The nation’s biggest public health system is seeing a faster turnaround in referrals for certain medical specialties and a big drop in the time its gets patients scheduled for specialty office visits.
What’s accounting for the success at NYC Health + Hospitals, which operates Bellevue Hospital in New York City and serves 1.4 million patients, including more than 475,000 uninsured patients annually, is the continued expansion of a system wide electronic referral tool linked to the health system’s electronic health records system.
Since NYC Health’s eConsult system was initially piloted at two hospitals starting in August 2016, the new electronic referrals system has been expanded to include NYC Health hospitals such as Bellevue, Coney Island, Harlem, Kings County, Jacobi, Lincoln and /Woodhull and to 81 specialty clinics from 29 clinics.
The number of monthly referrals also has increased to about 4,100 from 2,300, the health system says. More important, for patients referred for a specialty care visit, the median wait time decreased from 50 days to 28 days in June 2017. For patients who needed a high urgency specialty visit, the median wait time for a visit over the same time period decreased from 30 days to 16 days, says NYC Health director of specialty care transformation in the office of population health Hannah Byrnes-Enoch. “By having a significant number of patients managed in the primary care setting and by reducing the number of inefficient first visits to specialists, we have freed up valuable appointment time with our specialists, which makes a huge difference for patients,” she says.
Using the new electronic referral system, primary care providers and specialists can communicate and co-manage patients when appropriate. The system also helps physicians more efficiently connect patients to specialty care when needed, says NYC Health.
For example, when a primary care doctor’s patient has a health concern that would typically be treated by a specialist, the physician can send a message through the system and expect a quick response from the specialist regarding the next steps for the patient as well as making a referral. A specialist might also recommend the primary care physician prescribe a certain medication and give guidance about tests and imaging studies that the patient should undergo before determining if a specialty visit is needed.
When a specialist visit is necessary, the specialty clinic next contacts the patient directly to schedule an appointment. Since the eConsult system has been implemented, more than 3,600 NYC physicians have used it to make more than 50,826 referrals to endocrinologists and other specialists. “Specialists like oncologists, orthopedic surgeons, and ophthalmologists often play a critical role in diagnosing and managing our patients’ illnesses,” says NYC Health vice president and chief population health officer Dave Chokshi, “EConsult helps facilitate more rapid access to specialist expertise, which is a priority as we continuously work to improve patient care.”
NYC Health continues to make the rollout of more digital healthcare a priority. In October, NYC Health announced it has finished the first phase of a $1 billion, multi-year implementation of an Epic electronic health records system that will eventually have more than 40,000 users.
So far, four hospitals, 25 community ambulatory care sites and 14,000 users are active on the new electronic health records system, says NYC Health.
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