This blog post is part of an ongoing series on the RxRM initiative at PowerObjects—configuring Microsoft Dynamics CRM to address the highly specialized needs of healthcare organizations. This post features guest blogger Timothy Pratt, Ph.D., Solution Design Consultant for the Health and Life Sciences at PowerObjects.
What is RxRM?
Microsoft Dynamics CRM is a powerful development platform for a broad range of business relationships, and is commonly referred to as "XRM" in non-traditional applications, often "built-to-order." In healthcare, due to its complexity, regulation and ramifications (someone's health is, after all, often a matter of life and death!) highly specific product CRM/XRM development undertaken in conjunction with clinical experts can be appropriately spoken of in terms of "RxRM" These are processes and methodologies appropriate for healthcare activities are developed and proven, and then configured as needed for the individual circumstances rather than built from the ground up in every instance.
How the physician referral process typically works
When considering the continuum of care for most patients, it is very often the case that the primary care provider (PCP)—which could be a physician (MD), nurse practitioner (NP), physician assistant (PA), etc.—may refer the patient to another provider for specialist opinion or treatment. This is commonly called a referral, and this seemingly simple process looks something like this:
This belies the many points of failure and problems that are commonplace in the process today. A number of effects arise from the "usual" referral process: dissatisfaction/frustration, less-than-desirable patient outcomes, reduced productivity, missed opportunities, unnecessary cost overheads. Worse still, problems with referrals have been identified in 55% of malpractice lawsuits as contributing factors (See Brigham & Women's research paper below).
Common problems with physician referrals and ongoing care
Patients referred for specialist consultation commonly go through a process where the PCP requests their clinic's scheduling assistant to make an appointment for the patient for a particular service. It is at this fundamental point that problems begin to emerge. Difficulties in communicating with the specialist clinic (usually by phone) means the patient is often simply given contact details and requested to make their own appointment—and over 20% of the time they don't. Almost always, if the patient is a no-show, the PCP will not become aware of the issue until the next time the patient is seen at their clinic. This can be months or even years into the future, by which time easily correctible conditions may well have become serious and intractable.
Assuming patients do make the specialist appointment, they often arrive ill-prepared. The PCP may not provided adequate information about their condition, or they may not be appropriately prepared (such as fasting, when to take medication, etc. In turn, PCPs often express frustration about not receiving feedback/diagnoses/treatment from the specialist after the patient visit. This occurs far more often than anyone interested in quality health outcomes would prefer.
RxRM Physician Referral Management as a solution
EHR, varying as it does across practices and institutions, and being primarily concerned with managing individual patient encounters, is not the answer. So what is? Well-designed Dynamics-based RxRM physician referral management (PRM).
Appropriately designed PRM can critically contribute to specialist clinic or services success on both the strategic and tactical level. Implementing such a system would allow specialist practices to:
Increase patient and PCP scheduling satisfaction and increase actual referral visits scheduled
Decrease "no-shows"; enhance PCP awareness of potential problems
- Workflows trigger predefined phone and email RxRM PRM system communication to patients with visit reminders, additional information, etc.
- PCPs automatically notified if the patient fails to make the scheduled appointment, enhancing their ability to provide comprehensive care and condition follow-up
Increase visit productivity
- RxRM PRM ensures basic patient, problem and treatment detail accompanies each patient
- Context sensitive up-to-date patient preparation information is automatically available at time of referral appointment scheduling
Track referral patterns; identify growth opportunities
The analytics capabilities of the Dynamics CRM platform are ideally suited to map referrals over time by PCP clinic, provider, condition, region etc.
- Trends and splitting behavior can be easily identified and PCP outreach campaigns developed and executed from within the system
Ensure timely PCP communications; enhance PCP engagement
Using the mail merge and template functions, automatically generate post-visit letters back to the referring PCP
- The Dynamics platform makes it easy to have context (diagnosis) sensitive block content available while still allowing flexibility to add or modify letters to reflect findings for the individual case
Using the campaign "marketing" functions, regularly schedule update-type communications via email fax or letter to increase PCP clinic engagement, for example -
- New/changed Specialist services offered
- Clinical research news
- New therapies and therapy guidelines
Beyond the basics outlined above, a PRM system could be configured to add further value without great difficulty in most cases. For example, specialists often require test and diagnostics from other providers as part of the process of diagnosis and treatment – these activities and associated documentation can easily be handled by the Dynamics platform. CPT, ICD-9, DRG, APC etc. codes can be loaded into the system for automatic, semi-automatic or manual assignment for tracking and billing purposes – the fewer systems personnel need to use to complete their work the more productive they're likely to be, and the benefits of working with a common set of tools/interfaces such as that provided by Microsoft and the dynamics platform are well known.
Brigham & Women's Hospital, MA: Research involving 84 PCPs and 405 Specialists – details problems and the utility of electronic referral management systems in improving communication and outcomes.
American Academy of Family Physicians: article detailing referral access problems, identifies need for process to ensure all relevant PCP information provided to specialist and audit metrics.
JAMA Archives of Internal Medicine Journal, January 2011: comprehensive analysis of data from >4700 physicians highlighting ongoing problems with Specialist-PCP communication.
About Our Guest Blogger
For the past 25 years, Dr. Timothy Pratt has worked around the globe both as a clinician and technology solutions designer/advocate in the life sciences and healthcare industries enhancing patient care, profitability and productivity in areas including clinical trial operations, practice/market development, sales and systems integration. Leveraging post-graduate qualifications in cardiology, cardiac electrophysiology, critical care, psychiatry and business, Dr. Pratt has assisted organizations from small start-ups and clinics to Fortune 500 enterprises source and adopt technology solutions that dramatically improve outcomes for patients, practices, life science companies and hospital systems. A firm believer in automating processes to reduce costs and provide visibility into critical data, Pratt is known for his work as a long-time member of the Applied Clinical Trials Journal editorial advisory board and many publications and lectures regarding information technology use in the healthcare and life sciences space.
At PowerObjects, Dr. Pratt's role is to collaborate with healthcare organizations to drive the design and delivery of technology solutions that run the gamut from referral management, community outreach campaigns, clinical trial operations systems, chronic disease management, grant management, safety surveillance/monitoring and health maintenance/prevention programs.