IntroductionThe lifeblood of any medical center is its referrals, but keeping

those systems flowing takes focus. In 2010, Scott & White

Healthcare (now part of Baylor Scott & White Health) was

continually hearing from referring physician offices that it

took too long to obtain referrals and that there was a dearth

of communication from the scheduling department.

The main issue was the fax-based system the Physician

Referral Network (PRN) was using, which relied on physical

pieces of paper, multiple fax machines, filing cabinets and

spreadsheets to schedule patients. Keeping track of paper

was difficult, especially when the referring physician office

did not include all relevant information the first time. Even

after a referral had been scheduled, the referring office

rarely was updated with the status of the patient.

Recognizing the need for better communications and

quicker response among referral sources and PRN staffers,

the health system decided to leverage the Salesforce.com

solution it was using for physician relations to help automate

and streamline this highly manual process, including fax

management services from zPaper.

Since the change, satisfaction scores from more than 50

referring physician offices have improved by 26.5%, and

negative ratings have dropped by more than one-third.

What’s more, patients are being seen quicker, and PRN staff

now have time to perform other service-related duties.

“We have insight into this process that we didn’t have before,”

says Brian P. Borchardt, director of Physician Relations.

“The automated processes that zPaper helped implement

brought us great efficiencies and helps us maintain good

relations with physicians who refer patients to us.”

Accelerating Referral Scores

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Medical center’s physician satisfaction marks rise dramatically after automating its referral process.

Challenges• Highly manual, paper-based process cumbersome, resulting in long lead times for scheduling• Lack of acknowledgement, updated to referring physician office• Lack of insight into the process• Low satisfaction with the referral process

Results• Electronic process speeds scheduling, even in cases where more information is required• Consistent, ongoing communication with physicians regarding status of all patients referred• Transparent process• 26% improvement in satisfaction with ease of referral process & • 17% gain on overall referral experience

Quick Facts• Hospital system: Scott & White Healthcare, part of • Baylor Scott & White Health• Facilities: 13 acute-care hospitals and more than 140 clinics at • 70 locations throughout Central Texas• Employees: More than 14,000• Medical staff: More than 1,200 physicians and scientists

Beyond low-hanging fruit

Scott & White Healthcare strives to be the go-to referral source in its

Central Texas service area, bringing Borchardt on board in 2007 to launch

its Physician Relations program. During the first two years, Borchardt and

his staff spent time meeting and educating physicians to develop positive

relationships that result in referrals.

While talking to physicians and their staff, Borchardt kept hearing about

scheduling issues that were hurting the system’s reputation. “We were

known as the black-hole department,” Borchardt says. “Physicians would

send patients to us and never hear back. They didn’t know whether we

had lost their records or had taken the patient away.”

The issue Borchardt was hearing about only affected physicians outside

the S&W network, since internal referrals are handled by the health

system’s EMR. Although the Physician Referral Network was not part of his

department, Borchardt received permission to study the referral process.

A year-long review revealed that nearly every process was manual and

could be improved. The department received more than 140 paper faxes

a day that had to be gathered up, sorted, manually logged and filed. The

machines often were busy and were prone to break down.

Few referring physicians received confirmation that an appointment had

been scheduled, and referrals that required additional information

frequently got lost in the paperwork shuffle. “We really didn’t know how

long the (referral scheduling) process took,” Borchardt says.

Automated solution speeds referral process

Borchardt reached out to Salesforce.com, the cloud database solution that

Physician Relations uses, for its assistance with automating and creating

consistency in the referral process. The Salesforce consultant S&W uses

brought in zPaper to craft a custom solution to automate the fax receiving,

storage and communication processes.

Now when a fax is received, a new referral record is automatically created,

with the digital fax attached. Caller ID technology links the referral to the

referring practice record and routes it automatically to the appropriate

person based on the fax number used: the “normal” number, the “urgent”

number or the one used in South Texas.

The person working the referral can electronically “separate” the fax into

multiple files or multiple referrals, make the appropriate notations and

automatically acknowledge receipt through a template, resulting in more

consistent communications.

“zPaper set up a barcode system that’s used in requests for additional

information from clinics,” Borchardt says. “When the sheet with the barcode

is used as a cover sheet, the new information is automatically linked to the

appropriate referral record.”

Not only are referral requests quickly acknowledged, the referring physicians

receive daily reports that show where each patient is in the referral process.

As part of its internal tracking, the system creates weekly reports for S&W

department heads showing the status of all referrals.

Surveys before and after the system was implemented show a 26.5%

improvement among those practices that “strongly agree” or “agree” that

it is easy to refer to S&W. More telling is the 36% drop among those that

“disagree” or “strongly disagree” with the same statement, as results from a

survey of more than 50 referring offices show. Answers to a question about

the overall patient referral experience improved 17% following implementation.

Impacts beyond initial deployment

Leadership at Scott & White Healthcare strive to have urgent patient referrals

seen within three days. The baseline goal is 65%, but the average department

was meeting that goal only a quarter of the time, Borchardt says. “We have

seen a significant improvement in that metric, which we can track now but

couldn’t before,” he notes. Most departments are at 70% or higher.

The timeliness of appointments has definitely been noticed by referring

physicians. On a survey question that asks whether referred patients are

seen by a “reasonable” date, responses improved by nearly 50%.

By electronically receiving faxes, S&W saves on paper, toner, filing space

and equipment maintenance. But freeing the department from handling

paper also has brought labor savings. Scheduling staff frequently had to be

supplemented by other departments — today the staff can not only handle

all external referrals, they are performing service activities they previously

did not have time for.

“zPaper was very responsive, focused on our needs and on developing a

really good solution,” Borchardt says. “They’re not just a fax solution but have

been a great Salesforce.com resource for anything related to this project.”

Address:1000 Holcomb Woods PkwySuite 280Roswell, GA 30076

Phone:1-844-4zPaper

Fax:1-855-343-3801

Email:sales@zpaper.comsupport@zpaper.com

Website:www.zpaper.com

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