consultloop http://www.consultloop.com ConsultLoop Mon, 20 May 2019 10:33:43 +0000 en-US hourly 1 Let’s #Axethefax, but with Surgical Precision http://www.consultloop.com/lets-axethefax-surgical-precision/ http://www.consultloop.com/lets-axethefax-surgical-precision/#respond Mon, 10 Dec 2018 17:48:44 +0000 http://www.consultloop.com/?p=5548 The NHS announced that it is banning the purchase of fax machines next month with the aim to phase them out entirely by April 2020. This was met with near-universal approval on social media among physicians, policy-makers and […]

The post Let’s #Axethefax, but with Surgical Precision appeared first on consultloop.

]]>
The NHS announced that it is banning the purchase of fax machines next month with the aim to phase them out entirely by April 2020. This was met with near-universal approval on social media among physicians, policy-makers and patients. At ConsultLoop, we are certainly pleased to see this as well, but believe that a more careful approach is needed to be effective.

ConsultLoop was started to address gaps in communication between healthcare providers. As family doctors new in practice, we were surprised at how commonplace these gaps were, and how universally accepted they seemed to be. Since virtually all communication between doctors’ offices occurs by fax, this had to an important area to learn more about.

We came across a study done in Hamilton, Ontario, which reported that 21% of all faxed referrals “get lost”. We read the news stories about patient records being faxed to a wrong number for years. We then decided to create a referral platform to replace the fax.

With the announcement of the NHS’ ban on new fax machines, the question is whether we will see the same change in Canada. Let us first ask why we are in this situation to begin with. As Andre Picard rightfully points out, “… the single biggest impediment to banning the fax is that the computer systems and electronic health records that we have are rarely able to communicate with each other. Interoperability has not been a priority and that has left us beholden to largely paper-based technology.”

Given that our computer systems don’t talk to each other, and have no incentive to do so, let’s ask how we can wean off, rather than axe, the fax. Yes it’s less dramatic, but it’s possible, and possible now, and much more promising.

The ConsultLoop platform helps clinics manage the referrals that they send and receive by providing a simple dashboard that shows the status of all referrals, and what the next step is. This also includes a patient notification system, so that patient can track the status of their referral much like they would track delivery of a package, and get email or text-based notifications. We also developed Ontario’s largest specialist directory that includes clinical scope of practice, wait times, and response times. (We published a report last month on wait times and response times for 26 specialties.) In October 2018, we reached a milestone of 25,000 referrals.

So how do we as a health care system move on from fax? Well, given that EMR companies in Canada do not readily integrate with third-party vendors like their international counterparts do, we chose to augment rather than outright replace the fax. After all, a key feature of any new system is that it must facilitate communication to anyone in the healthcare system. A purely digital system would remain unused otherwise – imagine Ebay with no sellers, AirBnB with no apartments, Uber with no drivers.

ConsultLoop works best when the sending and receiving clinic are on the platform. They can write messages to each other, for example to request additional information, can reply to referral requests within the platform so it’s instantly communicated to the patient and referring clinic, and of course all this is secure, encrypted and audited for patient safety and privacy. When a specialist is not on ConsultLoop, we will send the referral along by fax, but augment it in four key ways:

  1. Every referral is sent to our one fax intake number – no wrong numbers, changed numbers, etc.
  2. A referral is flagged until the referral documents are received by the sending clinic.
  3. We perform audits of our e-fax logs twice a week to ensure all transmissions were successful.
  4. We send a follow-up fax at 2, 3, and 4 weeks if the referral has not been booked, often re-sending referrals lost in the pile of papers at the specialist’s office.
  5. (For some paying customers) We will call the specialist’s office to follow up, which we can do at scale for all our customers who referred to that office.

We are creating a digital platform for referrals, and eventually, all communication between offices. Right now, we, like other new-wave digital health companies, are beholden to EMR integration and the lack of it. However, we are providing an essential security layer above the fax, and as more clinics join the platform, we will evolve into a fully digital communication system for clinics, doctors, and patients. Whether EMRs participate is their choice to make.

We should aim to #axethefax. But a fax-free future begins by augmenting it with a digital layer and slowly cutting the ties that bind. After all, the fax is universally accepted, and for a digital platform gaining traction, that’s an essential feature. Let’s move on from fax with with surgical, rather than lumberjack precision.

To learn more about how ConsultLoop can add security, efficiency and transparency for your clinic-to-clinic communication, email us at hello@consultloop.com.

The post Let’s #Axethefax, but with Surgical Precision appeared first on consultloop.

]]>
http://www.consultloop.com/lets-axethefax-surgical-precision/feed/ 0
The ConsultLoop Wait Time Report: Data Shines Its Light http://www.consultloop.com/consultloop-wait-time-report-data-shines-light/ http://www.consultloop.com/consultloop-wait-time-report-data-shines-light/#respond Tue, 20 Nov 2018 16:29:26 +0000 http://www.consultloop.com/?p=5545 The ConsultLoop Wait Time Report: Data Shines Its Light is available for download here. The wait to see a specialist is an important period in healthcare, both for the patient and the referring clinician. Patients describe this period […]

The post The ConsultLoop Wait Time Report: Data Shines Its Light appeared first on consultloop.

]]>
The ConsultLoop Wait Time Report: Data Shines Its Light is available for download here.


