In the new value-based health economy, payers and health systems are employing new technologies to help increase revenue and to help coordinate care and improve efficiency. Specialist referrals occur every day in the outpatient setting, yet the referral process continues to operate without the data-driven precision needed for true patient-centered care.
In the nonelderly population, about one in three patients each year is referred to a specialist (Forrest, Majeed, et al. 2002), and among the elderly, on average two referrals are made per person per year (Shea et al. 1999). However, 20-40% of referrals are never completed which can lead to unnecessary hospitalizations and ED visits, as well as reduced patient satisfaction.
As more and more patient data is captured electronically, whether in electronic health records or in electronic claims, health care providers are able to leverage this data through enhanced point-of-care tools such as appropriate use criteria for lab and image ordering and clinical decision support that efficiently identifies a patient’s preventive care needs. However, patient-specific clinical decision support has not made its way to the referral process. Doctors in Touch was built to leverage data from payers, health plans, and large health systems to help identify the most appropriate specialists for any patient based on demographic and clinical data similarities.
What it does
When a primary care provider needs to find a specialist for a particular patient, they can use Doctors in Touch to query a network of providers. Using the patient’s diagnoses and services from previous claims or their electronic health record data, Doctors in Touch will provide a list of recommended specialists whose current patient populations match the patient in need of the referral - taking into account both demographic and clinical data including diagnoses and medications. By humanizing and personalizing the specialist referral process, primary care providers will be able to efficiently identify relevant specialists and patients will feel more engaged, leading to improved patient satisfaction and health outcomes.
How I built it
The prototype retrieves data from the Athena Health EHR API, determines the likely specialist to refer to, and uses the Better Doctors API to show physicians in that specialty.
The MVP would use diagnostic codes from either an EMR or billing system to match the case of the patient being referred to cases seen by potential specialists. The referring physician would be shown by default the specialists that have the most experience treating patients with cases similar to their patient.
Challenges I ran into
Finding a reliable and HIPAA-compliant source of patient population data for a network of providers was one challenge that needed to be addressed. Deciding to make the target purchaser of the product health plans, payers and/or health systems resolved this problem since using patient data for the purposes of improving the efficiency and efficacy of referrals within the network would be considered using PHI for healthcare operations. Doctors in Touch would become a Business Associate to the payer/health plan in order to deliver this service.
What's next for Doctors In Touch
Continue to work with potential stakeholders to refine the product while, in parallel, developing a more data-driven algorithm for matching patients to specialists.