News: Effective Resource Matching and eReferral – More than just email from primary care physician and specialist.

Electronic information connectivity within a patient’s circle of care is a fundamental driver for clinicians adopting information technology in health care today. Exchanging information for referral purposes is recognized as one of the most important processes in the relationship among health care providers. The challenge is that optimally programming for today’s care transitions in a health economy is incredibly complex. Expanded patient need, expectation, a complex array of patient resources with specific admission criteria, and a rapidly aging population with multiple chronic diseases makes program design and care coordination extremely challenging. A simple email between a primary care physician and a known specialist or post-acute provider is no longer enough. To be effective, today’s eReferral must deliver:

Standardized workflow process; Intelligent health record filtering; Patient prioritization; Health system prioritization; Real-time patient to service provider matching; Real-time patient to resource matching (vacancy matching); Accurate and timely access to services ; Live patient-facing interaction; and Real-time dynamic business intelligence.

Some may say that it is enough for eReferral functionality to simply attach a patient’s encounter summary to a secure ‘point to point’ email between, for example, a Primary Care Physician and specific known specialist, acute discharge coordinator and rehab admission coordinator, or physician and community program. Others say that once an HIE is in place, an eReferral solution becomes obsolete since all clinicians can access all patient information to make transition of care decisions. That may be the case; however other important questions need to be asked:

What specific health information or minimum data set does the post-acute care or community mental health agency really need to determine whether care can be provided? Does the specialist known to the PCP truly offer the expertise needed, the fastest, access time to a consult; and will the appropriate tests/prep be completed prior to consult? Does the known rehab centre offer the best geriatric program and outpatient services to meet the patient’s clinical need in that patient’s home community? Is the physician aware of all community-based Mental Health and Addiction options, their admission criteria, and availability in designing the community care plan referrals? Which long-term care or rehabilitation facilities have an empty bed, right now, that meets the patient’s need and preference? Which clinically-appropriate care provider options are available within the patient’s health plan and provider network?

Simply providing access to health information or even secure point-to-point messaging across the care continuum does not allow clinicians to answer these critical questions. Rather, answers to these questions can only be provided by highly intuitive, truly intelligent Resource Matching and eReferral solutions that are integrated with the patient flow process. This presents a new opportunity for health systems to not only access health information, but to action health information in order to ensure the right information is used to transition patients to the right care at the right time.