Lowell Community Health Center (LCHC) serves the greater Lowell communities by offering comprehensive primary healthcare as well as dental, eye care, and specialty services. It aims to provide culturally-competent health services regardless of a patient’s financial status in order to reduce health disparities and empower each individual to maximize their overall well-being.
Background
When a patient needs specialty care outside the scope of services provided by LCHC, the patient’s clinician sends a referral request with relevant notes to a specialist at an affiliated clinical organization. Depending on the urgency of the required care, either LCHC or the specialty organization then calls the patient to schedule an appointment. Once the patient is seen by the specialist, their consult notes are sent back to LCHC to close the referral loop.
Challenge
In the past, referrals and consult notes would be sent between LCHC and its clinical partners via paper fax and phone calls. This manual process resulted in significant delays between the start of the process and the close of the referral loop, as well as a months-long backlog of paperwork that needed to be scanned into LCHC’s EHR system and added to each patient’s electronic health record.
Solution
To resolve the extra work and delays, LCHC leveraged its eClinicalWorks (eCW) EHR system to send referrals via P2P, eCW’s secure provider-to-provider communication network. P2P is integrated with the Mass HIway, so by using P2P, LCHC can send referrals to any HIway-connected organization. Now, when a patient needs to see a specialist, the clinician sends the referral and appointment request via P2P Direct Messaging to the relevant organization.
Once the patient has been seen, the specialist sends their clinical notes back to LCHC via Direct Messaging directly into LCHC’s eCW EHR.
For trading partners that don’t use Direct Messaging, LCHC established electronic faxing using eCW’s fax capability. This allows LCHC to send referrals directly from the eCW EHR and to receive faxes from trading partners electronically. While this is not as efficient as Direct Messaging, this alternative still speeds up the process and all faxes are visible within the eCW EHR.
Implementation
Once the new workflow was established, LCHC met with staff to walk them through the new process step-by-step to ensure each clinician and staff member understood what was required. By highlighting the steps that changed from the old workflow, they were able to ensure that everyone could understand and utilize the new workflow effectively.
“Direct messaging has given us the ability to create workflows that allow us to aim to minimize paper and eventually go paperless. It gives us a chance to build better relationships with our patients by providing easy and timely access to their information. Our staff are now able to spend more time on things that add more value than scanning hundreds of pieces of paper daily. It is more secure and reducing paper is good for the environment. It has given our providers easy access to the information they may need to give our patients the best care possible.”
- Venus Grigg, Manager of Health Information, Lowell Community Health Center
Concerns
It can be challenging to work with many organizations at once. When launching the project, LCHC faced varying levels of enthusiasm for the new workflow from their clinical partners. Some partners still required paper faxing. In other cases, with partners that used different HISPs, there were issues of incorrectly labeled messages or missing information. In such instances, accommodations were made to adapt to a hybrid process of electronic referrals and phone calls.
Support from the Mass HIway
The Mass HIway assists organizations in the effective deployment of HIE to enhance care coordination. The assistance is provided by HIway Account Managers. For LCHC’s project, a HIway Account Manager facilitated calls and correspondence with the trading partners, worked with eCW and trading partners’ EHR vendors to resolve technical issues, and documented feedback to keep the project on track.
Timeline
LCHC started working with a HIway Account Manager to explore potential solutions in February 2020. The project began with migrating their fax lines to the eCW EHR electronic fax capability, which was completed in March 2020. During the COVID-19 pandemic, the Direct Messaging part of the project was delayed due to staffing issues. LCHC hired temporary workers to help clear their backlog and the project was completed in April 2021.
Impact
LCHC’s targets for scheduling patient referrals is:
- Stat (emergency): within 24 hours
- Urgent (important but not debilitating): within three days
- Routine: within a week
Prior to the project, these targets were not always met. The paper faxing caused gaps in the process that could delay medical care as patients waited for referral appointments to be scheduled. At times, scheduling could take days to be completed. It could also be up to a month before specialists’ consult notes were added to the patient’s electronic record.
With the new workflow, LCHC was able to condense the gaps in its process and now consistently meets its referral targets. The improvement ensures that patients with stat or urgent needs can be seen by a specialist in a timely manner. Furthermore, once the specialist’s consult notes are received, these are added to the patient’s electronic record within 24 hours.
“At the end of the day, this is about our patients and how best we can support them navigate their way through the complex health care delivery system. Timely and secure access to key information is critical for patient care. Technology such as Direct Messaging provided us the opportunity to exchange information across organizational boundaries, reduce delays and bottlenecks in communication with the specialists while keeping the patient in the loop regarding their care, which is key. We are committed to leveraging the tools we have to optimize care coordination and experience for our patients.
- Padma Sastry, Director of Information Systems, Lowell Community Health Center
With the implementation of Direct Messaging and the assistance of additional staff, LCHC was able to work through their backlog of referrals. LCHC anticipates that future issues with delays in processing referrals is unlikely to happen again.
Moving Forward
Using the new workflow has become routine for staff. They automatically look for the clinical partner on the P2P log in order to utilize the Direct Messaging method of communication first.
LCHC hopes to apply the lessons learned from this project on additional projects with other trading partners and to leverage the experience gained in this project to enable a smooth implementation.