Interoperability may be boring, but it presents the opportunity to put the fax machine where it belongs – in the past.
Standardised national referral rules and technology could finally spell the end of days for the seemingly unkillable fax machine, multiple GP software vendors tell The Medical Republic.
The Medical Software Industry Association, which represents companies like Best Practice, Tyro Health and HotDoc, emphasised the importance of referral reform in its submission to the Department of Health, Disability and Ageing’s consultation on modernising referral pathways.
“Reform of eReferrals directly impacts high-volume clinical workflows, interoperability architecture, billing logic and patient-facing documentation,” the submission read.
“Durable reform depends on sound policy design and practical implementation settings. It must reflect how software systems currently operate across mixed paper, fax, secure messaging and API-enabled environments.”
The association cited ePrescribing as one area where government successfully worked with industry to deliver a digital solution to a largely paper-based system, calling referral reform “arguably less challenging”.
Standardising referral information is the first step.
Beyond the general rules that referrals must include relevant clinical information, patient identifiers, a date and a referrer signature, there are no hard and fast rules on referral format or additional information to be included.
There is no shared standard for core elements and attachments. Where one hospital system might be able to digitally accept referrals in a certain template, the neighbouring hospital district may require that same referral to be sent in using a different digital template or via fax.
This could be solved by creating nationally agreed minimum datasets for referral types and interoperable specifications.
Besides killing the fax machine forever, digital referral systems could potentially allow GPs to respond to queries from non-GP specialists and edit referrals which have already been accepted, avoiding the administrative work of a referral being rejected on the grounds of, say, a missing test.
“Over 80% of GPs have some sort of clinical system in their practice, and yet there are many hospitals that are still more than 80% reliant on paper referrals,” InfoMedix COO and MSIA member Kim Gilbert O’Dowd told The Medical Republic.
“It just makes no sense … I think it is really important that we push for [referrals] to be digital first, because the stats are there in terms of the benefits associated with digital referrals.”
Ms Gilbert O’Dowd said the ideal solution wouldn’t be one single, nationalised referral system, but instead it would be a patchwork of bespoke systems which would be able to speak to each other.
“There’s already a big ecosystem there,” she said.
“And not to say I’m jaded, but if you look at Australia’s track record for building a single national system – it’s not great, you know?”
The InfoMedix COO pointed out that, while there is a plethora of innovative digital health pilot programs across the country, very few made it to the point of full national scalability.
“I think we just really need to focus on standards for hospitals that they can adhere to, and then giving them the freedom to implement them,” Ms Gilbert O’Dowd said.
“Like, if you’re Optus and I’m Telstra, I can still text you. It doesn’t need to be a single system for everyone.”
The MSIA submission backed reforms that would target digital referrals specifically.
“Reforms should explicitly target avoidable repeat GP consults undertaken solely to renew an unchanged referral or to obtain additional referrals for administrative reasons,” the MSIA submission said.
“It should avoid specialist appointments where advice-only would suffice.”
Somewhat controversially, the MSIA supported the government proposal for longer default referral times, an idea which was roundly criticised by the AMA in its own submission.
The AMA argument is that strict 12-month referral periods are necessary to ensure that patients regularly check back in with their GP.
MSIA member Associate Professor Vikram Palit, who is CEO of specialist-to-specialist referral software Consultmed, told TMR that the technology already exists to keep GPs and specialists up to date with a patient.
“We don’t need to rely on referrals for three- and six- month periods to be up-to-date with where patients are in their care,” he said.
“The technology has now enabled that, and we can move past this administrative layer that I think was useful previously, but hasn’t kept up-to-date with modern tech and the modern way we look after patients.”
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Dr Carmel Cervin, CEO of referral management service Cervin, said that digital referral systems where hospital specialists could receive updates from a patient’s GP already existed in New Zealand.
In New Zealand, she said, GPs are able to write an addendum to an existing referral without reissuing it.
“A referral system isn’t a regulatory structure, it’s a functional one,” she told TMR.
“The [government] need to be thinking about the functions that need to be supported as much as anything.
“The AMA was pointing to the information gap [between the GP and non-GP specialist] and how that’s not helpful clinically, but [we think] the solution is better functionality to support that gap.”
The MSIA also supported the government proposal to mandate the inclusion of certain additional materials, such as a link to the Medical Costs Finder website, but felt that it should go further than simply explaining potential fees.
“Alternatives should be welcomed as the Medical Costs Finder has not been effective, so more future-proofed robust alternatives for patients and providers should be facilitated,” the MSIA wrote.
“Outcomes based requirements will enable greater ability for specialists to shape their practice speciality, so they see the patients they are best qualified to help. Likewise, patients will be empowered to make the best choice for their specific context.
“Cost transparency is important, but just one element of a referral.”
