Another downside reported by users, say the report's authors, is the lack of automation in some of the programs. "People want the site applications interfaced with their registration system. If there is a patient you've already seen in the ER, that patient has been registered. If you decide to put in an e-referral, unless you've interfaced your systems, you have to enter all of the information again," says Metzger. This "busywork" has led to some resistance from physicians who do not have the time or inclination to enter the information for a second time. "It's definitely the biggest resentment, why should I have to type all information in?"
And you may be asking yourself, why should I bother? Well, take the case of Aurora Sinai Medical Center—a 195-bed community hospital in Wisconsin. Aurora Sinai was struggling under the burden of trying to care for a large number of uninsured patients coming to the ER for primary care. In an effort to reduce overcrowding, the hospital had implemented a triage program that diverted patients to ambulatory facilities. While the program was successful, turning patients away did nothing for the hospital's image in the community, and staff had no way of following up with patients to ensure they received care.
Hospital administrators wanted to find a way to help staff find and schedule appointments for patients who came to the ER seeking non-urgent care. Enter My Health Direct. For $50,000 per hospital, per year, the program enables staff to schedule an appointment while the patient is still present. Appointments are made using a host of criteria including insurance type, service type, distance from home, preferred language, and need for public transportation. The appointment request is transmitted to the receiving provider, the appointment slot is removed from availability for booking, and the patient is given a printed handout with details of the appointment.
Referral records are kept remotely on the Web database, providing a history of not only that patient's referral record, but a tally of referral volumes by service type, insurance type, etc., according to the report from Metzger and Zywiak.
Since implementing the program, Aurora Sinai has reduced its ER visits from nearly 80,000 a year to 43,000. Overall hospital losses have dropped from almost $25 million annually to "the low single [million] digits," the report says.
"There is plenty of value in thinking about addressing this process. The problem with continuity of care is who really owns it? Whose problem is this? E-referring is one relatively simple way to close a huge gap in the care delivery process," says Metzger.
So what does all this mean for your hospital? Even if you aren't a safety-net hospital looking to reduce overcrowding, the low upfront cost combined with improved tracking ability could make e-referring a very attractive proposition for any provider. And, as more healthcare delivery processes become electronic, your move to a Web-based system could put you a step ahead of where all your peers will eventually be anyway.