Do I use a Recommendation or Referral to send a patient to an allied health provider?

Question: Is entering a Referral order appropriate to send my patient to physiotherapy or another allied health provider?

Context: If a provider does not require closed loop referral management (i.e., confirmation that the patient was seen by the specified allied health provider and the outcome of that appointment), this is considered to be a Recommendation rather than a Referral. If a Referral is instead placed in such a situation, the provincial standard agreed upon is to confirm with the ordering provider that the Referral was intended to be a Recommendation rather than a Referral order. A comment can then be added in the Communication section summarizing the discussion, and the referral can then be closed with the "non-clinical flag". 

Answer: If a provider does not require closed loop referral management, a Referral order should not be entered. Instead, a Recommendation can be made via a Communication letter, or, if a prescription is required by insurance, it can also be made via a Patient Care Order. See the tip sheet for further details and screenshots.

• Tip: Prescriber Allied Health Recommendations vs. Referrals

How can I refer a patient to the FAST program?

Question: How do I refer a patient to the Facilitated Access to Specialized Treatment (FAST) program?

Context: As part of the Alberta Surgical Initiative (ASI), a central access and intake program called Facilitated Access to Specialized Treatment (FAST) has been implemented across Alberta. The FAST program is responsible for reviewing referrals for completeness and assigning them to a next available provider with the shortest waitlist, a specific provider, clinic or site, or an out-of-zone provider. 

Not all specialties have implemented FAST. Previously, a customized FAST referral order was available for each relevant specialty. Now, to both accommodate a growing number of specialties using FAST and reduce confusion, FAST referrals are placed via the standard specialty-specific referral order. If that specialty uses FAST, a question will be available in the order where the prescriber can indicate that the referral should be directed to FAST and include any FAST specialty-specific questions that may need to be answered. 

Answer: To submit a FAST referral, search for the standard specialty-specific referral order (e.g., "Referral to Orthopedics"), and then add a specialty reason of FAST. Searching for "FAST" referral orders will bring up specialties that are FAST-eligible. 

• Tip: Referral Order Updates
• Resource: ahs.ca/FAST

Where is that Intake (RAAPID) encounter?

Question: Prescribers who have participated in, and later seek follow-up access to, an "Intake" encounter may have difficulty finding this in the usual places. What could be the problem?

Context: RAAPID consultations facilitate care of patients in their home facility, as well as transfer to other facilities when needed. Associated communications, documentation, billing and other clinical activities can be managed through the "Intake" encounter created by RAAPID services when a consultation, referral or transfer event is initiated. The correct encounter is automatically opened when prescribers seek the relevant patient in a "My RAAPID Consults" or similar system patient list.

There may be reason to go back to an Intake encounter after the RAAPID event has closed and the patient has dropped off the associated system patient list. For example, additional documentation may needed or professional billing taken care of.

Answer: Intake encounters can be found within any opened patient chart. Go to the "Chart Review" activity and then select the "Encounters" folder. Look for encounter(s) of the "Intake" type. If not listed, be sure to uncheck the "Hide Add'l Visits" filter checkbox. 

If the encounters listing is very long, consider selecting the "Filter" tool and then choose encounter types that match "Intake".

The Intake encounter can be opened for additional work by selecting the appropriate row then using the "Encounter" button (above the list) to jump to that encounter.

• Manual: RAAPID Consultation Workflows
• Tip: RAAPID Consult Workflow - Specialties
• Tip: RAAPID Consult Workflow - ED

How can I line up Home Care Services for Inpatients?

Question: How can arrangements for home care be ordered for inpatients prior to discharge?

Context: The requested home care services will be fulfilled outside the current inpatient admission. Consequently, prescribers may wonder how specific requests can be placed. 

Answer: Home care referrals and service requests can be entered using an integrated "Home Care Orders" orderset. This should appear when using the inpatient orders activity to search for "Home Care". If proximate to discharge, home care orders can also be entered within the Discharge Orders portion of the Discharge Navigator. 

In many cases, these orders are entered by transition coordinators or nurses, with a prescriber co-sign. Specific medication monitoring, professional service and other requests need to be entered with a Home Care Service Order. Step-by-step instructions are provided:

• Tip: Physician Orders for Home Care Referral and Services
• Manual: Home Care Referral and Service Orders

How can a referral be directed to a specific colleague?

Question: How can a referral for specialty services be directed to a specific individual?

