The document discusses eReferrals, which is a system for electronic referrals between general practitioners (GPs) and specialists. It provides an overview of how the system works, including that referrals are translated and stored in a referral management system database. Specialists can then view referrals and update status. The document also notes some challenges like document-centric records promoting data duplication and difficulties with hybrid systems. It advocates for simpler, open-source tools that are configurable by local user groups without needing developers.

1. eReferrals
It’s about communication
Lara Hopley
Specialist Anaesthetist,
Clinical adviser digital innovations
Waitematā District Health Board
Sarah Thirlwall
Director Strategic ICT
Transformation
Counties Manukau Health

2. Identify the
missing numbers

3. Identify the
missing numbers

5. Conflict of interest
I work with a multitude of software vendors
I don’t take pens, cookies or coffee
Or other bribes
I am the clinical champion for Information Systems within
my hospital

6. 1. Make people’s lives better through technology
2. Success is a lot of little things done well
3. Embed the virtuous cycles
4. Own the problem.
5. Live what you preach.
Our principles! “best care for
everyone”
everyone
matters
With
compassion
better, best,
brilliant
connected

7. Standing on the shoulders
The Magnificent Seven
Kim Bannister
Jim Kriechbaum
Helen Liley
Grant Ramsey
Tony Scott
David Grayson
Wilbur Farmilo
The long steering, Steering group
Gillian Cossey
Sarah Thirlwall
Sarah Tibby
Linda Wakeling
Ngaire Sharp
Martin Orr
Stuart Bloomfield
The foundation Northland eReferrals
dynamic wife and husband team
Dianne and Alan Davis
The cast is thousands, but their
contributions add up to be worth
millions!
Ad Blankenstein

10. eReferrals High Level Overview
DHBshA/OrionHealthLinkGP Practice
Translated
Referral
Database
GP PMS
RMSApplicationaccessviaAJPConnector
HealthLink Client
Submission
Gateway
Messaging
Server
(Rhapsody
5.4.1)
Application
Server
(RMS 2.0.0)
Forms
Library
Regional
eReferrals
Repository
WebServices
Status
Updates
HLK Messaging
System
PMS
Server
Forms
Director
E1
E2
E3
Ack
E4
Status
Updates
(HL7 2.4)
Reporting Data
E4
E8
E4
E5,6
PMS ack
E7

16. ALL referrals process run chart

17. Patient referrals process run chart

18. Time and type of message

19. Great work stories

20. Sharing and
Patient A
Patient B
Patient C
Patient D
Cross monitoring

21. An Anaesthetic perspective
Problem list
Decreased liver function
On two long term opioids
Possible heart rhythm issues
- in theatre
- on the wards at 3 am

22. Éclair database
= result repository
Referral
Management
System
Print/grade
healthLink GP
forms
eReferrals
FSA, FU request
Specialist Advice
Radiology
eReferrals
Ix - Radiology
GP
Patient
Management
System
DHB
Specific
Concerto
Radiologist
Report
DHB
Lab
LabPlus LTA
Laboratory Reports
eOrder/eRequest Module
link to Patient Visit Number
LaboratoryRadiology
Other DHB
Radiology
eBlood
NZ blood TF service
Workflow
board
Growth charts
eCardiology
Workflow &
grade
DHB specific Modality
Sign off
Push
Orders reception
HL 7 and
Phlebotomy
Print &
scan
Print &
scan

23. Named Clinician to review/Second opinion

24. Addendum

25. Web Portal - Go live October-ish

26. Internal Referrals

27. A few recurring problems
• Document-centric records promote data denormalization
• We’re struggling with hybrid systems, have few virtuous cycles
• We need to empower clinicians and make them feel valued
• We have not “taught our people to fish”
• We are thus held hostage by the vendors in New Zealand
• We are spending less, but we are doing less

28. A robust, long-term solution (10+ years)
1. Grow the clinicians we need: dual-trained in Medicine and eHealth;
2. Use the skills of mature clinicians who are not e-savvy.
3. Simpler tools based on simpler models: easily configurable at a local
“user group” level, without having to go cap in hand to the software
developer;
4. Open-source across the board;
5. Ownership by clinicians, as this will empower them.

29. Continuous Quality Improvement
1. Show and teach everyone good statistical
practice
2. Drive out fear by eliminating numerical goals
3. Maximise overall value through collaboration
4. Train everyone on the job
5. Facilitate pride in workmanship
6. Build this new way into processes of
continuous improvement
7. Do this forever...
Out of the Crisis. W Edwards Deming. ISBN-13: 978-0262541152

30. Questions

31. Mythbusters movie – herding cats

32. We need problem lists
• Centre all clinical practice on the problems
• Any concerned party can amend, augment and refute
problems
• Including and especially, the patient
• With wiki-like traceability
• And complete integration, without duplication

33. Complete integration
Every problem is clearly associated with:
• Primary evidence (‘history’, findings, tests)
• Current state (activity, severity, current therapy)
• Future plans (investigations, management, prognosis)

34. We can answer questions…
• “What are the problems?”
• “What is the current medication list?”
• “What’s this medicine for?”
• “How certain are we in this diagnosis?”
• “Why was this drug stopped?”
• “Should I recheck this test?” …

35. Documenting a living, virtuous cycle
Processes extend over time
Clinicians/carers interact with patients within “epochs”
Interventions produce results
Results provide evidence for the existence of problems
Aetiological hypotheses (Cause & effect) tie problems
together
Clinicians propose management solutions that engender
processes

36. Toll E. The Cost of Technology. JAMA 2012: 307(23) 2497
This is still difficult.

37. A first attempt at “the right thing”

39. “I think you’ll find it’s a little more
complex”