Efficiency of eReferral use in Northern Ontario

Many patients requiring consultation often face unexpectedly long wait times from the time of their referral to the date of the consult.¹ A retrospective chart review exploring patient wait times to receive specialty care in Ontario in 2018, reported a long median wait time for many specialties, such as a median wait time of 98 days to receive an orthopedic consult.²

Digital health infrastructure equips clinicians with the necessary tools to support a streamlined workflow. It supports providers’ efforts to reduce wait times and improve outcomes for patients.³ The Ocean eReferral network (eReferral) is an electronic solution that has been actively deployed since 2018 across five subregions in Ontario (Waterloo Wellington, Erie St. Clair, South East, North East and Champlain) to support patient care. Growing adoption of eReferral has been demonstrated across the province with over 100,000 referrals; of which 10% are from the northern region.

Currently, eReferral supports the musculoskeletal referral (MSK) model across the five subregions in Ontario to help reduce wait time issues for orthopedic patients. eReferral facilitates a seamless flow of referrals from providers to central intake where orthopedic referrals are triaged and forwarded to rapid access clinics (RACs). At the RAC, orthopedic patients are assessed, managed by an advanced practice physiotherapist (APP) and prioritized for a surgical consult, if needed.³ eReferral also supports the deployment of other referral pathways in Ontario such as diagnostic imaging (DI), cardiology, mental health and assessment, ophthalmology, surgery and internal medicine.

The solution’s various features help improve efficiency and referral management.⁴ For example, the Ocean eReferral technology supports a legible and complete referral form. It facilitates faster and easier communication of patients’ referral information among providers through proper secure channels and enables the online acceptance of booked appointments. It also helps patients and providers track patients’ referrals and stay up-to-date with their progress.

North Eastern Ontario Medical Office (NEOMO), a unique primary care medical clinic in Sudbury, Ontario, which was recognized for its innovative work as Ontario’s ‘2017 Family Practice of the Year’,⁵ went live with eReferral on October 21, 2019. Using Ocean database, efficiency indicators (time to process referrals and wait time) for orthopedic eReferrals sent from the NEOMO clinic, between October 21 and December 15, 2019, were compared to orthopedic paper-based referral data from the same clinic two months prior to the eReferral go live (Aug 26—Oct 20, 2019).

Benefits

Overview of Current Referrals at Northern Ontario since Ocean eReferral Go-Live:

• In total, 9,257 (hip, knee, shoulder and low back pain) referrals were processed through central intake and directed to RACs and surgeons within the region
• 94% of eReferrals were received complete at central intake
• To date, 102 clinicians have adopted and sent referrals electronically through the Ocean eReferral network
• Eighty-three per cent (83%) of the clinicians have actively used the system and sent an eReferral in the past 90 days

At a glance—eReferrals from NEOMO Primary Care Medical Clinic (October 21–December 15, 2019):

• A total of 25 orthopedic eReferrals sent from NEOMO medical clinic were processed through Ocean. Of those, 96% were forwarded to a RAC for an assessment and 4% were sent directly to surgeon for a consult
• To date, 68% of patients had their appointment booked or completed at the RAC and only 46% of patients were considered a surgical candidate and referred to a specialist for a consult

The comparative findings of the efficiency indicators for electronic and paper-based referrals processed through the system illustrate a substantial time savings by using the Ocean eReferral network as shown in the table below.

About the SCA Program

The System Coordinated Access (SCA) Program was originally initiated to support the development and adoption of electronic referral in the Waterloo Wellington region. As a result of an investment by the Ontario Government, the program, in collaboration with the Think Research Consortium (Think Research, CognisantMD and Centre for Effective Practice), has now expanded to support the implementation of Ocean eReferrals to three of the five Ontario Health regions across the province ( West, East and North) .

eReferral replaces paper-based faxes with electronic referrals. Through a secure integration with electronic medical records (EMRs) referrals are sent, tracked and updated right from the patient’s electronic chart. The local SCA deployment teams provide training, solution set-up and support.

If you have questions or would like more information on this Benefits Realization (BR) case, please contact:

Heba Tallah Mohammed, BR Specialist, eCE
SCAProgram@ehealthCE.ca

This document is not to be reprinted without permission from the eHealth Centre of Excellence.

¹Thind A, Stewart M, Douglas M, et al. What Are Wait Times to See a Specialist? An Analysis of 26,942 Referrals in Southwestern Ontario. Healthcare policy. 2012; 8: 80-91.

²Liddy C, Nawar N, Moroz I, et al. Understanding Patient Referral Wait Times for Specialty Care in Ontario: A Retrospective Chart Audit. HealthCare Policy. 2018; 13 (3):59-69

³Aiken A , Harrison M , Hope J. Role of the advanced practice physiotherapist in decreasing surgical wait times. Healthcare Quarterly. 2009; 12(3): 80-83

⁴Ontario Health Team: Digital Health Playbook. 2019. Accessed from: http://health.gov.on.ca/en/pro/programs/connectedcare/oht/docs/dig_health_playbook_en.pdf.

⁵Neomo medical Centre. .https://www.neomo.ca/new-index-1