Answer: If the referral is "internal" to a clinic, service or consultant using Connect Care as the record of care for the requested service, then use the "To Provider" field (usually left blank) to request a specific individual.

If the referral is "outgoing" to a service operating outside the Connect Care record of care, then it is essential to use the "To Provider" field. The look-up for this will filter for the requested specialty and will allow selection specific to a provider at a particular location.

If the provider and location of interest cannot be found in the "To Provider" lookup, then the field can be left blank. The referral order process is still valuable and a standardized referral letter can still be generated. You can address the letter to the missing provider and mail or fax with information you possess. It is important to submit a help desk request to have the missing provider added to the Connect Care provider registry.

How can a prescriber know whether to choose an "internal" or "outgoing" Referral?

Question: How can a prescriber know if an "outgoing" referral "class" should be used?

Context: The top of Referral order requests asks for the classification of a referral order as “Internal” or “Outgoing”. Think of the province being divided into health care settings where Connect Care is or will become the record of care and settings where Connect Care is not and will not be the record of care. Referrals that start and end within the Connect Care “sector” are “Internal”, even if the destination clinic has not yet launched the CIS. Referrals that are fulfilled outside the Connect Care sector are “Outgoing” and rely upon delivery and fulfillment steps that occur in other information systems.

Answer: The most practical answer to this question is that "you will know". Connect Care physicians will have a limited number of ambulatory referrals used for commonly requested specialty services. Once one of these referral pathways is figured out, the associated referral order properties can be saved as a personal preference. This includes whether an internal or outgoing order class works best.

If in doubt, start an unfamiliar referral order with the class set to "internal". Try finding the refer-to department of interest. If nothing can be found (with various keyword attempts), then it is likely that the required specialty services is not yet active in Connect Care. The "outgoing" class can be selected and an order placed that involves the referral letter being mailed or faxed to the clinic of interest.

If you believe that there is an error in the list of available internal referral destinations, please send this observation, with specific clinic name(s) to ClinicalOperations-Patient.Access@ahs.ca.

During the early weeks to months post-launch, some clinics may not be fully referral-ready. It is always possible to generate the "internal" referral order and benefit from the standardized referral letter it generates. This can additionally be faxed (from within Connect Care) to the clinic as a fail-safe until referral notifications confirm that closed-loop referral capacity is fully established.

How can prescribers complete an outgoing (external) referral without support staff assistance?

Question: How can a prescriber complete an outgoing (external) referral order (and letter) without medical office support staff assistance?

Context: Physicians working in contexts that have medical office assistant support can place outgoing referral orders (ie., to non-Connect Care specialists) and trust that the support staff will take care of tweaks to the referral letter when ensuring that it routes (fax or mail) appropriately. There are other contexts (e.g., placing an outpatient referral order from within an inpatient context) where such support is not available. And some physicians simply prefer to do things themselves!

Answer: A short (7 min) demonstration walks through all of the steps that a prescriber can independently complete and control when ordering an outgoing referral.

• Demo: Independent Outgoing Referral Workflow

How can Referrals be tracked within a Patient Chart?

Question: How can the state of a referral order be tracked for a particular patient using that patient's Connect Care chart?

Context: Prescribers participating in referral intake and management will do most of their work through In-Basket workflows. Referring physicians can also use In-Basket for referral tracking, as that is where they receive notices about the status of the referrals they have ordered. In addition, referring physicians may wish to quickly check the the status of one or more referrals that pertain to a particular patient.

Answer: The "Chart Review" section of any opened patient chart has a tab labelled "Referrals". Opening this gives access to a list of all active referrals for the current patient. These can be selected to dig deeper, check referral progress and facilitate communications.

• Demo: Workflow Quickstep - Referral Tracking

How do Physicians triage incoming Referrals via In Basket?

Question: How does the Connect Care In Basket help prescribers who facilitate triage and acceptance/rejection/deferral of incoming outpatient referral requests?

Context: Prescribers working as part of a specialty service may take turns triaging incoming referral requests. This step of closed-loop referral management usually requires a decision about the relative priority of a referral, a target schedule-by date and any needed actions for the patient to be ready for the clinic visit.

Answer: A short (6 min) demonstration walks through all of the functions and actions that a triage prescriber can manage through In Basket alone.

• Demo: In-Basket Referral Triage

Do Connect Care Referral Workflows address CPSA expectations?

