PhysicianOne Urgent Care is a network of 23 urgent care centers throughout Connecticut, Massachusetts, and New York. Its clinics offer walk-in, appointment-based, and telehealth treatment for non-life threatening illness and injuries, providing a cost-effective alternative to the Emergency Room and a convenient option for primary care visits both during peak and off-peak hours. If a patient is in need of additional specialty care, clinicians may refer them to PhysicianOne’s partner, Tufts Medical Center (Tufts MC).
Tufts Medical Center is a teaching and research hospital providing nationally recognized routine and emergency medical treatment options to adult and pediatric patients throughout New England. The health care providers at Tufts MC work with referring physicians and community hospital partners to ensure convenient, high quality care is available for all patients.
Prior to 2019, care providers who referred patients to Tufts MC used one of four main methods to send their referrals:
- Phone call
- Proprietary Secure email
- Fax, or
- Crimson, an online Referral Management Tool used by Tufts MC
Originally, PhysicianOne’s referral workflow involved faxing referral paperwork to Tufts MC, which required the patient to schedule their visit with the specialist. This method was inefficient and put too much responsibility on the patient. In 2019, PhysicianOne reached out to Tufts MC to discuss implementing an electronic health information exchange (HIE) for referrals and a workflow that would alert Tufts MC physicians via Direct Message of patients that needed to be seen.
PhysicianOne utilized Direct Messaging to implement a new HIE workflow with Tufts MC. PhysicianOne clinicians can now send their referrals via HIway Direct Messaging from their DocuTap EHR system to a dedicated mailbox at Tufts MC.
To send a referral, a Direct Message is sent to Tufts MC with a PDF attachment containing patient information such as specialty department, scheduling preferences, and the diagnosis made by the PhysicianOne clinician. The contact at Tufts MC enters the patient information manually into the Crimson referral management application and sends the specified department the referral request.
The Tufts MC and PhysicianOne teams adapted their existing workflows to accommodate the use of Direct Messaging.
PhysicianOne added a new “Tufts MC Patient Navigator” specialist option in their EHR, DocuTap, and trained their clinicians to find and select that option to make referrals. By embedding the new referral option in existing workflows, PhysicianOne was able to easily train clinicians on how to use this new communication method.
Tufts MC added the entry of referral information into Crimson to their workflow, but otherwise the daily practice did not change. There was no training involved for the Tufts MC ambulatory practices as they can see the information in Crimson, a tool they already use.
“The ability to now use the Mass HIway to refer patients in need of specialty care to Tufts Medical Center, now allows us to more easily and seamlessly ensure that PhysicianOne patients are able to quickly get the high-quality specialty services they need.”
– Phil Davis, Chief Operations Officer, PhysicianOne Urgent Care
The new workflow was implemented quickly. PhysicianOne reached out to Tufts MC in summer 2019 and the first referrals were sent via the Mass HIway in October 2019.
With this project, the two organizations were hoping to improve turnaround time to schedule patients for referral visits. Their target was to schedule visits within one to two days of receipt of a referral. Prior to implementing the new workflow, the turnaround time was unpredictable because it was left to the patients to call in to schedule their visit. The average turnaround time to schedule a visit is now 1.25 days.
Tufts MC anticipated that reaching out to patients to schedule visits after a referral would increase the number of actual visits and that the departments would need be prepared for this workload influx. Orthopedics was expected to experience the largest increase, and Tufts MC prepared the department by utilizing two dedicated new patient staff members to handle the orthopedic referrals.
Between January and September 2020, the top three departments at Tufts MC indeed saw a significant increase in their referral visits. As the improvement coincided with the COVID-19 pandemic, infectious diseases saw a far more significant increase than any other department.
- Infectious diseases – 28%
- Orthopedics – 12%
- Neurosurgery – 9%
Tufts MC recommends getting input and feedback from all stakeholders that will be involved in the implementation and use of a new workflow. Tufts MC made sure that all supervisors, day-to-day operators, IT, and other affected providers and hospital employees would be aware of the changes to the workflow so that the project would be successful.
“Having a good team in place contributed to making the project a success.”
– Emily Cameron, Manager, Ambulatory Operations, Tufts Medical Center
The solution was piloted and tested before it was launched. This was useful to ensure issues were resolved before the new workflow went live. Assessing which departments were likely to process more referrals was also helpful in preparing them for the influx prior to roll out.
PhysicianOne shared the results of this use case with its urgent care centers in an effort to reinforce the opportunity of this one-click referral selection. Since this project, the organization has successfully implemented similar workflows with other trading partners and is eager to see comparable results.
Tufts MC is discussing the solution with its other partner organizations as well and hopes to implement similar workflows.