For many patients, a visit to a primary care provider is just the first stop on a long journey through the healthcare system. Getting to the second -- moving from the PCP to a suggested specialist -- can take a very long time.

For example, according to a recent article in the New England Journal of Medicine, a 2005 internal study at the San Francisco General Hospital found that patients were waiting an average of 11 months for an appointment in the hospital’s gastroenterology department, 10 months for nephrology and seven months for endocrinology.

As Alice Chen, MD, director of the eReferral program at SFGH, recently summed it up, "We had untenably long wait times, and we didn’t have a way to triage those patients who needed care most urgently."

In response to those findings, SFGH developed the eReferral program, a Web-based, specialty referral and consultation program that enables PCPs connected to SFGH to communicate more thoroughly with specialists, while enabling patients to benefit from the greater efficiency and more in-depth care.

As Chen described it, the eReferral program has helped SFGH providers move beyond "hand-scrawled notes that are then faxed over to clinics." Now, an electronic form is automatically filled out with information about both the patient and the PCP, along with the reason for the referral request and the relevant case history and exam results.

That form is then reviewed by a "specialist reviewer," who often begins to co-manage the case with the goal of ensuring that subsequent care is delivered more efficiently and in a timely fashion. According to Chen, there are three benefits to the eReferral system:

1. It enhances provider to provider communication. "A big part of healthcare is contingent upon providers talking to providers on an efficient and timely basis," Chen pointed out. With the addition of a de facto case manager via the eReferral system, specialists have a clearer understanding of the cases before them when they first see the patients, and PCPs have been able to provide more comprehensive care before reaching out for consultation.
2. It enables providers "to fill in the inevitable blanks." A PCP herself, Chen noted the time constraints providers are under as they move from patient to patient throughout the day. That pressure can lead to oversights in case documentation, but the additional eyeballs in the form of the specialist reviewer means those blanks will be noticed and corrected, and additional information can be requested as the reviewer deems necessary.
3. It makes first visits more effective, and the PCP to specialist process more efficient. "We want that first visit to be as efficient as possible," Chen said, meaning not just that the visit itself is conducted smoothly, but that it also enhances the effectiveness of the overall care continuum. She added that, now, "within 72 hours, referring providers are getting feedback from reviewing physicians."

Since implementing its eReferral system, Chen said, SFGH has reduced the wait time in its gastroenterology department from 11 months to four months, and the system is now used by 40 SFGH departments.

And don’t think others haven’t noticed. Chen said the SFGH eReferral system is "being actively piloted" by L.A. County hospitals, and the process is being explored by other California counties as well as by hospitals associated with Harvard University.

[See also: Specialty practices grapple with unique EHR barriers]