Island Health Care utilizes the Mass HIway to close the referral loop with Martha’s Vineyard Hospital and Cape Cod Healthcare

Island Health Care logo

Island Health Care is a community health center serving the population of Martha’s Vineyard. Its nurse practitioners, nurses, and psychiatrists collaborate to meet patient-centered goals and high performance standards to provide quality care.

Download PDF


For patients requiring specialist care, Island Health Care’s clinicians refer most patients to specialists at Martha’s Vineyard Hospital and Cape Cod Healthcare. Martha’s Vineyard Hospital is a critical access community hospital that strives to deliver quality health care, including specialty, acute, and ambulatory care. Cape Cod Healthcare, the leading provider of healthcare services on the Cape, is comprised of two acute care hospitals, homecare and hospice services, a skilled nursing and rehab facility, an assisted living facility, and multiple health programs.


Island Health Care building

In the past, the referrals department at Island Health Care printed referrals from the patient’s electronic chart and faxed referrals to specialists and then forwarded the faxed documents to Island’s medical records department to be scanned into the patient’s electronic chart. Once a specialist had seen a referred patient, their staff faxed the visit notes back to Island Health Care who then scanned the fax into the patient’s chart for review by a Nurse Practitioner (NP).

This workflow wasted paper and was time consuming, inefficient, and error prone as faxed documents were sometimes misplaced. This process also made it hard to assess the workload of the referrals department and added to the medical records department scanning work.


To improve the process, Island Health Care developed a solution that uses Direct Messaging. This effort accelerated referrals, improved information tracking, and reduced paper waste.

Island Health Care now utilizes their HISP, MedAllies, to exchange referrals and visit notes with their trading partners via Direct Messaging.

In the new workflow, an Island Health Care clinician alerts the Referrals Department to a new referral. The department processes the insurance information needed for the referral, assembles the visit and diagnosis notes, and sends the information via Direct Messaging to the selected specialist at Martha’s Vineyard Hospital or Cape Cod Healthcare for integration into their patient’s electronic record.

After the specialist meets with the patient, the visit notes are sent back to Island Health Care via Direct Messaging. The notes are imported into the patient’s record by Island’s medical records team for review by an NP, closing the referral loop.

Implementation and Rollout

Martha's Vineyard Hospital logo

Island Health Care piloted the implementation of their new workflow with the Orthopedics, General Surgery, and Women’s Health Departments at Martha’s Vineyard Hospital. The pilot started in January 2017 and went live with the three departments in October 2017.

Island Health Care created documentation to explain the new workflow to staff with flowcharts and images showing how to use Direct Messaging. Workshops were also held to train and motivate staff members who needed more time to embrace the new method and consistently utilize Direct Messaging.

Support from the Mass HIway

The Mass HIway offers free-of-charge HIway Adoption and Utilization Support (HAUS) Services to assist organizations in the effective deployment of HIE to enhance care coordination. This assistance is provided by HIway Account Managers.

Island Health Care enlisted HAUS Services for this project. The Account Managers acted as intermediaries between the trading partners, finding contacts who were aware of their organization’s systems and could implement a new workflow. They also assisted with navigating the HIway’s Provider Directory 2.0 to look up the Direct Addresses of specialists at the partner organizations.


Through this project, Island Health Care met their goals of improving efficiency, reducing paper handling, and better tracking referral data. All referrals and visit notes to and from the departments that engaged in the project are now consistently sent via Direct Messaging.

The new workflow enabled Island Health Care to better understand the referral loop with their partners and the needs of the Referrals Department in processing referrals. The Referrals Coordinator can now see how many referrals were sent, the status of these referrals, and what return documents to expect from the partner organizations. Island Health Care can now also track the volume of messages being exchanged, giving management insight into the workload of the Referrals Department and where additional support may be needed.

Island Health Care sends approximately 50 Direct Messages a month to the three departments at Martha’s Vineyard Hospital. In 2020, on average they closed the loop for 38% of referrals, higher than many similar healthcare organizations in Massachusetts.

“With all of the technology features our vendors offer, we can’t implement them all! It’s a challenge to choose functionality that is both easy to implement and has an impact for staff, management, patients and providers. Using the HIE to send referrals and receive visit notes is a perfect combination of ease of implementation and impact.”

       – Joan Menard, Chief Data and Information Officer

Not all of Island’s trading partners have the capability to send and receive Direct Messages yet. For these instances, Island Health Care replaced paper faxing with efax. While not as efficient as HIE, this change did contribute to the reduction of paper waste.

Patient Impact

Utilizing Direct Messaging has improved patient care. With fewer missing faxes and phone calls between providers, all patient information is now in one place and patients can schedule specialist appointments more quickly.


Island Health Care advises providers to identify the specialty departments that would benefit from electronic exchange the most, and to start there. They also recommend understanding the specialty department’s workflow, because it is difficult to design an effective workflow and troubleshoot issues without knowing what happens on the other side. Once successfully implemented with the initial departments, the workflow will more likely gain traction in other areas.

The HAUS Services were particularly helpful for the Island Health Care project, as the Account Managers helped determine which of their trading partners would be most receptive and provided advice on how to coordinate the implementation.

Cape Cod Healthcare logoMoving Forward

With the successful implementation between departments at Martha’s Vineyard Hospital, Island Health Care was able to duplicate the workflow to begin sending referrals via Direct Message to all departments at Cape Cod Healthcare. This expansion began in late 2020 and the connection went live in June 2021.

Island Health Care is now working with Martha’s Vineyard Hospital to convert additional departments to the electronic workflow. They also plan to work with other trading partners to establish similar results.