Pediatric Informatics: Computer Applications in Child Health (Health ...

15 Pediatric Care Coordination: The Business Case for a Medical Home 215
RHIOs, however, and the movement to increase information availability through
this venue appears to be gaining momentum.
15.6 Case Study: Automating Referrals and Reports
Using the same five provider practice from the business case, let’s assume that the
practice has automated its medical record system. Each practitioner has a personal
login, password, and specific “work areas” in the electronic record, as do all of the
staff members. Access to laboratory tests and reports has improved greatly, usually
requiring only a few mouse clicks to retrieve a wealth of patient information. For
their CYSHCN, special reports are available that trend data, such as anticonvulsant
drug levels, with prompts activating when levels are outside normal ranges for the
reference lab. The providers have come to realize, however, that many of the physicians
who comanage these children have significant information regarding care
pathways and interventions, but relaying information from the subspecialists to the
practice’s EHR is tedious and error-prone. They create a process map (Fig. 15.1)
that outlines the current process of referral and management of incoming reports.
From the process diagram, the practice manager determined that a number of steps
that required manual intervention in the system could be eliminated. For example,
at node 1, two steps were needed to create a referral request and select a subspecialist
based on the patient’s need and payment profile. The EHR has the ability to
match specialists with specific insurance plans, making these steps redundant. At
nodes 2 and 3 in Fig. 15.1, the traditional method of making referrals and sending
records to the subspecialist added additional costly manual steps, often requiring a
nurse to effect the referral and ensure proper portions of the record are transferred.
With the shortage and expense of nurses, these process steps are particularly problematic.
Finally, at node 4, the paper document returned from the subspecialist is
scanned and associated with the patient’s record so that it is available to the practice’s
providers.
Using a lean process review, the staff identified several steps that could be eliminated
or modified. First, the group determined which subspecialists received most
of the practice’s referrals. These physicians were invited to be “Practice Partners,”
which allowed secure connections to the EHR system and access to specific patient
records. Practice Partners had to agree to a few process changes, however:
Willingness to accept appointment requests by email or instant messaging, with
a priority response within 5 min
Willingness to submit reports electronically by uploading the report into the
patient record on the practice’s EHR
Ability to function as a HIPAA compliant business associate
Maintenance of at least one workstation compatible with current VPN and telecommunication
standards
Practice Partners then receive “preferred” referrals from the practice, which should
be financially beneficial.