Design and development of Referrals Automation, a SMART on FHIR solution to improve patient access to specialty care

Abstract

Background Referring patients to specialty care is an inefficient and error-prone process. Gaps in the referral process lead to delays in patients’ access to care, negative patient experience, worse health outcomes, and increased operational costs. While implementation of standards-based electronic referral options can alleviate some of these inefficiencies, many referrals to tertiary and quaternary care centers continue to be sent via fax. Objective We describe the design process and architecture for a software application that has been developed and deployed to optimize the referrals intake process by automating the processing and digitization of incoming specialty referral faxes, extracting key data elements and integrating them into the electronic health record (EHR), and organizing referrals. Methods A human-centered design approach was used to identify and describe the inefficiencies in the external referral process at our large, urban tertiary care center. Referrals Automation, an application to convert referral faxes to digital referrals in the EHR, was conceptualized based on key stakeholder interviews and time and motion studies. This application was designed using Substitutable Medical Applications and Reusable Technologies (SMART) and Fast Healthcare Interoperability Resource (FHIR) platforms to allow for adaptability into other healthcare organizations. Results Referrals Automation software was developed as a healthcare information technology solution to streamline the fax to referral process. The application was implemented into several specialty clinics. Metrics were built-in to the applications to evaluate and guide the further iteration of these features. Conclusions Referrals Automation will enhance the referrals process by further streamlining and organizing the patient referral process.

Standardizing Primary Health Care Referral Data Sets in Nigeria: Practitioners' Survey, Form Reviews, and Profiling of Fast Healthcare Interoperability Resources (FHIR)

“…We reviewed paper referral forms and surveyed frontline health workers, drawing inspiration from similar work conducted by Odisho et al [24]. We checked how consistent the referral data sets were.…”

“…Health authorities in many LMIC countries will benefit from standardizing and exposing its required referral data model for Women and Child Health, which encompasses MNCH [24]. Publishing a public FHIR specification that can be leveraged by MNCH solution implementers will help simplify interface implementations.…”

Change Management and Digital Innovations in Hospitals of Five European Countries

“…Opportunity Threat mHealth Wide user basis of mobile phone users [49,50] Rapid growth in the number of applications supporting self-management [51][52][53] Applicable to a wide scope of diagnoses [47,53] Increased patient engagement during treatment [47,[52][53][54][55] Ethical and legal aspects [53,[56][57][58]] Limited evidence of outcomes and benefits (insufficient randomised controlled trials) [47,52,56,59,60] Low interoperability and integration with existing work procedures [56] Uncertainty concerning data reliability [47,56] Declining patient self-discipline over time [52] Absence of personal contact with physician [55] Non-certified applications, large number of applications [ [36,64] Reduction of cost related to poor documentation [64,65,69] Violation of the interoperability condition [53,63,70,71] Problem with aligning operating standards with the current information exchange protocols for Big Data [72] Regulatory restraints [72][73][74] The risk of possible re-identification [74] Financial sustainability [75] Digital biomarkers Wide user base…”

Designing a Model for Evaluating the Performance of Electronic Patient Referral System in the Healthcare System of Iran

“…In the healthcare system, the volume of referrals from primary care physicians to specialized care professionals has steadily increased worldwide (2). Gaps in the referral process have led to interruptions in patients' access to care, negative patient experience, worse health outcomes, and increased operation costs (3). What is observed in paper-based referrals is a delayed referral and booking due to incomplete or missing information of patients or clinical laboratories (4,5).…”