The wait to see a specialist is an important period in healthcare, both for the patient and the referring clinician. Patients describe this period as one of anxiety, frustration and confusion, where all they can really do is wait. For family doctors and nurse practitioners, it represents a delay in getting expert advice or treatments, which can sometimes be difficult to manage clinically and personally.

Being a period of transition, there is also a risk of faxes getting lost, a lack of coordination around notifying the patient, and a risk of no-shows due to none other than good intentions being wasted by bad processes. This compromises patient safety, patient experience, and does so at the expense of clinical overhead budgets. Physicians pay dearly for the manual, ineffective referral processes we have today.

Today, we release our report on wait times and response times in Ontario: “The ConsultLoop Wait Time Report: Data Shines Its Light”. We managed 12,468 referrals in the first 9 months of 2018, sent to 2,192 specialists in Ontario. This constitutes the largest dataset of referrals that we are aware of in Canada. At ConsultLoop, we calculate provider wait times and response times on a quarterly basis to update the the information for individual listings in our specialist directory, now including 5,500 specialists throughout Ontario.

For this report, we included all twenty-six specialties with more than thirty referrals over the study’s time period, and took an average of the wait times for providers in that specialty. The average wait between specialties is 61.7 days (range 29.5-98.2), lead by Sports Medicine, Infectious Disease and Cardiology as the specialties with the shortest wait time. We found that 42% of patients are seen within 4 weeks.

This study breaks new ground in reporting response times by specialty. We see here that the average response time between specialties is 19.6 days (range 11.6-28.3), lead by Infectious Disease, Cardiology and Rheumatology as the specialties who reply quickest to a referral request.

This report’s methodology is starkly different from others published by high-profile organizations such as CIHI/Commonwealth Foundation and HQO, and the Fraser Institute. None of these reports use actual referral journeys to gather their data, relying instead on smaller phone surveys of patients, or paid surveys of physicians. We believe that our report demonstrates the potential of digital health to provide a valuable service that improves quality, while generating the data to inform decisions happening thousands of times a day in clinical environments throughout the province.

You can download the full report here with its summary data tables. We hope that this not only sparks interest in our work, but in that of digital health companies, like ours, that prioritize connectivity, usability, and patient inclusion in order to generate data that is valid, relevant and impactful on individual patient journeys.

 

The post The ConsultLoop Wait Time Report: Data Shines Its Light appeared first on consultloop.

]]>
http://www.consultloop.com/consultloop-wait-time-report-data-shines-light/feed/ 0
ConsultLoop Reaches 20,000 e-Referrals: What’s next? http://www.consultloop.com/consultloop-reaches-20000-e-referrals-whats-next/ http://www.consultloop.com/consultloop-reaches-20000-e-referrals-whats-next/#respond Tue, 17 Jul 2018 14:21:32 +0000 http://www.consultloop.com/?p=5431 Just last week, we reached a major milestone at ConsultLoop. Our network of physicians has sent over 20,000 e-referrals through our platform. We’re thrilled with this for a few reasons, and look to the future with the same […]

The post ConsultLoop Reaches 20,000 e-Referrals: What’s next? appeared first on consultloop.

]]>
Just last week, we reached a major milestone at ConsultLoop. Our network of physicians has sent over 20,000 e-referrals through our platform. We’re thrilled with this for a few reasons, and look to the future with the same enthusiasm as a graduation day.

For a company started by three front-line family physicians, this is all about patients. We started this company because we kept talking about the same problems again and again when it came to patient referrals – how can we find the right resources, how can we have insight into wait times, how can we increase safety so referrals don’t fall through the cracks, and how can we make a better experience where patients are so often thrust in a passive and anxious role? By reaching 20,000 referrals, we have transformed the care journey for thousands of patients. Gone are the 21% of fax-based referrals that get lost. Gone are the days of phone tag communication with offices. This is a big impact in safety and experience, and patients seem to agree.

 

ConsultLoop_Feedback

By reaching 20,000 referrals, we accomplished something important as a business – we learned a ton. You can’t reach a number like this by doing one thing and keeping course. You have to listen to customers, understand the real-life constraints users face, and make changes along the way. We had to be agile, responding quickly and creatively to challenges with customers, competitors and business pressures. There are many examples of amazing things about our service that came out of this close, listening relationship: our directory of 5,000 specialists, capturing the time to reply to a referral, creating videos, posters, and even material in other languages, among many other things. And let’s be frank – doing these things does not mean we have enjoyed a parade of success. There have been challenges and failures, but our ability to get to this milestone means we have been able to meet them and react with ambition rather than retreat quietly.

Now that we’ve reached 20,000 referrals, what’s next? This is a great question and one we are very excited about. We still need to grow our network, continue expansion into more communities and build upon our current software – that job will never end. However, we are now in a position to do some really impactful things. For example, our data on wait times has tremendous value for measuring access and resource planning around health services in communities. We have used our data for good too, in measuring a gender bias in referral patterns following discussions on Twitter. We want to continue with this. But more importantly, we see a key asset as an area for future growth – our relationship with patients.

We believe that for any health care entity – company, clinic or institution – to have an impact and a future, it must serve patients well. We know patients are satisfied with getting referrals through ConsultLoop. However, we have tons of ideas on how to improve their journey during a referral, as well as before it and after it. We have created a small, focused digital link between patients and their physicians’ offices, and see many opportunities to expand that into other areas of communication, data access, and other ways to shine light on the shadows of uncertainty, apprehension and disempowerment that can sometimes affect patients.

