A number of improvements to the referrals process in Epic@UNC will go into effect June 14, 2015. Most notably, the priority status of referrals has been standardized across Epic@UNC, with stat orders requiring a phone call from the “referred from” department within one day and urgent orders requiring a phone call from the “referred from” department within two days.
To support this phone call requirement, all urgent and stat schedulable orders will route to the “referred from” orders to review workqueue along with any external referrals or referrals without a specific “referred to” department. Routine priority referrals with a “referred to” department valued will continue to route to the “referred to” orders ready to schedule workqueue.
The improvements going into effect June 14 build on previous work completed by the Referrals Workgroup:
- Revisions to the referral and schedulable orders order composer to make the process simpler and more useful.
- More than 280 unused workqueues were removed from Epic@UNC.
- Appointment template redesign work was done to ensure that visit types and appointment slots were are adjusted to maximize ease of scheduling.
- More than 60 departments/locations that are not referral recipients were removed from selection lists in Epic@UNC.
Required Training for Clinic Managers, Referral Coordinators
To ensure that the new standards in effect June 14 are met and that the updated referrals workflows are fully understood, all Referral Coordinators and Clinic Managers are required to attend an “Advanced Referral Management” instructor-led class by June 12 (for Referral Coordinators) or by July 31 (for clinic managers). Additionally, clinic managers are required to designate at least one acting Referral Coordinator per clinic and ensure they register and attend training.
New referral order metrics now available
NOTE: We are currently experiencing issues with these reports. View the latest info at this link.
Additionally, the Reporting Workgroup developed a set of metrics now available in Epic@UNC to monitor the overall referral process and help identify areas needing improvement or additional training. Examples of the metrics available in Epic@UNC include:
- Volumes and percentages of internal vs external referrals,
- Time from initial referral to scheduled appointment,
- Percent of appointments scheduled which are linked to a referral,
- Time to close referral loop back to referring provider (internal and external),
- Time to the third next available appointment,
- No show rates,
- Cancellation rates
There are three levels of data available for the reports above – data can be compared across the health care system, by department, or can be provider-specific. The full list of metrics, including the definition and formula used to for the metric, is available via SharePoint at this link.
(Note: If prompted to login to SharePoint, use the same login you use to access Epic@UNC. If that does not work, make sure you type “unch” before your username.)
UNC CareLink referral and lab orders available for many UNC Health Care locations
Since May 20, UNC CareLink users can electronically refer patients and place lab orders to UNC Medical Center, Rex Healthcare, Chatham Hospital and UNC Physicians Network. UNC CareLink is a component of Epic@UNC that provides external community providers and their staff with read-only access to their patients’ medical records. Nearly 3,500 community users across 35 counties are already using UNC CareLink.
UNC CareLink also provides the ability to upload medical records and access to phone and fax numbers of UNC Health Care clinics. In the future, a radiology referral order option will be added.
These referral orders go directly into Epic@UNC workqueues and are managed by the appropriate staff at UNC Health Care. When a CareLink referral order comes into a work queue, it will arrive as an “incoming” order and fall into the receiving department’s “Orders Ready to Schedule” workqueue. Please see this tip sheet or video for more details.
Note the following:
- Referral orders will no longer occur through myUNCreferral.com effective July 1, though staff should manage all outstanding orders placed in myUNCreferral.com. The Infina Portal at Rex will remain open and operational.
- Electronic referrals and lab ordering are not yet available for Go-Live #3 locations. These locations will receive this functionality in the future.
The Referrals workgroup meets regularly with the goal of improving the user experience when requesting and receiving referral orders. The Workgroup developed the following guiding principles to ensure patient safety, efficiency, service excellence, quality and accountable care when sending and receiving referral orders:
- Clinic medical directors and administrators are responsible for clinic compliance and are expected to have a defined process to:
- Manage referral orders;
- Utilize metrics to determine areas of referral service delays; and
- Utilize Epic@UNC reports to track referral orders through completion
- Scheduling an appointment requires a direct dialogue with the patient/guardian. No appointments are to be scheduled “unilaterally” or request the patient to call back to reschedule.
- Staff will “close the loop” for both internal and external referrals by following up on each referral order to ensure that results are received and the ordering provider is notified.
- The “orders to review” and “orders to schedule” workqueues are to be managed daily.
Understanding and properly using correct referral terminology is important:
- “Internal Referral” – A referral that is staying within the Epic@UNC system. For example, a referral from a UNC Physicians Network primary care practice to a UNC Medical Center specialty provider.
- “External Referral” – A referral that is going outside of the Epic@UNC system. For example, a referral from a UNC Physicians Network practice to a Vidant provider. This could also be a referral to any clinical operation not on Epic@UNC regardless of affiliation.
- “Incoming Referral” – A referral received from outside the Epic@UNC system.
- We know there is more work to be done to improve the referrals process. The next focus area for the team involves communication back to the referring provider (‘closing the loop’).
- The Referrals and Access Workgroup is working closely with Dr. Matt Ewend, chair of Neurosurgery at the UNC School of Medicine, who leads the Carolina Value “Care Access” team. The two teams plan to work together to address issues identified during the Carolina Value project that will help improve the referral orders process.
- Please continue to share your feedback on the items above and any other ideas you have to improve this process with your manager.