Closing the Loop on Referrals: Early Report

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Closing the Loop on Referrals Early Report

• Joe Kimura, MD MPH
• Medical Director for Quality Measurement
• June 2, 2008

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Overview of Presentation

• Organizational Context
• Review of Referral Process Improvement
• Highlights of IT Tool (EPIC Referral Module)
• Tracking Improvement
• Next Steps

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Organizational Context

• Multi-specialty ambulatory group medical practice
• 350,000 patients
• 500 physicians, 3,500 total employees
• 19 locations across Eastern Mass
• Common electronic medical record EpicCare
• Accepts most major insurance products
• Mix of FFS / Capitation
• Both internal / external referrals

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Review of Referral Process Improvement

• Long history of improvement attempts
• Primary Care / Specialty Care Relationship
• Hx of Staff Model Organization
• Lack of Actionable Data
• Opportunity to improve in late 2007
• EPIC Referral Module (IT Tool / Workflows)
• LEAD initiative (Org Change Context)

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Review of Referral Process Improvement

• Information Technology Tool
• New functionality to improve tracking of
  referrals
• Opportunity to streamline/standardize
  workflows
• Systematic data collection around referrals
• Organizational Change
• Emphasis on Collaborative Learning Community
• Open Dialogue between Primary and Specialty
  Care
• Referral Improvement Meeting Winter 2007

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Review of Referral Process Improvement

• Completed Group Exercise to Map Current State
• Identified Recurrent Themes
• High Variability in Workflows
• Individualized follow up only no system for
  follow up
• Trust issues between primary and specialty care
• Built Consensus Around
• EPIC module will enable better performance data
  collection
• Implementation will lead to standardized
  workflows
• Keep initial improvement efforts focused
• High Risk Cancer Cases
• Internal Referrals

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Review of Referral Process Improvement
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Review of Referral Process Improvement
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EPIC Referral Module (1/5) Tracking Worksheet
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EPIC Referral Module (2/5) Link to Appointments
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EPIC Referral Module (3/5) Review of Referral Hx
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Referral Module (4/5) Link to Action
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EPIC Referral Module(5/5) Link to Clinicians
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EPIC Referral Module Standardized Simplify

• BEFORE
• B. 4-6 Weeks
• C. 2-4 Weeks
• D. 1-2 Weeks
• E. lt1 Week
• Elective
• Emergency
• Routine
• Urgent

• AFTER
• lt 1 wk
• lt 1 month
• Routine

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Tracking Improvement
All Referral Orders
External Referrals
Internal Referrals (2841)
Routine Referrals (2479)
Priority Referrals (362)
BH / Canceled Referrals (16)
Target Referrals (346)
No Follow Up (?)
Specialty Appointment (?)
Summary YTD
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Tracking Improvement
Internal Referrals Completed
Go Live
Completed
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Next Steps Ensuring Change

• Q1 Experience with EPIC referral module noted
  variable implementation across organization
• Need ongoing training around correct use of IT
  tool
• Accountability for open referrals needs
  clarification
• Need regular feedback of performance data
  reports
• Need active senior management oversight (IT /
  Ops / Clin)
• Time for Deeper Understanding Analysis of root
  causes of performance gaps possible with greater
  objectivity

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Thanks

• Joe_Kimura_at_vmed.org
• [phone]

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Appendix

• Provider knowledge base
• Acquiring Full History and Complete Physical
  Exam
• Ordering Appropriate Screening Tests (Order and
  Result Review)
• Patient Knowledge Base and Activation

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Appendix Data Exploration for Early Triggers