Progress on eReferrals, early stages for electronic DI requesting

The big news this week came out of the west, where WA Health has finally gone to tender for a new electronic referral solution to replace the SharePoint system it has used for many years. WA Health has a centralised referrals processing system for its metropolitan hospitals and SharePoint would have done the job in the past, but newer technology has fast overtaken it.

WA Health says just over a quarter of referrals to its public hospitals are done by secure messaging and it appears faxes and letters rein supreme otherwise. It would be a surprise if the situation is any different between GPs and private specialists. There’s a lot of easily available, cheap and very good secure messaging technology out there, so it appears that the referrals management system (RMS) will be central to this project. WA Health is looking for a new RMS that also has to integrate with webPAS and its internal eReferrals system. That’s where a lot of the complexity of eReferrals comes to the fore.

On our reckoning, only the Northern Territory is yet to announce a jurisdiction-wide solution, although this may be due to its big core clinical systems renewal program (CCSRP) taking up its attention. But to be honest, eReferrals into public hospitals should have been sorted out long before now. Only Tasmania seems to have a working solution covering both the public and private sectors.

NSW and Victoria are both a bit of a hodgepodge. While we have been told privately that eHealth NSW is planning on its Engage Outpatients being a statewide solution, officially the word is that it’s not. The Hunter New England region, as is its wont, is using New Zealand’s BPAC SeNT solution, and we hear that the two Sydney children’s hospitals are using a separate solution altogether. No one is quite sure what Victoria is doing, which is par for the course.

And while South Australia has big plans to show the rest of the country how to do secure messaging interoperability, our readers tell us that those big plans have yet to come to fruition. And Queensland, which despite having one of the most centralised systems in the country, is doing very strange stuff with five different vendors.

Any movement on these sorts of projects is welcome, however, and we also hear that there are moves to improve electronic requesting and referrals for diagnostic imaging. This project has been kept very hush hush for some unknown reason but came to light recently with the release of a new radiology referral set that is aimed at enhancing interoperability and data accuracy between referrers and radiology providers.

One of the more obscure items in the 2021-22 federal budget was the $37 million pledged to modernise diagnostic imaging in Australia. Most of this was a slush fund to help radiology practices in rural areas to buy new equipment, but there was also a bit of cash to “fund development of a streamlined electronic referral solution, which will assist in the determination of the need for diagnostic imaging”. There was also a small sum to “make enhancements to the diagnostic imaging register location specific practice number to improve data integrity and granularity”. No, we don’t know what this means either.

We did read this budget item at the time and thought it was just another attempt by the beancounters to rein in MRI referrals, but it turns out to have a much grander purpose, under the Modernisation of Diagnostic Imaging (MoDI) project. Apparently, this has been running since October 2021 and aims to enable digital requests, referrals and results for diagnostic imaging. It brought together practice management, medical record and radiology information system vendors to take a look at how an electronic requesting workflow would work, with a connectathon held early last month. We admit that we here at Pulse+IT are generally pretty slow on the uptake but even we haven’t heard a word about this in the eight months it has apparently been going.

We have instead received lots of pretty useless PR from the Australian Digital Health Agency, none of which is of any use to anyone, but something as crucial and interesting as this? Not a squeak. It might be because it seems this project is being run out of the Department of Health and Aged Care rather than ADHA. Former ADHA medicines safety guru Andrew Matthews, who ran the ePrescribing program, is now listed as the engagement lead in the digital delivery section at DoHAC … running the Modernisation of Diagnostic Imaging program.

We hope it succeeds, but we are also aware of the decade of toil that the Royal College of Pathologists of Australasia (RCPA) and its pathology informatics community put in to the PUTS and PITUS projects. Pathology is admittedly incredibly complex, but a lot more effort could have gone in to supporting the enormous amount of work the RCPA dedicated to it. Progress there has been made in terms of standardisation of terminology, barcoding, use of healthcare identifiers and electronic systems, but it is still the case that at the point of care, the collector still handwrites names and requests on a sticker in pen. It’s a wonder things don’t go wrong more often.

That being said, actual progress has been made in ePrescribing, eReferrals and now eRequesting. This is good but bloody hell has it taken its time.

That brings us to our poll question for the week.

Will improvements in eReferrals have a measurable impact on GP workflow?

If yes, how? If not, why not?

Vote here or comment below.

Comments  

0 # Kate McDonald 2022-07-15 16:04
Will improvements in eReferrals have a measurable impact on GP workflow? Three quarters of you said yes, but 25 per cent said no. Here’s what else you said:

- it should be it will be a disaster

- Referrals wont be lost in the system, new technology will recieve better outcomes for the patients.

- If the solution has a simple address finder in GP software. Otherwise, it will be a further time waster.

- They will make referring and the handling of referrals easier, higher quality and more efficient

- Why would GP workflow change?

- History is a good predictor of the future, at least in Digital Health. Glacial is a word that come to mind.

- it has to be a complete end to end solution to have an effect on workflow - in GP software to gateway to end systems and integrated into those end systems - but this is very hard. will it happen? hope so, but it will not be easy.

- Mandatory info resulting in much improved referral quality with pre-work up being done at the GP community level instead of in the most expensive tertiary sectors.

- And reduction in rubbish referrals that should stay at the GP/community for management

- Doesn’t really alter the amount of work a GP needs to do. Benefits are really accrued by the patient, which is how it should be.

- eReferrals that are PMS integrated/init iated, should all be occurring from within the GP's patient record, and store a submitted copy there too.
- Using secure messaging standards, successfully submitted eReferrals will also be acknowledged by recipients, upholding information integrity for patients.

- Replacing paper and faxes with digital information that can be stored and more easily shared and found will improve quality of care. The question you should have asked is why there is not a national approach to e-Referrals rather than a state by state approach. We need to avoid rail gauge problems with our digital health systems.

- Less requests from patients for reprints of lost scripts.

- It is likely to have an impact. Unfortunately it is just as likely that the impact is negative as positive, depending on how its done.

- End to end routing and triaging. Look at the ERMS system used in the southern region across the ditch to see what productivity gains can be made

- “It depends”. It depends on whether the referrals forms become more complex and time consuming to complete than ‘paper’ referrals, whether the directory helps get referrals to the right place first time, and whether the eReferrals systems provide active feedback to the GP as to the progress through the provider’s organisational processes. There are many lessons to be learned about getting the balance right regarding minimum data required from GPs, effective decision support vs. complex rules that obstruct and ensuring referrals are clinically actionable by the receiving provider. Just turning the same paper / fax form into an eReferral doesn’t offer the GP much of a benefit, and in face could have dis-benefits.

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