eReferrals used to manage diabetes education

OAKVILLE, Ont. – The Mississauga Halton Central Intake Program has deployed a software solution that automates the referral process for patients who require diabetes education. It replaces the older methods of fax, phone and paper requests with a computerized system that uses embedded workflows and a sophisticated rules engine.

Using Microsoft-based technology, the eRequest system from Novari Health has produced dramatic results. Administrative workloads have been reduced by 50 to 75 percent, while patients get into programs much faster.

Prior to the opening of the Central Intake Program, physicians were dealing with multiple referral forms and referral pathways to arrange diabetes education for their patients.

The Central Intake Program implemented a single referral form and a single access point for all diabetes education services in the Mississauga Halton Region in 2013. However, referrals sometimes sat on desks for three to four months before physicians were notified when and where the patient was booked for an appointment.

In 2014, the Central Intake Program entered into a partnership with Novari Health to build an electronic platform to receive and route referrals to diabetes education services in the region.

The first phase of Novari eRequest took place in November 2014, with positive responses from Central Intake and the partnering diabetes education programs. The key to success was in the built-in collaboration between Novari and the team at the Central Intake Program.

Nala Sriharan (pictured), manager of Mississauga Halton Central Intake Program and a registered nurse with a background as a diabetes educator, said that, ideally, anyone with diabetes should go through a diabetes education program.

“Diabetes is a chronic condition that requires ongoing management by individuals. The sooner they get education, the better their confidence and skill in managing the disease and preventing complications,” said Sriharan.

Complications of diabetes include heart disease, stroke, kidney disease and blindness. People with diabetes also have a higher risk of foot ulcer and subsequent amputation.

According to Canadian Association of Wound Care, 50 percent of all lower limb amputations in Ontario are directly related to diabetes, and diabetes foot ulcers cost our healthcare system more than $150 million annually.

John Sinclair, Vice President at Novari Health, said the system is all about matching patients with the right provider at the right time. “It’s a win for the patient and the province because patients get seen earlier and can learn how to better manage their condition, avoiding serious complications and ICU and emergency room visits. That’s good for the system because those things are really expensive,” said Sinclair.

Recognizing the various barriers to technology and the learning curve associated with change, Novari and Central Intake were committed to building a system that would be easily adopted by various providers.

The system was designed to make the transition easy for doctors’ offices that still rely on fax for referring. “The fax is converted to a PDF, so it is completely electronic at the intake center and for the selected provider. Doctors can continue to work the same way until they are completely comfortable with the new system,” added Sinclair.

Phase Two of the program is currently underway, and adds an online electronic referral form for physicians who want to eliminate paper completely. Physicians can choose to use either fax or the online eRequest system, and regardless of which method selected, can log in to a dashboard at any time to view each patient’s status.

“That’s revolutionary in Canada,” said Sinclair. “Where a doctor can actually send and track the referrals, they can see where it is, that central intake has triaged and routed it to a provider, that the appointment has been scheduled, and whether it has occurred. It’s all visible so the primary care doctor can see it.”

By spring 2016, the Central Intake Program will be further expanding its scope to accommodate referrals to community addiction and mental health services in Mississauga Halton via the Novari eRequest platform. This initiative is in its early phases of implementation, with the vision to provide care coordination and support for people seeking access to addiction and mental health services. The business software platform was designed to accommodate any type of healthcare service, and just needs to be configured for the specific health issues.

“Other LHINs, health authorities and ministries of health are watching the Central Intake Program with interest,” said Sinclair. “This is a hot button issue because healthcare leaders across the country are looking at one way to improve access to care, not just for diabetes, but for everything.”

Novari, a solution provider with more than ten years’ experience developing access to healthcare solutions in Canada, were selective when it came to determining the technology platform for eRequest.

“We made a deliberate decision to move from a proprietary development technology to a .NET solution running on Windows and SQL Server on a Microsoft Private Cloud because it was secure, scalable, it enabled fast development, and kept software acquisition costs very low for healthcare clients,” said Sinclair. “It also means more choice for our healthcare clients. They can run on this on their own premises, or as a hosted solution at an authorized data centre, or directly on Microsoft’s Azure cloud. It puts all of the control and decision about how to deploy in their hands.”