1. PI- Referral Project Open Door Family Medical Center HCNNY Meeting November 20, 2015

2. Referrals Project Referrals
Improving care coordination between primary care and specialist clinicians is increasingly recognized as a high-priority area to focus on for improving patient care and safety.
Joint Commission
NCQA Patient Centered Medical Home Focus

3. CPCI Referral Process

4. CPCI Referral Process

5. Referrals Project Referrals
Nationwide, less than half of referrals result in a specialty consultation.
Specialists often perceive referrals from primary care clinicians as lacking necessary clinical information with which they can execute a meaningful consultation
Primary care clinicians frequently do not receive consultation reports back from Specialists

6. Referrals Project Referrals
Not following through on a necessary referral may negatively impact a patient’s health status
Miscommunication or under-communication among clinicians lead to concerns around polypharmacy, duplication of diagnostic tests, and waste of healthcare resources

7. Referrals Project Referrals
Work group: Debra Gerson, MD; Louise Petersen – practice administrator; Maryam Motabar – practice administrator; Mary Rose Puthiyamadam, MD; Bobbi Jackson – Medical Records – Clerk; patient advocates, nursing personnel
Baseline: ___referrals are completed (or are no longer needed) within 90 days; __% high-priority referrals are executed within 14 days

8. Referrals Project PI Project Goal Established
Goals: 60% of regular-priority referrals are completed or closed (no longer needed) within 90 days.
90% high-priority referrals are completed or closed (no longer needed) within 14 days

9. Referrals Project Referrals
Review referral making process and barriers, by interviewing clinician s, care team members, and patients.
Interview highly utilized specialists to understand their perception of referrals coming from Open Door, and consider incorporating their recommendations

10. Referral Baseline Data 2014

11. Project Efforts Define the type of Referral
Provider defines the referral type – routine, urgent, stat
Remove review of dental referrals.
Urgent or Stat referral is followed up by Nursing or Patient Advocate supporting provider.
Routine referrals were assigned to the Medical Record Clerks.
Medical Record Clerks Trained; Sorted referrals by name of provider and reached out to the individuals

12. Medical Record Work Eliminated the dental referrals
Found that 15% of the referrals were not assigned to a specific provider but a specialty – Medical Records would not follow up those
Providers and staff need retraining on making referrals.
Divided work amongst the Medical Record staff
Followed up with specialists that had at least 10 referrals or more per month.
Letter sent out.
Followed up with call

13. Medical Records Initial Work Flow

14. Learnings to Date
Many facilities ask for a release form from the patient before sending the report.
Very few of our ECW community specialists are using ECW P2P.
Several specialists have been supportive, and do the follow up to share no shows.
Reports are not attached to Referral but placed in Consult Notes; often there are reports without referrals since patient continues with specialist- i.e. pediatric neurologist, cardiologist, etc.

15. Referral Data 2015

16. Referral Data 2015 By Month

17. Referral Data 2015-Urgent/Stat

18. Results to Date – October 2015
Not many providers are defining their referral as urgent or stat.
The information learned by our medical record staff has assisted us in speaking directly with the hospitals or specialists to eliminate HIPAA form need.
Learning that specialists are not happy about large no show rate from Open Door.
RHIO exchange would help, but not there yet.

19. Referral Project
Any questions?