eReferrals by Accident

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Dr Dianne Davis
Northland District Health Board
www.northlanddhb.org.nz
(P14, 1/10/09, Sigma Room, 11.13)

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eReferrals by Accident

  1. 1. E-referrals by accident “right service – right time”
  2. 2. <ul><li>Fast, safe and reliable transmission </li></ul><ul><li>of </li></ul><ul><li>high quality clinical information </li></ul><ul><li>that </li></ul><ul><li>enhances the patient journey </li></ul>What is a good referral?
  3. 3. Key points <ul><li>An e-referral is not a good referral by default </li></ul><ul><li>Clinical content most important element of a referraln </li></ul>
  4. 4. Key points continued… <ul><li>Define current state of service </li></ul><ul><li>Team approach required and GPs must be part of that team </li></ul><ul><li>A deliberate and consistent co-design approach </li></ul>
  5. 5. The Colorectal project…
  6. 6. Why did we do it? <ul><li>Clinical problem </li></ul><ul><li>2007 Colonoscopy service at capacity </li></ul><ul><li>evidence based paper template developed </li></ul>
  7. 8. How did it come about? MOH call for submissions
  8. 9. How did we design them? <ul><li>Define service and current problems </li></ul><ul><li>GP design group </li></ul><ul><li>Face to face meeting </li></ul><ul><li>Paper form + Hutt form = draft form </li></ul><ul><li>E-mail communication to finalise design </li></ul>
  9. 10. How do we receive them?
  10. 11. Impact of e-transmission <ul><li>GP -> Central Bookings office </li></ul><ul><li>January: 4 days March: <1 day </li></ul><ul><li>( GP printing ) (e-transmission) </li></ul><ul><li>GP -> prioritisation </li></ul><ul><li>January: 9.8 days March: 4 days </li></ul><ul><li>Faster to get there </li></ul>
  11. 12. Pilot GPs feedback <ul><li>20% completed within 2 minutes </li></ul><ul><li>75% 3-5 minutes </li></ul><ul><li>Almost 90 %: a lot or somewhat faster </li></ul><ul><li>Improved confidence in content </li></ul><ul><li>Faster to generate </li></ul>
  12. 13. Impact of generation speed <ul><li>Positive impact on GP workload </li></ul><ul><li>80% of referrals done ”in-hours” </li></ul><ul><li>Positive impact on patient care </li></ul><ul><li>More referrals being done closer to time of decision to refer </li></ul>
  13. 14. Specialist feedback <ul><li>30% reduction in prioritisation time </li></ul><ul><li>Improved information presentation </li></ul><ul><li>Moving to Clinical nurse specialist taking over role </li></ul><ul><li>Improved confidence of prioritisation outcome </li></ul><ul><li>Faster but Better??? </li></ul>
  14. 15. Rate of up-take (number of referrals per month)
  15. 16. Rate of up-take:2 (percent received electronically)
  16. 17. Caution! <ul><li>Uptake = usability ≠ a good referral </li></ul><ul><li>Success = patient in the “right service at the right time” </li></ul>
  17. 18. lessons learnt <ul><li>Define the current service </li></ul><ul><li>“ reason for referral” most important section </li></ul><ul><li>GPs must be part of the design team </li></ul><ul><li>E-referrals should only a part of the much bigger referral improvement package </li></ul><ul><li>Introduce full platform from start </li></ul><ul><li>Balance between “tick boxes” and free text </li></ul><ul><li>Perfection not likely first up, need ability to alter once in use </li></ul>
  18. 19. Generic forms, how useful?
  19. 20. Warning <ul><li>E-referrals are the “first impression” of the hospital, get it wrong and while they may be used they may not be used well and could damage relationships beyond the referral interface </li></ul>
  20. 21. Acknowledgements <ul><li>Healthlink for travel grant to HINZ </li></ul><ul><li>Mr Mark Sanders – colorectal surgeon </li></ul><ul><li>Chris Budge – Information Services NDHB </li></ul><ul><li>Glenys Wynyard – Central Bookings NDHB </li></ul><ul><li>Participating Northland GPs </li></ul>

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