Question: The College of Physicians and Surgeons of Alberta (CPSA) has recently updated standards that physicians must meet respecting the receipt, acceptance, notification and fulfillment of referral requests in outpatient settings. There are metrics and milestones. Would adoption of Connect Care closed-loop referral workflows comply with these standards?

Answer: Prescribers and support staff who use Connect Care referral management tools (both to place and to receive referrals) will use information flows that include all data elements required by the CPSA. Tracking of CPSA events occurs automatically. Required notifications to referring physicians are automatically prompted. For a quick review of CPSA expectations and Connect Care matching functions:

• Norm: Prescriber Referral Management
• CPSA Standard: Referral Consultation

How can an Outpatient Referral be ordered in an Inpatient Context?

Question: Physicians ordering referrals for outpatient specialty assessment cannot find the needed orders when using the Order activity in inpatient encounters. How can follow-up consultations be arranged?

Considerations: Whereas inpatient consultation requests can only be placed from inpatient or emergency contexts, outpatient referrals are available to outpatient, inpatient, emergency, critical care or continuing care contexts. Unfortunately, inpatient and outpatient order catalogues are different. Users may be frustrated when trying to find outpatient referral orders from within an inpatient order navigator.

Answer: Outpatient referrals can be ordered during Inpatient encounters, but there are a few tricks to be aware of. Emergency physicians need to pay attention to where ("After visit procedures") the referral order may appear. Inpatient physicians need to use either the Discharge Navigator or an External Orders tool to make the outpatient referral arrangements; all explained in:

• Tip: Outpatient Referrals from Inpatient Contexts
• Demo: Referral Optimization Clinic (jump to minute 4)
• Demo: Using External Orders for Inpatients
• Manual: Referral Workflows 

How are Referring Prescribers notified of a Referral's progress?

Question: How are referring physicians notified of the receipt and processing of their request?

Context: Connect Care has a standardized approach to communicating about the progress of outpatient referrals and appointments. The Referrals workflow has been designed to transform the referral experience for both clinicians (sender and receivers of referrals) and patients. It meets expectations of CPSA Standards for Referral Consultation, Path to Care and the AHS Wait Time Policy.

Answer: Once a referral has been accepted and processed, an “accepted and waitlisted” letter will be automatically sent to the referring provider according to the communication preferences they have indicated in the system. Typically, these communications will route via In Basket. If the provider does not use Connect Care, the letter will be generated for print and mail or RightFax.

A number of automated notifications are sent to the referring prescriber as Connect Care referrals pass milestones in closed-loop referral management.

• Guide: Referral Notifications

Where can Optimization Clinic Resources be found?

Question: Each week of post-launch optimization training has a different theme, with a mid-week optimization clinic as the anchor event. Where can prescribers access recordings and other resources (e.g. tip sheets) that relate to the optimization recommendations?

Answer: Preliminary resources are described and linked in the physician updates blog (blogs.connect-care.ca) at the beginning of each week. Other resources arise during the week, especially answers to questions raised by Connect Care users. These are described and linked at the end of each week. The following exemplifies this approach for the Referrals Workflow theme:

• Optimization Prep: Referral Workflows
• Optimization Review: Referral Workflows

How do physicians participate in referral triage and prioritization?

Question: Once a referral order is placed, what do physicians in the target service need to do respecting the review and prioritization (triage) of incoming referrals? I understand there are all sorts of rules about responding in a timely manner etc? How are those being managed during the “soft launch” of schegistration?

Answer:  Our pre-launch training emphasis for physicians focuses on getting referral (outpatient) orders placed the right way so they get to the right destination with the right information. But there is a lot more to the process!

After an outpatient referral order is placed, the next steps could be relatively simple, with support staff managing an incoming referral work queue and scheduling appointments according to pre-set protocols (each specialty has its own, worked out as part of ARD or Path-to-Care or eReferral). More complicated processes do involve physician review, triage and priority setting at one or more steps.

Most of the Connect Care referral destinations (outpatient) are former eCLINICIAN sites. They already have referral processes in place, admittedly with a lot of variation between specialties. And eCLINICIAN upgraded to referral work queues, so there are no major workflow changes in Connect Care.

Those groups that use physician triage steps already know who they are. Some use physicians assigned to consult rotations. Presumably, they will maintain current process in Connect Care. But there is opportunity to do more to centralize, standardize and use the new closed loop visibility of Connect Care to improve efficiency. Our post-launch optimization work should involve learning from the best practices of the most experienced referral-management groups.