Electronic Referrals and Discharges Connecting with Secondary Care

1
Electronic Referrals and DischargesConnecting
with Secondary Care

Tony CookeHutt Valley District Health Board17th
April 2008
2
Topics

• Primary Secondary Connection
• Problems
• Solutions
• Implementation Experiences
• Future Development

3
Primary-Secondary Interface

• Referral
• Patients are referred to the right practitioner
  with the right information and receive the right
  response
• Discharge
• Patients who are discharged from hospital will
  have relevant and accurate information available
  to those who continue their care

4
Patients view

• Smooth transition of responsibility for their
  care
• Good logistics and communication
• Continuous medication management
• Continuity of the patients record
• Good information to support high quality care

5
The Referral Problem
Too little

• Frustration with excessive information
• Frustration at receiving insufficient information
  - legibility
• Duplication re-requesting phone calls
  inefficient
• Re-keying patient data is inefficient
• Significant risk of lost paper
• Poor security
• Slow acknowledgements and updates (if any)

6
The Discharge Problem
7
Discharge Summary Problems

• Frequently receive discharge summary after
  patient has arrived for follow up
• Too much time spent on past medical history and
  little information about current admission
• Usually illegible
• Very unclear as to GPs follow-up
  responsibilities
• Sometimes quality of info very poor GPs still
  want follow-up registrar letters

8
Discharge Medications - Issues

• Not confident about medications on discharge
• Dont know why medications have been altered
• Sometimes cannot work out why a medication has
  been prescribed
• Some patients kept on short term meds for years

9
Why an electronic solution?

• Supports better quality and timeliness
• Delivers referrals/discharges quickly and
  reliably
• Provides structured information to improve
  accuracy
• Templates encourage collection of relevant and
  more complete information
• Supports better continuity of care
• Integrated with existing systems
• Status messages for practitioner and patient

10
Key Milestones at Hutt

• Electronic Discharge Summaries
• Went live in April 2003
• Currently averaging 94 across all services
• Electronic Referrals
• Design Specifications (March 2003)
• Project begins (Aug 2005)
• First electronic referral (Nov 2006)
• Relaunch of pilot (April 2007)
• Operational stability (Dec 2007)

11
Progress Report25 General Practices28
Specialties160-180 per week (50 of referrals)
12
e-Referrals design
Senders sites
Recipient sites
Forms distribution server
Practice Mgt Sys
Forms engine
HL7
XML
Submission gateway
Referral mgt sys
Patient Mgt Sys
Referral gateway
Message translation
Transmission to DHB
Monitor/acknowledgement
Comms
infrastructure
Message delivery
Logging integrity
13
Key Features

• Referral forms pre-populated
• Attachments (lab results, photos)
• Specialty specific information
• Accuracy and completeness checking
• Status update messages in real time
• Tracking and processing done on-line
• Viewed in context of patients record
• Content and format complies with HISO RSD Standard

14
Implementation Experience

• Each General Practice system is set up
  differently
• Preparation and buy-in from all staff critical
• Structured information means more rigor
• Extensive testing is required
• Senior hospital clinicians need to be on-line
• Maintain both paper and electronic systems
• Referrals used for other purposes!

15
Future Development

• Further developments at Hutt
• Need all GPs and Practices participating
• Interfaces with hospital systems
• Include other referral sources
• Manage internal hospital referrals
• Consistent approach required
• further standardisation of forms and code sets
• Understanding implementation impact
• Costs are in implementation resources
• Dependence on the electronic process
• Potential to lead to significant changes in
  practice