As we look to our next chapters, we will remain true to ourselves – practicing physicians who care for our patients, our colleagues, and for our publicly-funded system. We will celebrate having reached this milestone of 20,000 referrals, and all the lessons we’ve learned. Today, we set our sights on improving other aspects of the health care journey, and it will be done through the patient. We will have some exciting announcements in the coming months in important areas such as mental health, and in the patient experience with our software. We know we can’t do this without a robust, trusting and empathetic relationship with patients, and many patients have inspired us on Twitter and in real life. We look forward to working with patients in co-design, advisory capacities, and to be inspired by their stories and experiences. We look forward to our next achievements. We look forward to the new chapter in ConsultLoop’s journey, and in healthcare’s journey, that we will write together.

The post ConsultLoop Reaches 20,000 e-Referrals: What’s next? appeared first on consultloop.

]]>
http://www.consultloop.com/consultloop-reaches-20000-e-referrals-whats-next/feed/ 0
The ConsultLoop Directory: A living, breathing look at our healthcare system http://www.consultloop.com/the-consultloop-directory-a-living-breathing-look-at-our-healthcare-system/ http://www.consultloop.com/the-consultloop-directory-a-living-breathing-look-at-our-healthcare-system/#respond Thu, 21 Jun 2018 21:03:39 +0000 http://www.consultloop.com/?p=5423   To family doctors and nurse practitioners, this situation is as familiar as the common cold. You have a patient in front of you, and you need to consult a specialist for help, treatment, advice or any combination […]

The post The ConsultLoop Directory: A living, breathing look at our healthcare system appeared first on consultloop.

]]>
 

To family doctors and nurse practitioners, this situation is as familiar as the common cold. You have a patient in front of you, and you need to consult a specialist for help, treatment, advice or any combination of the above. Maybe you have a trusted colleague in mind, but what if you don’t? What if the patient lives further away and wants to see someone closer to their home? What if the issue is specific enough that you need to find a sub-specialist, but don’t want to risk sending the referral to someone who does not see patients with that issue? What if your patient is simply struggling with their health issue and you want to find them someone sooner? (Of course, we hope you’ve considered e-consults too.)

As common as these situations are, much like the common cold, they remain unsolved for most of us. You can ask a colleague, but if you don’t know where to send a patient with a colloid cyst in their brain, they likely don’t either. You can check the CPSO, but as we all know, simply being an orthopedic surgeon is no guarantee that they can address your patient’s foot problem. Some LHINs have put together their own directories, but considering the average doctor refers across multiple LHINs, they are fairly limited, stale, and lack wait time information. You can get on the phone and make calls, but aren’t you and your staff busy enough?

It is from these limitations that the ConsultLoop Directory was designed, by family doctors, for family doctors. Here’s how the ConsultLoop Directory takes the stale directories of yesteryear to the next level:

  1. Practical: We developed a list of questions for each specialty to find out what conditions the specialist focuses on, and common reasons for referrals to be declined. This reduces the risk of having a patient wait weeks only to find out the referral must be redirected.
  2. Up-to-date: Using the thousands of referrals made each month in our network, we are able to report average wait times, and the average time it takes to reply to a referral request. The use of the directory and our referral platform keeps the information current.
  3. Centralized: As we receive new information, we update our directory so that is available to all our clients. Did the local hospital open a new clinic? Did the cardiologist down the hall retire? A centralized directory keeps everyone up-to-date without making each clinic find out about changes on their own, or worst case, through a delay and declined referral.
  4. Searchable & Sortable: Like most directories, you can search by name, description of what services are offered, and geography. However, you can also sort by wait time, and the ConsultLoop Score, a composite measure of how often and how quickly the doctor or clinic replies to referral requests. Pretty cool, isn’t it?

Our directory now includes over 5,000 specialists, specialty clinics, and centralized intake lines. Our most recent quarterly wait time update changed the wait time for over 600 specialists, showing that the data must be updated and tended to, like a garden. And of course, we have our team looking after this with dedication and care.

We know that there are many alternatives to the ConsultLoop Directory, but ours is the only one that has practical information on scope of practice, wait times, and is kept updated organically. Why use anything else?

To join the ConsultLoop network, gain access to the directory, and improve how you manage referrals, visit us at consultloop.com, or email us directly at hello@consultloop.com.

The post The ConsultLoop Directory: A living, breathing look at our healthcare system appeared first on consultloop.

]]>
http://www.consultloop.com/the-consultloop-directory-a-living-breathing-look-at-our-healthcare-system/feed/ 0
Access to Speciality Care: What can we learn from 1379 specialists in Ontario? http://www.consultloop.com/access-speciality-care-can-learn-1379-specialists-ontario/ http://www.consultloop.com/access-speciality-care-can-learn-1379-specialists-ontario/#respond Mon, 09 Apr 2018 14:10:16 +0000 http://www.consultloop.com/?p=5229 As a health technology company, we have an exciting opportunity to harness data and improve people’s access to healthcare. This is what every company is ultimately trying to achieve, and data is a terrible thing to waste in […]

The post Access to Speciality Care: What can we learn from 1379 specialists in Ontario? appeared first on consultloop.

]]>
As a health technology company, we have an exciting opportunity to harness data and improve people’s access to healthcare. This is what every company is ultimately trying to achieve, and data is a terrible thing to waste in this endeavour. Through a series of posts, we hope to show you a little bit more about the data we collect, how we use it, and the impact it can have. In this post, we’ll show you how we update wait times.

