Pacific Hospital Preservation & Development Authority: 2020 Annual Report

Project Details

Specialty Referral Barriers - CHC Internal Systems Improvements

Posted in Projects / Wed, March 13, 2013

Timeframe:   2009-2010   |   Amount:   $44,145.25


In 2010, the Pacific Hospital PDA funded a study to address referral tracking difficulties within community health centers. This project was an internal systems review. The Federal Way HealthPoint Community Health Center served as the pilot site for the analysis. Consultants were retained to design, implement, and evaluate improvements to the specialty referral processes within the community health center. The Pacific Hospital PDA funded over $40,000 for designing, implementing and evaluating the pilot and $3,800 for modifications to the NextGen electronic Medical Record referral module.

The goals and recomendations of the project were:

  • To decrease the rate of specialty referrals which are “patient to schedule”.

    Once given a referral, 34% of patients were asked to schedule their own specialty appointment. The pilot defined the situations when it was appropriate and desirable for the clinic’s referral coordinator to meet with the patient BEFORE they left the clinic and to help them schedule the referral appointment at that time. The patients needing this assistance were:

    • Urgent specialty referrals
    • Homeless patients
    • Charity care/uninsured patients
    • Persons in need of assistance (language, literacy and other factors)


  • To verify income eligibility every six months instead of annually.

    The pilot clinic recommended that income eligibility be verified every six months (versus annually) to be consistent with the Project Access NW’s eligibility requirements. This step made it much easier to schedule the specialty referral visit before the patient left the clinic—because their eligibility to receive free specialty care was known, making it possible for the Charity Care Application to be completed.

  • To understand why a high percentage of specialty referrals were being canceled. The clinic wanted to know why so they could follow up with the patient if the provider deemed it clinically necessary.

    Seven key reasons were identified and the Pacific Hospital PDA supported the cost of revising the specialty referral template in the EMR to program these choices.

Key Outcomes

Improvements were made to the NextGen electronic medical record referral module that simplified its use for both providers and referral coordinators.  Drop-down menus were added, the free-text option was limited. The names of the top 25-30 specialty providers receiving referrals were made more easily accessible, and internal referrals to providers within a Community Health Center system were separated from external referrals to specialists and other providers outside the CHC.