Electronic Referrals — A Progress Report

One of the gaps in provincial and national EMR strategies is the ability to move information seamlessly between different providers in the healthcare system. This includes primary care physicians and specialists and the myriad of additional care providers that are integral to high quality comprehensive care. With EMR adoption growing across the country, we are nearing a critical mass in some provinces — at which point it will become a requirement to be able to manage referrals and consultation reports electronically.

Physicians are primarily information exchangers. The transmission of referrals and the ability to electronically send a consultation report back to the referring provider should be a core foundational requirement of all EMRs. In a healthcare system that places the patient at the centre, no patient should be penalized because their doctor uses an EMR system that is unable to send or receive electronic referrals or consultations.

Canada Health Infoway provides a pre-implementation certification program for EMR systems that incorporates interoperability standards for labs, drugs, and clinical reports. Interoperability refers to the ability for information to be transmitted between systems in a standardized format that maintains the integrity of the message. This means that information sent from one system is presented accurately in the receiving system. According to the Infoway Certified Products list, six EMR systems have achieved certification. Three products are provincially certified and three have received national certification. All of these certifications expire in June or December 2013. There are a significantly greater number of EMR products available in Canada that are provincially certified under provincial EMR programs. Only one of the four BC provincially certified EMR systems (Med Access) has received Infoway certification. However, in order to be successful, two requirements must be met. All EMRs need to have equivalent certifications and those certifications must be well adopted in order for data to be effectively shared. BC, as well as other jurisdictions, has implemented provincial certifications for EMRs that include interoperability requirements.

A number of pilot projects to evaluate referral and consultation are underway in different Canadian jurisdictions; however, we need more active testing and implementation of EMR to EMR and provider to provider exchange of information. This is no simple undertaking, but it can be done. Denmark and New Zealand have been successful with their data interoperability programs. These are smaller countries than Canada both in terms of population and geography, but the lessons learned are equally applicable.

Electronic Referrals are a key starting point in the appropriate sharing of clinical information amongst care providers. But it is not enough to just enable this capability with the belief that the job is done. Until physicians have EMRs that are fully interoperable with other providers’ systems, they will be forced to function as hybrid practices managing some processes using paper and others electronically. This is inefficient, prone to error due to the need for duplicate processes and reduces the value proposition of an EMR, particularly to those clinicians who just want to manage their patients and are less interested in the technology.

There is a lot of work to be done. It is good that we are testing eReferral processes, but much more is needed.

To add your thoughts, click on the “Comments” link below.

Comments

[Glenn Lanteigne]

A very important topic, one that is gaining popularity amoung physicians in Ontario, and looking to leverage work done in the Champlain LHIN with their BASE project to leverage in South Western Ontario,
Glenn Lanteigne, CIO, South West LHIN

[Jeff Harries]

eReferrals have enabled EMR to EMR communication between and among Specialists, Family Physicians, Mid-Wives, and Aboriginal Health Clinics, here in the South Okanagan beginning over three years ago. And a beta-test for our Emergency Department to access a patient's community based EMR is ready to go live. This is not based on a single database, they are independent and separate clinics.

Using this technology has made wonderful improvements in care and continuity achievable. Near real-time collaboration and documentation, acquisition of extensive community based information on an otherwise unknown newly admitted patient, finding and transferring a patient to the care of a new physician, are just a few examples of the things that eReferral capabilities have made simple.

In my experience, eReferrals are one of the best aspects of being on an EMR. I look forward to when all EMR's can adopt this capability to send/receive structured and organized information. Currently, it works with a high degree of information granularity between Clinics using the same Vendor (MedAccess), I understand other Vendors are developing similar capabilities with PITO having released eReferral specs for interoperability within BC last spring.

Jeff Harries, Physician Lead, South Okanagan Similkameen CoP