 

Wait time data from real referrals

Every couple thousand referrals, we update the wait times, response times, and ConsultLoop score for all the specialists on our directory. How do we do it? Let’s show you.

First, we compile all the referrals made in the last 6 months across our network. For each specialist, we tally how many referrals were requested of them, how many got booked, the average wait time, and how long it takes for them to respond to a referral request. This allows us to report wait 0 (time it takes to book), wait 1 (wait time to be seen), and their response rate.

This latest round saw us collect data on 1379 specialists who received a referral request in ConsultLoop. They spanned ten LHINs, and 36 specialties.

Have a look at this map of the specialists included in this analysis.

Screenshot 2018-03-24 00.15.14

 

Of these specialists, we had enough data to provide an average wait time and response time for 825 of them. This is the information that is then updated in our specialist directory for referring clinics and their patients to consult when making a referral. This provides an updated and current directory of wait times on top of the descriptions, scope of practice, language and location information that’s already displayed and updated for each specialist. You can imagine the impact on access when we have this insight at the time a referral is being made – in fact, we often hear people hear of what we do and say we’re like the Waze of healthcare.

 

What do wait times look like?

Here is how the wait times break down.

Wait Times to see a specialist (Wait One) in Ontario

Here is the breakdown by response time reported as a decay curve – what percent of referrals are still pending by the number of days since the referral was first requested? It should be noted that these results regarding pending referrals are not generalizable – we follow up with specialists through several touchpoints in ways that a regular clinic is unable to do, so this data is likely better than what an average referring clinic experiences.
Percent of Pending Referrals by Days Since Request

As you can see we have a great many data points allowing for a statistical analysis that could not be done before. We know the average and median wait time by specialty, and which clinics perform best in replying quickly and consistently to referral requests. Our data is based on real referrals being sent through our network. In contrast, the Fraser Report on wait times is based off survey responses and recollection, and its methods have come under scrutiny by us and others. While we cover nearly 2,000 specialists in 36 specialties, Health Quality Ontario and Cancer Care Ontario capture wait times but in siloed surgical specialties. Other commercial e-referral platforms suffer in a similar way in providing a pathway to very few institutions or services.

 

How should this data be harnessed?

The question for our governments, health agencies, policymakers and researchers is how such data can best impact patient care. Can it be used to identify gaps in access, and make the case for more funding where it’s needed? Of course. But perhaps a better question to ask is how such information will be used by family doctors’ and nurse practitioners offices, when the referral is made and the patient is there. How will such centralized, updated and dynamic wait time information be used to provide patients with better access to specialty care? Data can only reach its potential value if put in the right hands, to help inform the right decisions. There is no better way to impact care than to let data influence and inform key health decisions as they happen.

How our wait time and response time data will be used on a grander scale remains to be seen. However, data like this is at the foundation of an improved, enlightened and informed health care system, and our clients who access it are part of that future.

The post Access to Speciality Care: What can we learn from 1379 specialists in Ontario? appeared first on consultloop.

]]>
http://www.consultloop.com/access-speciality-care-can-learn-1379-specialists-ontario/feed/ 0
How can patients and startups build something great together? http://www.consultloop.com/how-can-patients-and-startups-build-something-great-together/ http://www.consultloop.com/how-can-patients-and-startups-build-something-great-together/#respond Thu, 29 Mar 2018 19:58:06 +0000 http://www.consultloop.com/?p=5215 Patient engagement can be tricky. Despite good intentions, many do it wrong, as evidenced by the wealth of examples in the #HowNotToDoPtEngagement thread. At ConsultLoop, the wellbeing of the patient is at the core of every decision we […]

The post How can patients and startups build something great together? appeared first on consultloop.

]]>
Patient engagement can be tricky. Despite good intentions, many do it wrong, as evidenced by the wealth of examples in the #HowNotToDoPtEngagement thread. At ConsultLoop, the wellbeing of the patient is at the core of every decision we make even though they are not our customers. However, patients are what motivated us to start this company, and make the measuring stick by which we look at our accomplishments. We wanted to experiment with a type of patient engagement that works for startups, where we struggled to find examples of any kind. In this article, we will share our experience with a type of design sprint. We sincerely welcome any criticism of our approach, and any inquiries from other startups or health organizations who want to experiment with this model (email me here).

 

Patient Engagement and Startups

There are three main things that set startups apart from typical health organizations. First, they have to make decisions, act on them and iterate at a very high speed. Second, they have to create opportunities to spark ideas, explore new lines of business and new ways to create value to stakeholders. Third, startups are under the most direct pressure to align the interests of the business and better patient care. How could we engage with patients in a way that moves quickly, is sensitive to new opportunities, and supports audacious thinking? Could we do it cheaply? And can we do it in a way that respects the time, insight and experience of the patients who participate?

We decided to look at a key part of the patient journey in healthcare that is central to our e-referral platform – the time before a patient’s first appointment with a specialist. Typically, a patient may get some instructions about bringing a health card and some cancellation policies. Was this a lost opportunity? We strongly felt that we could transform this experience, if only we could get some insightful patient input. We also wanted to test a model of patient engagement. We read through many of the resources sent to us by patients we follow and admire on social media (a special thank you to @couragesings, @patient_commando, @solidfooting, @annetto, @aliesmaybe, @jenhoronjeff among many others), and tried to understand elements of good patient engagement in patients’ terms.

