New e-referral system links GPs, specialists and patients

EDMONTON – A family doctor and a team of technologists have created an online referral system that keeps patients in the loop when they are referred to specialists for care. The South Side Patient Care Network tested the system this spring and 35 medical clinics have since signed on.

Dr. Denis Vincent (pictured), who organized the project, estimates that about 50 family doctors in the Edmonton area have booked more than 500 patients to see about 50 specialists, including cardiologists and gynecologists.

More are jumping aboard, including psychiatrists, surgeons and doctors in Spruce Grove and Fort McMurray. Grey Nuns Hospital will be launching a pilot project in early 2016 so hospital doctors can track patients once they leave to see if and when they receive follow-up care from community doctors.

Currently, many doctors rely on fax machines or repeated phone calls to the offices of specialists to book patients for tests or consultations, Dr. Vincent told the Edmonton Journal. Patients often wait anxiously at home, unaware of what specialist is being contacted and how long they’ll have to wait for an appointment.

Sometimes they fall through the cracks as faxes get lost and appointments get missed.

“The medical system is stuck with faxing and phoning,” Dr. Vincent said. “There are so many phone calls into specialist offices. Everyone is calling before the fax, after the fax. Patients are calling. It’s very tedious. There’s a lot of phone tag.”

Dr. Vincent thought there had to be a better way to communicate.

His new ezReferral system automates those bookings through a secure, private website where family doctors log in, enter patient data and request an appointment with a specialist. When the specialist accepts the patient, the patient and family doctor are notified immediately.

At every point in the process, patients receive email or text updates that let them know to whom they have been referred, how to contact that specialist, their appointment date or the length of the wait list.

“They don’t have to call us and ask, ‘What’s going on with my referral?’” Dr. Vincent said.

“This is easy,” said Dr. Vincent, and it can save money. Some primary care networks spend upwards of $1 million to hire teams of medical clerks to track all the referrals from paper binders and on phones. He estimates his booking system will cost a doctor $200 each month.

“In my mind, doctors can afford this. If everybody pitches in, this service is completely viable and sustainable and it won’t cost the taxpayer a penny,” Dr. Vincent said. “We expect the government to hand everything to us. We all kick back and complain and wait for the government to fix it for us.”

He led the development of the system after one of his patients received delayed care because of a lost fax referral. The woman, a 38-year-old mother, had gone to emergency complaining of stomach pain. An ultrasound revealed a mass on her gall bladder and the emergency doctor immediately faxed a referral to a surgeon.

“She went home and waited two months,” Dr. Vincent said. She returned to Dr. Vincent, who discovered the surgeon was on a four-month sabbatical and the fax referral had been lost. The woman ended up waiting four months to have her gall bladder removed. By then, the cancer cells had spread to her liver. Chemotherapy followed, but the woman is now a palliative care patient.

“It was a disaster,” Dr. Vincent said. A December 2013 report by the Health Quality Council of Alberta outlined a similar case involving a Calgary man who died prematurely from testicular cancer after delayed referrals to specialists and gaps in care. The council recommended an electronic tracking and booking system be created.

Alberta’s Netcare system has an e-referral tool, but only for hip and knee replacement, and for breast and lung cancer. Since July 2014, 252 doctors have used the system to request 2,900 referrals. Dr. Vincent noted that patients aren’t looped in.

Alberta’s auditor general has been critical of the delays, especially since secure electronic systems are already in place for personal banking or education initiatives. In a September 2014 report, the auditor general said there are at least 12 different medical record systems being used by Alberta family physicians, which can’t talk to each other or share key patient information.

Dr. Vincent is pioneering a new approach: Front-line workers, he said, must develop the solutions. “We’re not kidding ourselves when we say we can save people’s lives,” he said. “I want to fix a program that is costing lives and harming patients.”