E-referral – Present and Future

1. E-referral – Present and Future Barry Robbins

2. THE FUTURE

3. E-referral - what do we want to achieve or e-referral nirvana • E-referral client information auto-populated from sending agency client management system • E-referral agency and service information auto-populated from service directory • Information sent directly from client management system in agreed standard format • Information imported to receiving agency client management system • Need to transmit data not forms

4. What are the e-referral building blocks? • Agreed common practices for exchanging information (PPPSs) • Agreed common referral information (SCTT) • Agreed common transmission format (HL7) • E-referral capable systems • Service Provider Directory (HSD + Local) • Secure Communications

5. What do software vendors need to build E-referral capable client management systems? • SCTT Data Dictionary • SCTT HL7 Specifications • SCTT Messaging Business Rules • Link to Services Directory • SCTT Functional Specifications

6. SCTT Data Dictionary • Specifies the structure of the database required to support SCTT in software • Available via website now • Will be revised for new SCTT • Minority of vendors have implemented according to SCTT Data Dictionary

7. SCTT HL7 Specifications • Specific standards for transmission of SCTT between systems • Available via website now • Will be revised for new SCTT

8. HL7 Messaging Business Rules • Describe how systems will deal with incoming referral messages • Don’t currently exist • Will be developed as part of HealthSMART

9. Link to Services Directory • Human Services Directory can be used to populate other systems • Already done by at least one system

10. Functional Specifications • Outline standards for how SCTT should behave in software • Don’t currently exist – plan to develop as part of SCTT review

11. What happens when vendors have these building blocks? • Client management system vendors need to build in secure e-referral capability • Users need to have access to reliable communications • Some years to achieve full compliance

12. PRESENT

13. E-referral current status • SCTT embedded in a wide range of client management systems to allow auto-population • Two major e-referral ‘middle’ systems used to securely deliver SCTT completed in client management systems - ConnectingCare and InfoXChange • Both e-referral systems also contain embedded SCTT

14. Current Implementation

15. Future Progress • Recent funding for e-referral • Regional approach through PCPs engaging key agencies to expand or implement e-referral • Key components • Change management • Protocol development • Training • Sustainability

16. Current E-Referral Systems Issues • Interoperability • Double keying on the input side • Inconsistent implementation of SCTT in client management systems

17. E-Referral Systems Interoperability - Why is this a Problem? • Inability to refer clients to agencies using different systems • Impacts on right service, right place, right time • Particularly difficult for Metro wide and statewide services (acute, RDNS) impacts on implementation

18. E-Referral Systems Interoperability- Working Towards a Solution • Two major vendors met on 7 July 05 • In depth discussion about current barriers and possible solutions • Encouraged vendors to work towards a solution • Some exploratory work has been undertaken by the vendors

19. Double Keying • Ultimately full implementation of messaging is the best solution • Some systems are exploring direct interfacing

20. Inconsistent Implementation of SCTT • SCTT embedded in many different ways • SCTT not universally available • Partially addressed by functional specifications • Need to keep negotiating with vendors

21. Conclusion • Keep nirvana in sight, but will probably never be achieved for all Client Management Systems • Much can be achieved in the meantime by e-referral ‘middle’ systems and local innovation within statewide standards