 

Let’s get going – but where?

We first needed to clearly identify what patients want before their appointment. So we drew up a first survey (email us if you are interested in the survey questions). We gave scant info for context, preferring patients draw from their own experiences, and asked “what could have been done differently so you would be more satisfied with this experience”? We then asked what would be important aspects of any instruction materials sent to the patient, listed several items for patients to choose from, and asked why the most important one was chosen. Through a twitter posting and listserv at our workspace, we got 27 responses in 2 hours. We offered $5 to Amazon and it took an average of 3 minutes to fill the survey.

We learnt a TON. First, we looked at the short answer responses and found key themes for patients. They wanted information to be clear and easy to understand. They wanted to have a good sense of what will happen in the appointment, and how they should best prepare for it. They also identified that this was an opportunity to reduce anxiety and feel positive about the care they will receive. This gave us a clear idea of what our designs must accomplish for patients. Patients also indicated what elements of pre-appointment materials would be desired. Ranking them by popularity, we could validate that they are consistent with the answers to the previous question, and we now knew what our design should have. It was time to get to the drawing board.

Screenshot 2018-03-29 11.37.42

 

Creating and Iterating

We set out to make two raw, independent prototypes of pre-appointment mailouts. We internally compared them and refined them, checking them against the patient responses from our first survey. 

Our next step was to get patient feedback on these two prototypes, as comparison is powerful in extracting feedback. Which did patients prefer, and why? Did they help accomplish what patients wanted them to accomplish? We sent out the survey to the patients who had replied to our first survey because they already had expectations of what “good” is. We showed both prototypes and asked for each one how much they agree with the following:

  1. The presentation overall is clear and inviting
  2. I am confident I can prepare for my appointment
  3. It is easy to find key info like appointment time, location, contact information
  4. Seeing this makes me more confident in the care this clinic provides

A dozen replies and a dozen $5 certificates to Amazon later, we had the info we needed. Though both scored well, there was a clear winner. In their comments, patients gave some great insight into why. This meant we were well-positioned to take the best aspects of each prototype and create a hybrid design and move towards a finished product.

 

The Finished Product

Thanks to all this input, we created a type of instruction sheet for patients that is almost a new type of document – rather than instructions of what a patient must follow, it is a guide to help the patient prepare for and understand their appointment (you can see the online version here). This change in positioning is important. We also created a companion app so that patients could see if the clinic was running behind by texting “WAIT” to our app’s number or visiting the clinic’s page.

We then took our design work back to patients one more time. Have we improved on the last examples? The answer was yes (15/15 respondents gave it a smiley face), but we had to find out for sure. We succeeded in improving on this key part of the patient journey.

 

Patient Engagement and Us

We know that we got tons of insight from this process, and that we could not have imagined anything like this without patient input. It was fast, allowed us to catch new creative sparks and ideas, and was guided yet open in its inquiry. It was pretty cheap – a couple hundred dollars is palatable for any startup. And it was certainly agile – we began without knowing exactly what we would do next and had a finished product within a few days. But did patients feel they had an impact? Was the length of the surveys and the compensation for them appropriate? Was their participation valued and were they respected as patients? And most importantly, how likely are they to recommend or endorse this design process to another clinic or institution? Well, we asked them:

CLsurvey

 

We are very pleased with this result, and propose every patient initiative be evaluated with these questions.

 

The Way Forward

Patients are an active, essential part of healthcare. We believe that startups are the sector within health that will bring in new, creative ways of doing things, and that patients’ voices must be heard as they are the “north star” we should be aiming towards. This is just one kind of engagement – asynchronous, temporary, and superficial. But we feel it is something that creates value for the system and can have an impact. As evidence, we look at the quality of this design and the positive experience patients report about this engagement process. We look forward to doing this again and iterating on this process, improving little by little each time.

If you have any feedback, you can reach Ilan by email, or on twitter. We want to hear from your, good or bad.

The post How can patients and startups build something great together? appeared first on consultloop.

]]>
http://www.consultloop.com/how-can-patients-and-startups-build-something-great-together/feed/ 0
What does the ideal referral process look like? http://www.consultloop.com/what-does-the-ideal-referral-process-look-like/ http://www.consultloop.com/what-does-the-ideal-referral-process-look-like/#respond Tue, 27 Mar 2018 18:17:16 +0000 http://www.consultloop.com/?p=5211 Referrals between doctors is a really important part of healthcare that has an outsized impact considering how our current processes for handling them does such a poor job of meeting needs for doctors and patients alike. Consider first […]

The post What does the ideal referral process look like? appeared first on consultloop.

]]>
Referrals between doctors is a really important part of healthcare that has an outsized impact considering how our current processes for handling them does such a poor job of meeting needs for doctors and patients alike.

Consider first that the majority of referrals are fax-based. This means that 21% get lost to the detriment of patient care and worry for admins and doctors alike. Additionally, faxes go out as flat pdfs with information distributed among siloed and incompatible EMR environments – this means that you can’t do anything meaningful with aggregate data and must copy over patient data through manual data entry. We then leave it to family doctor’s offices for the most part, to contact patients and tell them about their appointments by phone. All told, it costs doctors millions of dollars in direct overhead. And additionally, how about those no-shows? A referral system that produces less no-shows could prevent a significant loss of revenue for specialists. There must be a better way.

