Serving 300,000 people, Peninsula Health is the public health provider for Frankston and the Mornington Peninsula in Victoria, Australia. Over the course of two years, it transitioned away from paper-based referral and discharge processes to MasterCare+ for Referral Management, a secure, electronic messaging platform. The move transformed both the health service and its catchment.
Moving from paper-based to electronic referrals has had many benefits for us. There was not only the cost savings, but improved referral quality and faster processing times. Embedding and expanding secure electronic communication across the entire catchment has exciting possibilities for improving outcomes for all patients and facilitating more effective coordination between Peninsula Health and our partners.
David Hutchinson, Peninsula Health.
The Problem
Peninsula Health began overhauling how it communicated with GPs and other health service providers in response to new Policies for eReferrals and Access issued by its funding body, the Department of Health and Human Services (DHHS) Victoria. The policies laid out mandatory requirements for how inbound referrals were processed and introduced KPIs for key elements.
For Peninsula Health, the biggest challenge was meeting the time frames for triaging and notifying referrers. Both processes were mainly paper based, making them slow and inefficient.
The main hospital in the region, Frankston Hospital, received 150 to 200 referrals a day from GPs and specialists (around 60 per cent external). While some were phoned in or posted, most were faxes of up to 20 pages. Each referral was printed, filed in a folder and submitted for triage. The relevant clinician accepted or rejected the paper referral and informed the GP and patient of the outcome. Finally, referrals were scanned in bulk and uploaded into the digital medical record (DMR) system.
The Challenges
The system was slow, inefficient and costly
Peninsula Health needed to identify a number of challenges experienced daily amongst their stakeholders and based on these scoped out what exactly the project requirements would be.
A number of these challenges are listed below:
- Some clinicians only ran weekly or monthly, impacting the ability of clinicians to meet the five-day triaging KPI
- Paper-based processes increased the risk of referrals being misdirected and could potentially impact on security of patient information
- Referrals were often incomplete, lacking clinical detail and/or mandatory information about the patient or referrer required for billing purposes
- Direct costs were considerable – paper, envelopes, postage and associated costs were conservatively projected at approximately $1 per faxed referral
Another factor that needed to be considered, was that not all notifications were inbound or paper- based. Frankston Hospital sent up to 7,000 outbound discharge summaries securely to GPs every month through another secure message provider, but although they were sent and received electronically, practices used different software systems. There was no standardised approach and no base on which to build a catchment-wide system.
With the catalyst of new government requirements, Peninsula Health decided to look for a core, referral management system that would:
- Eliminate the paper exchange between GPs and the Hospital
- Introduce electronic triage so clinicians could do it remotely
- Replace manual scanning of paper referrals with automated upload to the digital medical record
The new platform would be the springboard for ambitious plans to scale up the benefits by embedding electronic communications across the whole catchment. To encourage acceptance, the enterprise software license would need to cover users outside the Hospital so they could use it for free – something that hadn’t been done before.
Frankston Hospital now sends over 80% of its discharge summaries via Global Health’s ReferralNet.
Key Outcomes
Through continued collaboration between Peninsula Health and the MasterCare+ team it was soon realised the project needed to be executed in 2 phases.
2 Phased Project
Peninsula Health went to tender, appointing Global Health because of its track record as one of three main providers across Victoria and the functionality and cost-effectiveness of ReferralNet’s secure electronic messaging platform – part of the MasterCare+ for Referral Management package.
Phase 1 Secure Discharge Summaries
The first phase of Peninsula Health’s eReferral project was switching to ReferralNet as the interface for delivering secure discharge summaries into GPs’ clinical systems. This was relatively easy and fast to implement, with the aim of quickly realising cost savings due to ReferralNet’s competitive price structure and easily installing ReferralNet into GP practices.
The roll-out involved remotely installing and commissioning ReferralNet at GP practices. Essentially, it added ReferralNet to their current software, a minor change that caused minimal disruption. To the clinician, it made no difference.
The back end was more challenging as it involved customised integration. ReferralNet was integrated with Peninsula Health’s Electronic Medical Records (EMR) system, Cerner, and the National Health Services Directory (NHSD). At that time, ReferralNet did not synchronise with the NHSD, so Global Health worked closely with Peninsula Health to make it happen and to align ReferralNet with Frankston Hospital’s discharge process.
Some GPs preferred to retain their existing systems or to transition later, and Global Health liaised with them to ensure their systems interfaced with ReferralNet. However, practices’ overall uptake of ReferralNet was strong. ReferralNet became Peninsula Health’s primary sending system, with Frankston Hospital using it to send more than 50 per cent of secure discharge summaries from its EMR system to GPs at the start of the project. Within 18 months, the percentage had risen to 80 per cent.
With Phase 1 a Success, we began planning with the MasterCare+ Team for Phase 2.
Phase 2 Outpatients eReferral
With phase 1 a success, Peninsula Health began planning phase 2 – moving to electronic outpatient referrals and triage.
This was more complex as it involved widespread change management for Peninsula Health, GPs and more than 40 on-site specialist outpatient clinics, as well as intricate systems integration.
