Efficiency Gains for Rheumatology Consultation Using a Novel Electronic Referral System in a Safety Net Health Setting.

The use of health information technology (HIT) in rheumatology holds promise for increasing access to rheumatologists, improving the quality of referrals and efficiency in the referral process. The study evaluated the use and impact of a novel electronic referral (eReferral) system in rheumatology in a safety net health system. The study found that pre-consultation exchange was used for a majority of rheumatology eReferrals in the safety net health system, and the use of pre-consultation exchange was found to be appropriate for a majority of referrals. eReferral allowed 25% of referrals to rheumatology to be triaged or managed without a scheduled appointment. Reviewer response time averaged between 1 to 4 days, and agreement between rheumatologists reviewing eReferrals was generally high.

The data demonstrated that the use of pre-consultation exchange utilising an HIT-enabled solution was well utilised after implementation, with almost three-quarters of rheumatology referrals undergoing such exchange as the system matured. This increase is suspected to be multifactorial, as both primary care providers and the reviewing specialist became more comfortable with the system. Corroborating findings in other studies, eReferral has been found effective in streamlining the referral process in other specialties. Additionally, the study supports the findings in two earlier studies done in rheumatology demonstrating that use of non-electronic pre-appointment management can increase access to rheumatologists. The stable wait time between 70 to 80 days in the setting of an increased volume of patient referrals suggests that eReferral improves access to specialty care.

The use of HIT to facilitate changes in the delivery of subspecialty care with primary care will likely be needed for specialties like rheumatology moving forward. HIT and pre-consultation exchange have the potential to help care for the increasing number of new rheumatology referrals, in the setting of rheumatology workforce shortages. The use of HIT and eReferral has had a positive effect with regards to primary care physicians. The use of HIT and pre-consultation exchange has the potential to help care for the increasing number of new rheumatology referrals, in the setting of rheumatology workforce shortages.

Scheibe MM, Imboden JB, Schmajuk G, Margaretten M, Graf JD, Chen AH, Yelin EH, Yazdany J. Efficiency Gains for Rheumatology Consultation Using a Novel Electronic Referral System in a Safety-Net Health Setting. Arthritis Care Res (Hoboken). 2015 Aug;67(8):1158-63. doi: 10.1002/acr.22559. PMID: 25623810; PMCID: PMC4515392.