The following are key aims for the ideal referral system.

  1. It should be reliable, safe and secure: This means that referrals do not get lost. That patient privacy is respected. That patient information be electronically protected.
  2. It should give family doctors the choice of where to refer: This respects that family doctor’s continuity and knowledge of the patient and their experience with the specialist. Siloing specialists by parallel electronic or form-based referral systems goes against this principle.
  3. It should catalogue specialists by the conditions they see and do not see: It should be easy to find the right specialist for the right patient, and avoid wasting time sending referrals for conditions that are outside that doctor’s scope.
  4. It should capture wait times and other key data: Tracking wait times, response times (time from request to assigning a time) and rejection rate could make an impact by providing them at the time a referral is made, thereby improving access metrics across the board.
  5. It should centralize information-gathering: Changes to the specialist landscape happen continuously, and once central monitor enables an efficient way to update all stakeholders across the system.
  6. It should be very cost-effective for physicians offices: Doctors must foot the bill for administration and the referral system. It should require as little resources as possible, especially costly labour that could be used to enhance other aspects of patient care and support clinic, rather than administrative work.
  7. It should provide a better experience for patients: Could this current system be considered patient-centred? Consider lost referrals, calling offices, being on hold, worrying about that to do… Patients rate the status quo as 3.3 out of 5.
  8. It should address the 8% gender gap in referrals: Female specialists receive 8% less referrals than their male counterparts. Easing a return from mat leave and democratizing how specialists promote themselves are two important things for a referral system to achieve.
  9. It should promote higher quality referrals: Specialists are often frustrated by incomplete referrals, missing key lab results, a referring doctor’s billing number, or important patient demographics. A good system should eliminate this source of work and frustration.
  10. It should reduce the no-show rate: Patients that miss appointments cause delays for other patients and represent lost income to physicians. A referral system should reduce the number of appointments through better patient engagement rather than punitive measures.


These are ten principles that we keep in mind as we grow the network of physicians. We are building a referral system that meets these goals. It’s taken a lot of work to meet with dozens of clinics and understand their workflows and processes prior to and after implementation, and to hear from patients about what is important to them in the referral process. By doing this work, 15,000 referrals later, we have a good sense of what the ideal referral system looks like, improving things for everyone. Talk to us about joining our network.

The post What does the ideal referral process look like? appeared first on consultloop.

]]>
http://www.consultloop.com/what-does-the-ideal-referral-process-look-like/feed/ 0
Can we Quantify the Gender Bias in Medicine? Lessons from our most recent 15,000 referrals http://www.consultloop.com/gender-bias-in-medicine-lessons-from-our-most-recent-15000-referrals-in-consultloop/ http://www.consultloop.com/gender-bias-in-medicine-lessons-from-our-most-recent-15000-referrals-in-consultloop/#respond Tue, 20 Mar 2018 19:15:28 +0000 http://www.consultloop.com/?p=5197   Medicine has seen some profound changes in the last decades, especially with respect to gender. While traditionally a male-dominated field, recent years have seen women represent the majority of medical students in Canada (1), and family physicians […]

The post Can we Quantify the Gender Bias in Medicine? Lessons from our most recent 15,000 referrals appeared first on consultloop.

]]>
 

Medicine has seen some profound changes in the last decades, especially with respect to gender. While traditionally a male-dominated field, recent years have seen women represent the majority of medical students in Canada (1), and family physicians under the age of 44 (2). The president-elect of the CMA is Dr. Gigi Osler (3), the first female surgeon to lead the CMA in its 150 years (4), but she’s also only the first female surgeon, and only the eighth female physician of any specialty. Yes we see female physicians deservedly winning awards but they are under-represented by a wide margin (5). Yes, we see female physicians in leadership positions all around us, excelling, yet only a small minority are in leadership positions both in our schools (6) and in our hospitals (7). So does medicine have a glass ceiling problem? Absolutely. Here, Google (8) it.

Are there other problems? Well, yes. Beyond the #metoomedicine movement (9) and income disparity (10), female doctors are judged more harshly – female surgeons are more likely to get fewer referrals from colleagues after an adverse event than male surgeons (11). Since we at ConsultLoop think of referrals every waking hour of the day (startup life being what it is), we had a question: Is this gender bias in referrals more pervasive? As in, is there a bias against referrals to female doctors, period?

As luck would have it, we have the ConsultLoop database of referrals and referral patterns mostly around the Greater Toronto Area. Looking at the last 15 000 referrals in our database, this includes referrals made to 1,951 specialists across 32 specialties. These specialists include those who are our clients, and those who are not. We initially built our specialist directory by calling nearly every doctor in most urban centres in Ontario, which should therefore be a reasonably representative sample of the full specialist population. Our directory grew organically through family doctors selecting a particular specialist or clinic as a destination of the referral, which should be relatively reflective of true family physician demand and referral patterns. Therefore, this sample of specialists and referrals to them is quite suitable for such an analysis.

We categorized all specialists as male, female or “neutral.” Neutral indicates that the referral destination was a hospital department rather than to any specific doctor. Our most frequent recipient of referrals is a client of ours. They are two male specialists who preferred to be listed as a clinic rather than individually, but we counted them as male. Let’s see how this breaks down:

specialistsandreferralsbygender

We then looked at the total number of referrals to each gender category and divided that by the number of specialists in that category, to give us the average number of referrals that a specialist received in each category. Here, we would expect that male and female physicians average the same number of referrals. There may be a glass ceiling, but we surely are blind to gender when working with our colleagues.