All aspects of the MasterCare+ platform are completely customisable, so the Global Health team worked closely with Peninsula Health to make sure MasterCare+ had all the features it needed to assess, process, triage and track inbound clinical referrals. A key feature was developing a configurable, cloud-based, Software as a Service (SaaS) version of MasterCare+ Referral Management that was optimised for mobility, so clinicians could triage referrals from any location, on any device.
The Global Health team integrated MasterCare+ with the IPM Patient Administration System (PAS) and InfoMedix DMR system in a way that supported the new process and eliminated the need to re-key patient details. Peninsula Health also gained instant access to the details of health professionals listed in the ReferralNet network through the MasterCare+ address book, which is maintained in real time and synchronised with the NHSD.
To help smooth the transition for both phases, Global Health and Frankston Hospital’s GP Liaison office developed a comprehensive GP communications campaign that explained MasterCare+ and ReferralNet, the new processes and the benefits. They also began educating GPs on the information different types of clinics need for a referral to be valid, to help increase the acceptance rate.
Healthcare consumers want a digitally enabled care experience. Providers that invest in digital tools and develop strategies to adapt to consumers’ expectations will close the gap between what patients demand, and what providers deliver.
Accenture
Key Outcomes
The projected cost savings for Peninsula Health from just one change – replacing acknowledgment letters with automated receipts – are $60,000 to $100,000 per year.
As the eReferral network grows, the benefits will increase exponentially. These benefits can be utilised across the healthcare system for all stakeholders to take advantage. The following are just some of the key benefits:
- Higher quality and more secure referrals
- Improvements to risk management, patient service and stakeholder communication
- Productivity gains
Benefit
With ReferralNet and MasterCare+
Efficiency
- More referrals processed more quickly
- Reduced printing, posting and faxing costs (health service and referrers)
- Fewer lost referrals so less time dealing with the impacts
- Positive impact on clinical outcomes
- Improved communication between GPs & health service
- Hospital resources released for higher-value tasks GPs know their referral has been delivered
- Referrals received into one inbox Faxes converted automatically to digital files
- Automated acknowledgment receipts
- Referrals assigned by central intake team to appropriate clinical team for on-site/off-site triage
- Referrals accepted or rejected and placed in appropriate electronic folder
- Referral document sets collated and submitted to DMR system
Accuracy
- Faster processing
- Invalid or incomplete referrals significantly reduced so less time chasing missing information
- No need to build and maintain Hospital address book
- Patient information automatically matched and compared through the PAS
- Interactive address book supports real-time address search for health professionals
- Standardised referral templates that auto-populate info from GP systems, with mandatory fields customised to the needs of each clinic
Security
- Security increased to best practice level
- Risk of privacy breaches minimised
- Peninsula Health, GPs and patients know information is being handled appropriately
- Referral is harder to lose
- Clear, robust, retrospective audit trail
- Software meets Australian Government Secure Message Delivery (SMD) standards and complies with Australian Privacy Principles
- Triage Dashboard records movement of referral through process with time and date stamp
Information access
- Faster triaging and processing
- Quicker to obtain extra information
- Potentially better health outcomes
- Improved patient communication e.g. referral inquiries dealt with faster
- Administrators can track referral status and act if not meeting KPIs
- GPs and specialists send and receive referrals from their desktop, tablet or phone
- Templates designed in line with RACGP guidelines and in conjunction with clinicians
- Clinician access to referral folders from Hospitals, private rooms or other preferred location
- Ability to remotely accept or reject referrals, add notes, return to scheduling queue for appointments, generate a GP update letter, request further information and inform patient
- Triage Dashboard displays referral information and journey
The Future
GPs are now clear they want to engage with Peninsula Health through secure electronic messages that they can generate from within their clinical systems.
Since the go-live, Peninsula Health and Global Health have worked collaboratively to roll out ReferralNet to more GP practices.
Peninsula Health then re-engaged Global Health to extend the eReferral workflow capability. This includes working with GPs and clinicians to improve key elements such as template usability and standardising referral acknowledgements. The overall approach aligns with guidelines from the Royal Australian College of General Practitioners (RACGP) so everything complies with national standards for secure messaging and how GPs prefer to work.
The ultimate aim is to replace all paper communications across the catchment, not just between Peninsula Health and its stakeholders, but between all healthcare stakeholders
There are also plans to make reporting easier for Peninsula Health, and to investigate the possibility of further integrating MasterCare+ into the overall IT architecture so it can interact with other core systems, such as Cerner and IPM.
Peninsula Health has also implemented secure e-messaging in its 40 acute outpatient clinic groups, which will further improve efficiency and reduce costs. ReferralNet’s ability to help service providers meet government KPIs for valid referrals is particularly important for clinics that receive Medicare Benefits Schedule funding from the Australian Government.
If you need to digitise your referral intake and reduce reliance on paper-based processes, then MasterCare+ for Referral Management solution may be exactly what you need.
About MasterCare and Global Health Limited
MasterCare is part of the Global Health family, building Australian solutions designed for tomorrow’s healthcare system, connecting clinicians with their consumers. Our vision is to enable a connected technology ecosystem delivering better outcomes, increasing productivity and profitability.
As an ASX listed company, we are proudly Australian owned and operated and have a market-leading understanding of the healthcare landscape. We listen to our customers and collaborate to build technologically advanced, innovative and market leading bespoke software and SaaS solutions.
