Boston Medical Center Community Health Information Exchange
A private, not-for-profit, 626-bed, academic medical center, Boston Medical Center (BMC) serves as the primary teaching affiliate for Boston University School of Medicine. The largest safety net hospital and 24-hour Level I trauma center in New England, BMC handles close to 30,000 inpatient discharges annually.
BMC Tackles Referral Management Gaps
BMC was eager to replace its cumbersome, confusing and inefficient manual referral process. Among its limitations: lackluster tracking of referrals and outcomes, limited standardization, extensive paper-based rework by staff, inadequate information for specialists and lack of specialty feedback to referring providers.
For patients, the referral process was long and cumbersome. Having won a 12-month federal grant for innovative technology development and implementation from the Health Resources and Services Administration's (HRSA) High Impact HIT Innovations Grant Program, BMC assessed multiple vendors based on HIE experience, vision, innovation, focus and track record. BMC chose to partner with Carefx based on its alignment with BMC's six core principles, its passion for innovation, its agility and dedication to fusing health IT's current realities with "what needs to be", according to Joel L. Vengco, BMC's executive director of clinical systems and technology.
Carefx implements eReferral on BMC’s CIE framework
A key component of the CIE and the one patient one record vision was the development of a referring physician dashboard to address BMC's cumbersome and inefficient specialty referral process that that often left specialists with inadequate patient information, referring providers with little or no feedback, referral coordinators with a very complex process, and all parties with insufficient referral tracking and issue mitigation.
Working with BMC, Carefx implemented eReferral on BMC's CIE framework within just eight months.
eReferral includes:
- Referral lists and tracking
- EMR integration
- Provider dictionaries
- Insurance, instruction and clinical data
- Accelerated appointment scheduling
- Patient-friendly summaries
- Reporting
BMC's newly re-engineered referral process is defined using the three "R's" - REFER, REPORT, RESPOND:
The patient visits a primary care physician (PCP) at a CHC and receives a specialist referral. The EMR sends a clinical summary and order to the CIE.
- The referral coordinator uses the eReferral portal to initiate and manage the referral process.
- The specialist coordinator (SC) receives a referral, communicates with the referral coordinator and receives additional information from the CIE.
- The patient sees a specialist who writes a note into the system, which the EMR submits to the CIE.
- Visit completion is flagged in the eReferral Portal while the Referring Clinic accesses a referral report from the portal and additional data from the CIE.
By implementing eReferral, BMC is able to offer its 1,500 clinicians composite views of relevant patient information housed in varied systems and applications across the community. Clinicians and referral coordinators can find specialists, book appointments online, transmit clinical data and track referrals from beginning to end. Among eReferral's key results:
- Facilitation of clinical information exchange through tracking of referrals from initiation through completion
- Streamlined referral coordinator and clinician workflows
- Improved alignment with community health centers
- Centralized referral coordination
- Enhanced communication between PCPs and specialists
"BMC's electronic referral management system integrates with physicians' current workflow and optimizes the effectiveness of referral coordinators," said Rich Kalish, M.D., medical director of Boston HealthNet. "By sending referrals via an electronic format, BMC ensures that clinicians will receive timely feedback and relevant information on referral outcomes."
"Our CIE, along with our partnership with Carefx, has successfully addressed the challenge of poor information exchange between care providers and ensured an optimal patient experience."
Key to the Carefx implementation of eReferral was its interoperability. Without eReferral's ability to interoperate with multiple information systems, BMC would not have been able to implement or see tangible results in such a short period of time.
eReferral Generates A Quantifiable ROI
- Referral coordination: Working with Carefx, BMC has transformed its referral process, making it more standardized, complete, trackable and efficient.
- Information availability: BMC specialists now have adequate information needed to work up patients, while referring physicians have the information to continue care delivery.
- Patient care: Patients benefit from improved patient tracking and care coordination
- Scheduled referrals: The rate of scheduled referrals jumped from 30 percent before eReferral to 60 percent with eReferral.
- Time to referral appointments: The time-to-referral appointments decreased from a maximum of 69 days, pre eReferral (June 2009), to 3.5 - 7.8 days, post eReferral (Nov. 2009).
- No show rates: No show rates declined from 30 percent, pre eReferral, to 4.5 percent to 8.4 percent post eReferral.
eReferral has generated an impressive projected ROI for BMC. Using grant funding of $543,535 and in kind personnel worth $90,905, BMC made an eReferral investment totaling $769,520. However, financial benefits totaled $7,384,482 for an incredible ROI of 553.09 percent. The total includes $6,476,022 generated through increased referral follow-through and $908,460 in reduced operating costs, as well as non-ROI benefits such as expedited operations, faster scheduling, enhanced quality and safety and improved participant satisfaction.