Well, take a look at this:

Referrals per MD by gender category

We can see why “neutral” specialists, who are mostly hospital departments, are the most popular. A department may have a different type of demand, triage a different case mix, represent a group of doctors, and may also promise faster access to “next available” specialists. But are male doctors getting more referrals on average than female doctors? Male doctors averaged 7.67 referrals per doctor. Female doctors averaged 7.07. So yes. And if you take the ratio of the two:

092referrals

And there you have it. Not only is there a glass ceiling in medicine, but women must navigate through bias that is pervasive even in the most germane of physician to physician interactions – the referral.

This is admittedly a back-of-the-envelope calculation, but it is an important finding. A bias in referrals has cascading effects on income inequality, career advancement in leadership within departments as well as medical associations, and the overall experience of female physicians as equals and partners within our medical system.

———-

Join us on Twitter and follow us using #CLchats on Thursday, March 22nd at 8pm. We’ll be discussing some ways this bias has affected female doctors in their professional lives, and some ideas on how we can tangibly begin to create more equitable referral patterns.

 

References:

(1): “Women outnumber men at most medical schools.” Maclean’s. http://www.macleans.ca/news/canada/how-many-get-in/

(2): Family Medicine Profile, CMA. https://www.cma.ca/Assets/assets-library/document/en/advocacy/Family-e.pdf

(3): “Dr. Gigi Osler elected the 2017 CMA president-elect nominee.” CMA.

https://www.cma.ca/En/Pages/Dr–Gigi-Osler-elected-the-2017-CMA-president-elect-nominee.aspx

(4): Comment: Access to health care is not a gender issue.” Times Colonist. http://www.timescolonist.com/opinion/columnists/comment-access-to-health-care-is-not-a-gender-issue-1.23128326

(5): Where Are the Women? The Underrepresentation of Women Physicians Among Recognition Award Recipients From Medical Specialty Societies. Silver, Julie K. et al. PM&R , Volume 9 , Issue 8 , 804 – 815. http://www.pmrjournal.org/article/S1934-1482(17)30660-3/fulltext

(6): Women are changing the face of medicine. CBC News. http://www.cbc.ca/news/health/women-are-changing-the-face-of-medicine-1.981567

(7): Promoting Female Leadership in Healthcare: An Interview with Dr. Lara Khoury, Co-Chair of the Female Physician Leadership Committee. UOJM. https://uottawa.scholarsportal.info/ojs/index.php/uojm-jmuo/article/view/2185/2003

(8): Search term: “Does medicine have a glass ceiling”. Google.ca. https://www.google.ca/search?q=does+medicine+have+a+glass+ceiling%3F&oq=does+medicine+have+a+glass+ceiling%3F&aqs=chrome..69i57.5039j0j7&sourceid=chrome&ie=UTF-8

(9): #metoomedicine. Twitter.com. https://twitter.com/search?q=%23Metoomedicine&src=tyah

(10): “Pay gap widens for women physicians; earnings average $105K less than men.” Fierce Healthcare. https://www.fiercehealthcare.com/practices/pay-gap-widens-women-physicians-doximity

(11): “Doctors judge female surgeons more harshly when patients die.” The Economist. https://www.economist.com/blogs/graphicdetail/2017/11/daily-chart-19

The post Can we Quantify the Gender Bias in Medicine? Lessons from our most recent 15,000 referrals appeared first on consultloop.

]]>
http://www.consultloop.com/gender-bias-in-medicine-lessons-from-our-most-recent-15000-referrals-in-consultloop/feed/ 0
ConsultLoop Asks Patients: Insights and reflections from a patient focus group http://www.consultloop.com/consultloop-asks-patients-insights-reflections-patient-focus-group/ http://www.consultloop.com/consultloop-asks-patients-insights-reflections-patient-focus-group/#respond Fri, 24 Nov 2017 01:34:30 +0000 http://www.consultloop.com/?p=5189 As a healthcare technology company, we are moved by the patient advocate and patient experience movement. We feel strongly that we need to better understand patient perspectives and needs, and revisit some ideas we have about patients’ experiences […]

The post ConsultLoop Asks Patients: Insights and reflections from a patient focus group appeared first on consultloop.

]]>
As a healthcare technology company, we are moved by the patient advocate and patient experience movement. We feel strongly that we need to better understand patient perspectives and needs, and revisit some ideas we have about patients’ experiences as users of our healthcare system. We recently held a patient discussion group to learn more about the key values, themes and elements of good healthcare from the patient perspective.

The first thing that came up is access. Patients want to be seen relatively soon, without much disruption to their work or family lives just to attend an appointment. They would also appreciate having a choice in the matter, willing to consider traveling further distances to be seen sooner. Waiting for things like elective surgeries can be life-changing, and waiting to clarify a diagnosis can add to stress and anxiety. As important as it was to have timely access to care, patients had very little to help them achieve that.

Communication came up frequently in a couple of important ways. One patient told us about things her new specialist said and did that made her feel like he was in her corner. Another described how great his care was with an interdisciplinary team that had all his information and always seemed to know the next step, making for seamless, purposeful care. Contrast this to the experience of a patient whose family doctor would never find out he was just in the ER at the same hospital. It is important for patients that their doctors have access to their health information, both so that they don’t have to spend a lot of time in the visit going through those things, and so that the doctor is better armed with the information they need to do their job. Our healthcare system is too disorganized to do patients and doctors justice in this respect, and this is certainly a call for patient-owned, or collaborative health records. 

