eReferral and patient communication in care transitions

Patient-centred care (PCC) is a priority for the Ontario Ministry of Health (MOH).¹ Communication between patients and providers is essential to sustain PCC.² In September 2019, the College of Physicians and Surgeons (CPSO) identified new guidelines that make improved communication between referring physicians, consulting physicians, and patients a priority.³ When these requirements are met, patients will have timely access to care and become more informed throughout their care transitions.³

Communication that flows smoothly between referrers, specialists, and patients is a key measure to these requirements for patient-centred care. Traditional paper-based referrals make communication difficult.⁴ Difficulties are often due to physician’s time constraints, illegible referrals, and missing information.⁵ Studies show that electronic solutions have the ability to enhance the referral process through automated communications.²

eReferral enables automated email notifications that inform patients of their referral location updates, appointment dates, and preparation instructions.

So far, Ocean eReferrals has been implemented through the System Coordinated Access (SCA) Program in six regions across Ontario. To gain insight into the patient experience within the eReferral program, 13 patient interviews were completed in October 2019.

The patients were invited to participate through the patient experience survey, which is attached to the patient notification received for a booked appointment. The phone interviews used semi-structured questions to explore patients’ experience with the email notifications.

Benefits

The interviews were completed with five male and eight female patients ranging in ages from 30 to 70 and above, all from within the Waterloo Wellington region. Overall, respondents appreciated the email notifications and acknowledged the benefits of communication during their transition of care. Patients seemed more informed of their care throughout the referral process.

Contrary to patients’ previous experiences with traditional referral methods, patients reported feeling more informed and engaged throughout their referral process.

A key benefit identified was that patients were able to track their referrals with the email notification and were updated on the progress.

 “It was really easy to see and follow…and there is a spot for comments, where they
explain the information because I needed to prepare for the appointment. So, it was nice to receive (the information) that way.”

 Patients also felt that communication of information was clear and effective. Having documented information in a format that they could easily reference, when
needed, seemed valuable.

 “I can actually keep it as a reminder. I can document it as a reminder for what’s coming up. I like the idea of that…I think that if you have it on an email then I can sit and read it… It’s not like someone phones you quickly and you have to answer all your questions right away. So, I like that idea that you could read it yourself.”

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 eReferral to five additional LHINs.

eReferral replaces paper-based faxes with electronic referrals. Using integrated electronic medical records, 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.

Contact

If you have questions or would like more information on this Benefits Realization (BR) case study, please contact:
Kayla Wierts, Analyst, eCE
Communications@ehealthCE.ca

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

¹Ministry of Health and Long-Term Care. Patients First: Action Plan for Health Care, Patients First: Action Plan for Health Care (2015). Retrieved from http://www.health.gov.on.ca/en/ms/ecfa/healthy_change/docs/rep_patientsfirst.pdf

²O’Malley, A. S., & Reschovsky, J. D. (2011). Referral and consultation communication between primary care and specialist physicians: finding common ground. Archives of internal medicine, 171(1), 56-65.

³College of Physicians and Surgeons of Ontario. Council approves Continuity of Care policies. (2019, September 20). Retrieved from https://www.cpso.on.ca/News/Key-Updates/Key-Updates/Continuity-of-Care-policies

⁴Epstein, R. M., Fiscella, K., Lesser, C. S., & Stange, K. C. (2010). Why the nation needs a policy push on patient-centered health care. Health affairs, 29(8), 1489-1495.

⁵Gandhi, T. K., Sittig, D. F., Franklin, M., Sussman, A. J., Fairchild, D. G., & Bates, D. W. (2000). Communication breakdown in the outpatient referral process. Journal of general internal medicine, 15(9), 626-631.