Use of Electronic Referral System to Improve the Outpatient Primary Care-Specialty Care Interface

This project conducted an evaluation of the implementation of the eReferral system developed by the University of California San Francisco (UCSF) and San Francisco General Hospital (SFGH). With eReferral, specialists review requests in order to clarify them, recommend additional evaluation prior to referral, and triage appointment requests. This process helps to prevent inappropriate and premature referrals, ensures that appropriate diagnostic testing has been completed prior to patients being seen by specialists, and ensures that patients are referred to appropriate services.

The main objectives of the project were to:

• Compare changes among specialty clinics on indicators of the quality, efficiency, accessibility, and patient-centeredness of outpatient specialty care before and after use of eReferral.
• Assess distinctive eReferral implementation practices among specialty and primary care sites and explore how these practices might influence the system's success or failure in achieving business and health care goals.
• Estimate the net costs (versus savings) of implementing eReferral for specialty and primary care sites and document the business case for the system's adoption and use

Both specialty and referring physician users reported that eReferral improved communication between one another and increased access to specialty care. Specialists reported a significant improvement in their ability to identify the question posed by referrals received, and the degree to which referrals were appropriate. Users felt that any increases in the time needed for the eReferral process were outweighed by improved patient care.

Seven of the eight medical specialty clinics noted substantial decreases in wait times for routine new-patient appointments. There was an increase in appointment availability as referrals were postponed so that additional workup could be completed by the referring provider, and other appointments were deemed unnecessary once PCPs were given advice via the eReferral system. The system also enabled acceleration of more-urgent care, indicated by an estimated 37 percent increase in expedited referrals.

A major factor in the system's acceptance was the perception that the system substantially improved access to specialty care, quality of care, and administrative efficiency in submitting and managing referral requests. The use of specialist reviewer was considered a major benefit by specialists themselves and was seen positively by referring providers as well.