Navigation & Single eReferral System

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Strata Health’s Navigation and Single eReferral system, Strata PathWays, is a source of truth for all transitions of care. Our platform acts as a hub, bringing together patient referrals from the NHS e-RS, primary, secondary, tertiary, social care, and 3rd sector / social prescribing systems into a single best-practice workflow that runs parallel to the shared care record, allowing clinicians to streamline and automate transitions of care workflows and source and deliver care plans without having to chase service providers.

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Example Scenario

A newly formed Integrated Care System (ICS) has determined that across the patch of approximately 1.8 million patients, six previous Clinical Commissioning Groups (CCG), and five local authorities, there are 17 best-practice patient record systems. Some systems talk to each other, but information to mobilize patients for care transitions is siloed, inefficient, and administratively laborious.

There also exists a Specialist Cardiac Hospital that services the entire ICS and national referrals for complex interventions to which these patients must be repatriated back to their homes across the UK.

The Strata PathWays Navigation and eReferral system has just gone live. A single point of access ‘transfer of care’ hub sees ALL inbound referrals with an agreed minimum data set (MDS) assessment criteria. These referrals are 100% complete and accurate because the format and content have been pre-agreed by all stakeholders. If any data is updated, it will be flagged and highlighted in real-time. Through roles and permissions, our software can engage the right clinicians, including full multidisciplinary teams (MTDs), to make the best decisions to deliver care.

Each referral is time-stamped as it is received, and each subsequent decision point/task is logged as the status of the referral advances towards assigning and completing the best-fit required package of care. Each acting resource (ward, GP surgery, or other) holds this real-time status on a dashboard for each patient. Benchmark goals can be set to monitor action taken by ‘X’ many days to ensure patients are seen in an optimal timeframe and no one slips through the cracks.

Resource capacity and wait times from Strata PathWays are presented for clinical consideration when securing the final package of care.

Results

Case Management at work

This single source of truth for finding and mobilizing patients into appropriate care transitions enhances overall system-wide patient flow, resulting in better care outcomes, more efficient use of resources, and streamlined workflows that reduce the administrative burden on front-line care workers.

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How To Get Started