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Online Referral, Consultation System Improves Access to Specialty Care

An online system connecting primary care providers and specialists at San Francisco General Hospital helped shorten wait times for specialty services and improved the coordination of care, according to a commentary in the New England Journal of Medicine.

SFGH, a safety-net hospital partnered with the University of California, San Francisco School of Medicine, created a web-based referral and consultation system called eReferral. When primary care providers refer a patient to a specialist, an electronic form with the patient's information is automatically filled out and a physician in the role of "specialist reviewer" reviews and evaluates the request. This process allows the specialist reviewer to seek clarification about the request, recommend additional evaluation or recommend an alternate site of care before a patient is scheduled.

Prior to implementation of eReferral, patients would wait 11 months for a routine clinic appointment for gastroenterology, 10 months for nephrology and 7 months for endocrinology, according to the report. With eReferral, the co-management of care by primary care providers and specialists reduced the volume of specialty clinic visits, shortening the wait time for an initial consultative visit from 112±74 days to 49±27 days within one year, according to the report.

The authors hold that eReferral is useful for not only improving access to specialty care, but also for coordinating care, educating providers through consultation and reducing costs through fewer unnecessary specialist visits, according to the report.  

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