CCI Voice Innovation of the Month: eReferral in San Francisco Safety Net
October 9th, 2012 / Alice Chen, UCSF/SFGH
eReferral is a homegrown, HIPAA-compliant, web-based electronic referral management and consultation system used to access specialty care expertise in San Francisco’s safety net. Primary care providers (PCPs) use the system to submit new patient referrals for specialty care. Every service has a designated specialist provider (generally a physician for medical subspecialties or nurse practitioner for surgical specialties) who reviews and responds to each referral within 3 business days. The specialist reviewer can use the system to schedule a routine or expedited clinic visit, ask for clarification or additional information, recommend additional diagnostic evaluation prior to scheduling a clinic visit, or provide education and management strategies for the PCP. The PCP and specialist reviewer can communicate via eReferral in an iterative fashion until both agree that the patient does not need an appointment or an appointment is scheduled. All exchanges are captured in real time in the patient’s EMR. Since 2007, eReferral has grown to include more than 46 specialty and diagnostic services at San Francisco General Hospital and Laguna Honda Hospital.
eReferral has resulted in significant decreases in wait times for routine clinic appointments, with some clinics experiencing a drop in wait times of up to 90% during the first six months of use. Depending on the clinic, up to 45% of initial referrals are managed without a clinic visit. A survey of subspecialty clinics found that compared with prior paper based referral methods, eReferral resulted in a 45-75% decrease in referrals for which it was difficult to discern the reason for referral, and a 60-80% reduction in referrals that were considered inappropriate. While there has been a shift in work to the PCP, PCP experience has been largely positive, with 72% reporting that eReferral improved clinical care for patients.
Given the recent interest in care coordination, global payment models, and Accountable Care Organizations, many health systems have approached us about adopting eReferral. Orange County, Los Angeles County, and San Diego County safety net organizations have each developed electronic referral systems modeled after eReferral, and both UCSF and UCLA Medical Centers are developing similar programs. We have an eReferral Handbook that we are planning to update this coming year, and will be developing web-based videos for other organizations interested in learning more about our system.