Thought progression on eHealth concepts and specifically eReferrals.
I have been a bit about eHealth, which is an area ripe for major growth. I started putting together a slide-pack overview of the concepts involved but I don't think this one fits at the same level - hence here. This post is likely to be little disconnected as I am working it out as I go along.
First question: What is a Referral? (In the health sense) What is the purpose and how is it used? With no direct insight into the industry I need to start at the highest level.
As I understand it, a referral basically represents the hand-over of patient care from one health practitioner to another - at the simplest level. As part of this handover, obviously there are details that need to be communicated. In the traditional method, the referer gives the patient a message to pass, along with themselves, to the receiver (referee?, or is the patient the referee?), often with limited associated details. The assumption that the receiver would contact the sender separately, or directly talk to the patient (the ball being hand-passed).
Doesn't sound like much of system when described like that, but it worked, at least enough, for many decades.
With electronic health records, the patient's full details can be communicated, and any notes or preliminary diagnosis etc., easily - as long as both sides have access to the data - and, presumably this would reduce mis-communication or lost patients.
Pros would include the ability for both doctors and patients to select the best local provider, for many definitions of "best" (most available, highest quality, cheapest etc.) rather than simply going with the usual suspects. Practitioners, or clinics or hospitals, which receive referrals would be able to place specialties, calendars, price-lists, wait times etc, where they can be seen during selection.
The ability for advertising and market forces to enter into this process may be positive or negative. The concept is somewhat unsavory when talking about the health industry - it exists but people often don't like to think about it.
As with most automation there is some loss of flexibility, for instance, if the patient decides not to follow-up themselves. Also with a very manual system, there is built in error correction since people tend to catch and deal with process failures without even noticing that that is what they are doing. That can get lost with automation as people start to depend on the machines. Note: this is true of any automation and is NOT a reason to not do it, it is simply a factor that needs to be allowed for (I keep intending to write about MyKi - which I think fails on exactly this point).
All of which is somewhat off my original train of thought - as usual.
The point is that this entire process is very basic Case Management and there are dozens of applications available off-the-shelf that can handle it. The major problem is simply ensuring both (all three if you consider the patient as well) have access to the same data - and that is the point of NEHTA and PCEHR. Referral is the transfer of ownership of a case (medical case in this case) from one practitioner to another. Ownership may be passed to an individual, a group (such as a hospital or facility) or a queue (such as a clinic for the first available receiver). This is slightly different to allocating an activity within the case to an external agency while retaining ownership. An example of the latter is requesting pathology or radiology tests. In that case, the referring doctor retains control while requesting services from the lab.
Another, similar analogy is Incident or Ticket Management. In that case the GP represents level 1 support. They perform triage and initial diagnosis, they can resolve most straightforward cases immediately while passing complex or specialist issues to level 2 support. Level 2 specialise in specific concerns and have greater resources, tools, skills or experience on the particular type of problem. Major or recurring problems may be passed to Level 3 which in this analogy would be hospital (acute care) or other facility (chronic care). To stretch a bit further, level 4 would be the biomedical research institutes who may publish papers on interesting case studies.
The point though is that, from my distant and inexperienced view, this is a solved problem. The high level processes and effective techniques are known. The devil in the details is how to set this whole system up for the medical profession which tends to be very conservative with its processes - and rightfully so given the stakes involved.
