrals were developed
• General psychiatry (for 1 CMHT)
• General Surgery Breast clinic
• Menorrhagia
• Pain Clinic
• Vascular Surgery carotid endarerectomy

3
Moving on to a ReferralManagement System

• June 2005 - Dermatology participated in a pilot
  enabling clinicians to electronically screen
  referrals.
• Clinicians screen referrals at source with the
  following options
• Booking clinic requests
• Cancelling referrals
• Redirecting referrals to other specialties/locatio
  ns
• Messages are sent electronically back to the GP
  practice via ERS indicating any updates.

4
Impact of ERS/RMS within NHS Tayside

• Reduction in the Patients Timeline
• Extended Referral Management capacity
• Robust information to Medical Records from
  Clinicians screening
• Currently 84 of referrals in e-format
• 4,519,177 current running total
• 84 of all referrals are electronically managed
  on line either in one or all locations across
  Tayside

5
What Happened Next and When?

• Introduction/migration of SCI-Gateway
• Pilot commenced 5th November 2007 completed May
  2008
• Over 5377 referrals processed during pilot
• In addition referrals being received within
  Medical Records from GP practices outwith Tayside
• Full training and roll-out to all Tayside
  practices following successful pilot conclusion
  and review.

6
Referral Management
7
Select the location, specialty, protocol and
clinician
8
A digital photograph of a lesion is attach to the
referral..
9
and the referral is sent through the Gateway
10
and arrives in RMS
11
The medical staff on call from screening in
dermatology receive the referral
12
and screen it
13
Upon screening, redirect referral to Plastics
Skin Lesion .
14
Gateway is updated accordingly .
15
and referral now received by Plastics
16
The patient is booked into a clinic and the
status of the referral is raised to urgent
17
The new status of the referral issent back to
the Gateway
18
In RMS the referral is printed andthe booking
confirmed
19
and the final status is sent back to the Gateway
20
Locally Agreed Referral Pathways

• Tayside Colorectal Service protocol based
  referral introduced pan-Tayside.
• Tayside Skin Tumour Service collaborative
  working with 3 disciplines (Dermatology, Plastics
  Surgery Oral and Maxillofacial with links to
  Ophthalmology) Joint screening with digital
  photographs, introduced across Tayside, into
  agreed management algorithms.
• Surgical Vascular Services referral management
  pathway to include vascular laboratory testing.
• First Seizure Service protocol developed and
  includes mandatory information to risk manage the
  patient.

21
Colorectal Protocol Based Referral storyboard
Key Information
22
Colorectal Protocol Based Referral storyboard
Clinical Information
23
(No Transcript)
24
SCI-Gateway referral Compliant with National
Standards

• National HEAT status updates electronically
  passing back to SCI-Gateway from RMS for all
  patient referrals.
• Tayside protocol modification to indicate
  Urgent Suspected Cancer in accordance with 62
  and 31 day Cancer pathways.
• Facility to record UK Veteran status to allow
  appropriate management of patients.

25
RMS Development

• Generic screening options include Any outpatient
  clinic, redirection, up/downgrade, cancellation
  (clinical messaging back to General Practice),
  flag-to (specific clinician or service).
• Specialty generic email and/or clinician email
  alert for flagged referrals.
• Screening/Triage Clinician directed RMS options
• E.g., Orthopaedics Physiotherapy.
• E,g., Medicine for the Elderly Falls Clinic.

26
(No Transcript)
27
(No Transcript)
28
The Future

• Complete alignment of referrals and referral
  management by all specialties with integration
  with PAS, and delegated appointment booking.
• Clinical Directory to be developed and introduced
  containing referral pathways and referral
  guidance.
• Introduction of electronic test requesting and
  appointing.
• The ability to attach documentation to the
  referral in secondary care by April 2010
  developed specifically for the Pain services to
  allow patient questionnaires to be electronically
  incorporated with the original referral.
• Clinical messaging back to General Practice from
  RMS through the EDT server into Docman.
• More Protocol Based Referrals to be developed
  following consultation with General Practice and
  Secondary Care

29
The future continued

• SCI-Gateway referral by GDP and referral
  screening by Hospital Dental Services.
• Inter-Hospital Usage of SCI Gateway for tertiary
  referrals.
• Development and adoption by Community Services of
  SCI-Gateway and RMS (referral screening) e.g.
  Dietitians, Physiotherapy, Speech and Language
  therapy.
• Inclusion of Mental Health Services in PBR
  development and referral screening.

30
Comments by Clinicians on-line screening

• Mr Amar Jain, Consultant Orthopaedic Surgeon,
  (specialises in Orthopaedic Foot referrals).
• I must admit I was a bit sceptical of whole
  system as I am a technophobe and computer
  illiterate. But I am pleasantly surprised how
  easy it was to get on it . After a few teething
  problems for me now it is functioning very well.
  Your and your colleagues support has been very
  valuable for me. It has been very useful in
  screening Foot referrals. This has made the
  whole admin of referrals easy and faster. Even
  I can recommend to all without hesitation.

31

• Dr James Cotton, Consultant Gastroenterologist.
• Prior to the implementation of RMS my colleagues
  and I had some concerns if it would influence the
  way we worked on a day to day basis of managing
  referrals How we would manage personal referrals
  and how would we screen referrals.
• We have seen benefits in managing referrals
  since implementation of RMS.
•   We can screen anywhere on our intranet, it
  is easier to redirect referrals and to cancel
  them with feedback for the GP.  Referral rarely
  get lost!
• From an audit point of view we can get better
  data regarding our referral patterns, and
  management.
• It did required a change in how we work and
  work as a team, but we have seen the time to
  screen drop to a mean time of 1 day.
•  
• Future developments into integrating the system
  with other hospital systems and
  results management would be welcome, which I
  believe is currently being looked into.

32

• Some Challenges
• Customisation for individual specialties is
  labour intensive and development requires
  considerable support.
• Support Team needs to be fully integrated, good
  communication in place to effect change.
• In Tayside we still have a mixed economy
  electronic and paper based referrals and referral
  management.
• Still new patient pathway development reliant on
  paper faxed route for referral/management.
• Expectations raised, immediate development now
  requested.
• Dealing with the less keen.

33
Doing things differently?

• Reprioritise to HEAT ref 2005
• Roll out of two programmes at the same time
  SCI-Gateway and RMS.
• Earlier link of RMS with PAS appointment booking.
• Integration of patient demographics and
  administration data with test requesting from
  RMS.
• Communication strategy.

34
Questions (Hopefully) Answers