1

Closed Loop Referral CommunicationsSession 223, March 8, 2018, 11:30 AM

Kristen Wohlford, Regional Director Practice Operations, Mission Health

Bridget Schmidt, Ambulatory Nursing Informatics, Mission Health

2

Kristen Wohlford, MHABridget Schmidt, B.S., R.N.

Have no real or apparent conflicts of interest to report

Conflict of Interest

3

Agenda• Mission Health overview

• Referral Management Project overview

• DMAIC Approach

• Project Vision

• Prior State of Referral Management

• Initial Analysis

• “Ideal” Future State

• Implementation

– New Tools

– End User Communication

• Project Wins

• Future Optimization

4

Learning Objectives• Identify what triggered the initiation of the referral management

project

• Describe 3 challenges faced by referral coordinators with the previous workflow

• Assess 3 ways the new process has remediated the challenges identified with prior current state

• Define Closing the Loop as it pertains to the referral management workflow

• Identify the vision for future state reporting

5

6

Mission Health System – EMR History

Cerner PowerChart Client since 2002

5 Hospitals live on full Cerner suite

Cerner PowerChart Ambulatory (PCA) Client since 2014

95 Practices live on PowerChart Ambulatory

7 Waves of Implementation

Primary Care, Internal Medicine, OB/Women’s, Pediatrics/Genetics, Surgery/Orthopedics, Neurology, Vascular/Interventional Radiology/Vein, Infectious Disease, Weight Management, Oncology, Employee Health, MyCareNow/Urgent Care, Cardiology

7

Mission Health System – Ambulatory Providers

County Provider Type Total

Physician AP

Macon 33 19 52

Mitchell 13 9 22

Yancey 4 2 6

Jackson 5 7 12

Burke 1 1 2

McDowell 22 26 48

Buncombe 249 183 432

Transylvania 22 4 26

Graham 4 3 7

Haywood 5 2 7

Grand Total 358 256 614

8

Mission Health Systems

Closed Loop Referral Process

9

Overview of Referral Management Project

Why?

• Pattern of Patient Safety Event logged related to a Referral

• RL logged related to delay in referrals

– RL is a patient risk management software tool

• Minimal, inconsistent tracking workflow and tool

• No transparency into referral management

• Staff and providers frustrated with process

10

DMAIC Approach

• Define

• Measure

• Analyze

• Improve

• Control

11

Referral Management Project Vision

The project purpose, in accordance with Mission Health System’s BIG(GER) AIM of Patient Quality/Safety, is to:

• Improve the efficiency and effectiveness of the patient referral process

• Standardize the referral workflow process across practices

• Insure patients receive necessary services and referring providers receive pertinent patient information

• Monitor Key Process Indicators related to referrals

12

Prior State of Referral Management

Analysis showed 41 steps from order placement to closing the loop

47 call outs of re-work, inefficiencies, problems, no standard process

13

Prior State Workflow

14

Prior State Workflow Continued

15

Prior State Workflow Continued

16

Prior State Workflow Continued

17

Initial Analysis- Waste and breakdowns in

communication between practices

- Duplicate documentation in multiple

systems

- Unknown volume, patterns and

performance associated with referrals

- Inconsistent processes across

practices

- Training gaps

18

“Ideal” Future State

• Tracking Tool – sortable to support monitoring

• Discrete data

• Reportable

• Utilize shared chart

• Set standards around processing Referrals

19

ImplementationSprints

– EMR Alert Notifications

– Retrospective Referral Clean Up

– Update and modify encounter selection window in PCA

20

New Referral Management ToolsInnovative use of current Cerner Tools

New Referral Orders build with Order Entry Format (OEF) updates

New Custom Referral Management MPage

Custom Rules for automation – closing the loop

Reporting

New Custom Referral PowerForm

Playbook for standard workflow

Direct Message

Provider letter

SOP for referral management

21

New Referral Management Tools –New Order Entry Format for Consult

Requests

Previous Order details: New Order Details:

22

Referral Management Tools –Consult PowerForm

Previous form for consults:

23

Referral Management Tools – New Consult PowerForm

New Referral PowerForm – shared

by ordering (sending) and consulting

(receiving) offices, when both are on

PCA

Each of the 3 parts will be discussed

on the next slides

24

Referral Management Tools – New Consult PowerForm

25

Referral Management Tools – New Consult PowerForm

26

Referral Management Tools – New Consult PowerForm

27

Referral Management Tools –Ambulatory Referral Worklist

New worklist – viewable to ordering and consulting offices (both on PCA); Updates are real-time

28

Referral Management Project –End User Communication

Training Plan

Roadshows

Super User Communications

Newsletter Blasts

Operations Meeting Communication

Command Center

29

Referral Management Project Wins

New referral workflow

Summary page allows Referral

Coordinators to manage and

track their referrals within the

EMR and is viewable in real-time

by consulting clinics on PCA

Reduced process from 41

Steps to less than 15 steps

Immediate increase in

Referral Coordinator

job satisfaction

30

Referral Management Project Wins

Automation to eliminate the repetitive manual

work required to close the referral loop for practices

Over the first 4 weeks after implementation, an

Average of 153 referrals were SYSTEM closed

per week. With an estimated savings of 9 min/

Referral with the new process, that equates to

23 human hours saved each week.

31

Referral Management Future Optimization

• “Vision” for future state Reporting – Mission Clinic Vital Signs (MCVS)

– Volume of referrals

– Internal and External Referral Patterns and Needs, Throughput

– Key Process Indicators

• Time from Ordered to Sent

• Time from Ordered to Scheduled

• Time from Ordered to Completed

32

Project Recognition

33

Questions?

• Kristen.Wohlford@msj.org

• Bridget.Schmidt@msj.org