CMS Closed-loop Referral: OCHIN Ahead of the Curve

By Ben Pierson, Program Manager, Interoperability and Health Information Exchange

The Centers for Medicare and Medicaid Services (CMS) have defined an objective around closed-loop referrals (1). The Health Resources and Services Administration (HRSA) is considering adopting the CMS measure for inclusion with their UDS reporting requirements in the future (2). Closing the loop on a referral involves the sending provider receiving a report from the receiving provider after completion of the visit that resulted from the referral. This has long been a common practice in clinics, with specialists faxing encounter reports to the primary care provider (PCP) after they see one of the PCP’s patients. This is important for care coordination, and ensures the patient will receive any necessary follow-up care. However, it has always been a time-consuming process because it requires printing, faxing, and scanning, and it does not involve the exchange of discrete data.

Fortunately, a method already exists to manage this process electronically and automatically, and OCHIN has played a pioneering role. In November of 2015, OCHIN and Boston Medical Center (BMC) were the first organizations to go-live with Epic’s Care Everywhere Referrals Management (CERM) solution for Epic-to-Epic closed-loop referrals. At the time, this was a brand new way to manage the referral workflow between provider organizations, and required a lot of effort to effectively implement. Today, that process is much more streamlined, and is being rolled out across the collaborative to other OCHIN member organizations.

OCHIN has made this CERM connection with BMC available to ten organizations in Massachusetts, and recently implemented a new CERM connection in Bend, Oregon, that is primed for expansion. Additionally, OCHIN has been reaching out to other Epic organizations around the country identified as significant referral partners for our member clinics. OCHIN’s goal is to implement CERM with every organization with whom our clinics might exchange a referral.

With CERM in place, the sending and receiving organizations are able coordinate management of the referral through the automatic synchronization of certain referral items. The sending organization is made aware of when the patient is scheduled for an appointment, and the receiving organization is able to easily request additional information to assist them with coordinating the referral visit. Once the patient is seen at the receiving organization, the patient’s PCP can be automatically notified of this through an InBasket message which will include the encounter note.

Feedback from clinics with CERM in place has been very positive, due in large part to the time savings for providers and support staff. In other implementations around the country, the true impact has been measured. After Sutter Health in California, implemented their own CERM instance, they saw a drop in the time from when a referral was ordered to when a patient was seen by the receiving organization of 22+ days down to 1-2 days. This kind of impact can be felt by the patient, greatly improving their satisfaction and perception that their providers are truly connecting over their care.

OCHIN will continue working with member clinics and their Epic referral partners to implement CERM as widely and rapidly as possible. Looking farther into the future, OCHIN also has an eye on Project 360X (3) which aims to bring this fully-electronic closed-loop referral process to disparate EHRs.