As patients relayed their experiences, siloing and accountability were repeated themes. We heard some stories of how in complex care, doctors would look after their specialty’s issue only, leaving nobody but the patient to look after the big picture. Another patient told of how after getting the run-around from various clinics, everything changed when a medical admin on the phone stepped up and went the extra mile to help connect her to a particular program. It took a few minutes but the impact on that patient’s experience was enormous. When it came to coordination between offices, patients often had to take on an active role because of that siloing and lack of accountability (it’s always the other office’s fault). These patients were very high-functioning – what of those who would struggle to advocate for themselves? Of course, many of these issues are because their doctors don’t yet use ConsultLoop, but we know that already. 😉

From a business standpoint, we were elated to hear that the ConsultLoop platform is doing things for patients that align with their needs, wants and values, and we’re inspired to take it even further as we develop our platform. However, from the standpoint of a physician, it was a rather depressing discussion. People want to do well, and to doctors and other healthcare workers, they will surely recognize themselves in that group. Where the patient experience was bad, it was often due to systemic, organizational and administrative issues that make doctors suffer too. Unfortunately, since doctors are the face of healthcare for patients, this is where much frustration is directed. It’s time to demand better from our healthcare system’s infrastructure. We are all suffering as a result of its inadequacy.

——

We would like to thank all the patients who participated in this discussion and shared their experiences in healthcare. We also thank patient advocates for their inspiration (@patientcommando, @patientcoop, @anetto, @kathykastner), and acknowledge organizations like @hqo and @stmichael’s Family Health Team for their leadership in patient engagement. For any questions on this process and how to do something similar, please reach out, we’re happy to help.

 

The post ConsultLoop Asks Patients: Insights and reflections from a patient focus group appeared first on consultloop.

]]>
http://www.consultloop.com/consultloop-asks-patients-insights-reflections-patient-focus-group/feed/ 0
#CanadaWAITS – But Will it Wait Less? http://www.consultloop.com/canadawaits-will-wait-less/ http://www.consultloop.com/canadawaits-will-wait-less/#respond Sat, 04 Nov 2017 19:45:58 +0000 http://www.consultloop.com/?p=5185 Canadian health care is always a hot topic, especially so on social media these days. Consider the activity online around last week’s visit by Senator Bernie Sanders and whether or not our system is one to be proud […]

The post #CanadaWAITS – But Will it Wait Less? appeared first on consultloop.

]]>
Canadian health care is always a hot topic, especially so on social media these days. Consider the activity online around last week’s visit by Senator Bernie Sanders and whether or not our system is one to be proud of, and one that performs well. Regarding the second question, many brought up our wait times to access speciality care, and how the long waits that characterize our system weaken it, and harm patients.

There have been efforts to objectively determine what the waits are for specialty care. The CIHI/Commonwealth Fund reports give a system-level overview, and the Fraser Institute’s Annual Report on wait times tries as well despite well-described methodological limitations. It’s encouraging to see Health Quality Ontario beginning to publish wait times for some specific conditions/services. Add in #CanadaWAITS, a hashtag boosted by journalist Andre Picard. Looking at the feed for the hashtag, you find many doctors, health care workers and patients describing instances of long waits for life-defining diagnoses or symptoms. The emotional toll is evident, and the frustration by the front-line healthcare providers who must navigate this system daily is plain for all to see. Timely access is a problem in our country, and it must be addressed.

ConsultLoop was started when we, as three family doctors, became too frustrated with long wait times, lost referrals and general opacity of the system as a whole. We built our platform to address many issues in the referral process, but wait times remain a priority. We strongly believe that we offer a solution to this crisis.

One key aspect of our platform is our directory. It currently includes 5,000 specialist listings, with descriptions on what they see and don’t see, as well as the most unique feature of all – what are their wait times based on referrals flowing through our platform. This information is readily available at the time the referral is made, and helps get the patient to the right doctor within a reasonable time frame. Looking for a neurologist with a practice focus on epilepsy? Looking for a gynecologist with a shorter wait time? Looking for a dermatologist who speaks Italian? We are here to help find that doctor for that patient.

We also hear from our rural colleagues who face an entirely different reality than docs like us practicing in the GTA. Specialist access is dismal, and surely many patients would be willing to travel elsewhere if only they could be seen sooner. Our directory provides that information, so that all doctor’s offices can have the same information about wait times and the specialists in our province. There’s no reason why a doctor in North Bay shouldn’t know about options available in Sudbury, Barrie or even as far as Toronto. The opacity serves nobody, and with a simple solution like ours readily available, it is reducing patient access unnecessarily.

We believe that the ideology behind our healthcare system is noble, just and worth being proud of. We also know that our healthcare system is under-performing in important aspects, especially around access and wait times. If we want to defend our healthcare system, we must be relentless in the pursuit of excellence, and that begins with addressing our shortfalls. That in turn begins with looking at new ways of doing things, new solutions – solutions in our midst. We are proud of our work because we see it as the essential system transformation that must take place if we are to defend our healthcare system’s core principles.

The post #CanadaWAITS – But Will it Wait Less? appeared first on consultloop.

]]>
http://www.consultloop.com/canadawaits-will-wait-less/feed/ 0