e-Referral Service in United States

Poor communication and coordination of care between primary care and specialty care providers leads to major inefficiencies in health care delivery. In resource-constrained settings, these inefficiencies exacerbate mismatches between the supply and demand for specialist services.

The University of California San Francisco (UCSF) at San Francisco General Hospital (SFGH) developed a Web-based electronic and referral system (e-Referral) staffed by specialist reviewers that allowed clarification of the consultative question, requests for additional evaluation, and triaging of appointment requests.

The dysfunctional interface between primary care and specialty care in the United States often leads to suboptimal patient outcomes and to major inefficiencies in the delivery of health care. These inefficiencies lead to unnecessary demand on specialist services. This makes access to specialty services more challenging, particularly in resource-constrained settings, where specialists are in especially short supply.

Information systems could potentially improve communication between primary care and specialist physicians by enforcing critical communications and by automating referral work processes. However, there is little literature reporting on such systems.

To act on the potential for information systems to improve referral processes, University of California San Francisco (UCSF)—San Francisco General Hospital (SFGH), San Francisco’s main safety net provider of specialty care, has created a secure, Web-based electronic referral system “e-Referral” for submitting electronic referral requests to specialty clinics.

Rather than submitting referral requests by fax or telephone, the referring provider completes an Internet-based form with the patient’s relevant history and the referring provider’s consult question. All relevant patient and provider information for each referral is automatically extracted from the electronic health record (EHR) at SFGH, the Siemens Lifetime Care Record (LCR), and is linked to the electronic referral request for subsequent review by a specialty clinician.

Each specialty care practice designates a primary reviewer who triages each referral request and can communicate with the referring provider via the e-Referral application.

By channeling all incoming referrals for clinical review and creating a mechanism for iterative primary care–specialty communication, e-Referral is designed to eliminate inappropriate referrals, reduce premature referrals by ensuring proper and complete primary care workup prior to the patient’s appointment in specialty care, clarify the consultative request, and identify and expedite urgent cases.  Initial implementation of this system for five specialty clinics at SFGH has shown promising early results, for improving specialty access and the timely delivery of critical services.

This initial success suggests that the system is ready to be extended for wider use within SFGH and affiliated safety net provider organizations and that the lessons learned from this wider use could help other provider organizations to reduce waste and improve patient care.