Enhancing patient pathways: Queensland Health's approach to referral management

In 2016, Queensland Health facilities received nearly two million referrals for outpatient services, but there were challenges in ensuring high quality information was available in the transfer and continuity of care through the referral process. To combat this, the integrated Referral Management Solution (iRMS) program initiative was created by Queensland Health. The program was split into five projects and Alcidion and NextGate Solutions partnered to deliver the foundation component, the Referral Service Directory, as a state-wide service that connected the primary health sector with tertiary referral centres across Queensland.
  • 2M
    per annum
  • 339
    GP practices
  • 9
    Hospital & Health Services

The customer

Queensland is the third largest State or Territory in Australia, with its population just under 4.6 million in October 2019, and covers an area of 1.853 million km2 of the north east of the country. The majority of the State’s population live in cities and towns along its 6,973 km east coast.

Queensland Health comprises 16 Hospital and Health Services (HHSs). Under the Hospital and Health Boards Act 2011, Queensland Health is responsible for the overall management of the Queensland public health system.

There are approximately 6,500 GPs working across Queensland as well as seven Primary Health Networks (PHNs).

The challenge

In 2016, the then Minister for Health and Ambulances Services for the State of Queensland in Australia convened two Waiting Time Summits with a focus of solving the challenges they were facing around waiting lists. The challenge encompasses the whole patient journey. That is, from General Practitioner (GP) referrals to outpatient appointments, while also considering any diagnostic procedures or any surgery and recovery requirements.

The strategy is a major component of the State Government’s My Health, Queensland’s Future: Advancing Health 2026 plan. An investment of AUD$361.2 million over four years was made by the government to make this strategy a reality.

The strategy covers initiatives including:

  • Funding for Hospital and Health Services (HHS) to provide more specialist outpatient appointments
  • Empowering GPs to easily manage and track a patient’s referral with consistent referral standards and electronic referral management systems
  • Providing GPs with greater understanding of the specialties and services available to their patients from the local health service
  • Providing patients with greater control over their healthcare through online booking systems
  • Establishing or enhancing alternative models of care, such as allied health and telehealth, to provide patients in rural and remote parts of the state with access to services closer to home
  • Enabling Queensland GPs to have access to real-time hospital information about their patient’s health and treatment needs

The situation

In 2016, Queensland Health facilities received nearly two million referrals for outpatient services. Despite the acknowledged importance of having high quality referrals in the transfer and continuity of care, challenges remained in the referral process.

The integrated Referral Management Solution (iRMS) program initiative was created to deliver key elements of the Specialist Outpatient Strategy: Improving the patient journey by 2020 with the program being split into five projects. These five projects were led by four HHSs, with each HHS leading the development and implementation of their project on behalf of the rest of the State.

Key elements of the statewide strategy that were delivered in this program are:

1. A state-wide services directory – GPs would have access to an online state-wide directory of public hospital services to better inform and direct their referrals
2. Electronic referral management systems – GP referrals will be submitted by secure electronic messaging to Queensland’s largest public hospitals with the aim to deliver a smarter and an integrated patient referral system

As part of the iRMS program, Queensland Health were looking for a solution which would be scalable across the State whilst still delivering what was required at the local HHS level. The Referral Service Directory (RSD) is a critical foundation component of the iRMS program that creates linkages between other components of the proposed referral processes.

The RSD is an integral element of the iRMS Program and is required to underpin and integrate with other key system elements, notably:

  • An External eReferral application
  • A digital referral workflow application
  • A Referral Lodgement and Tracking application
  • A business intelligence and reporting database

The longer-term roadmap for the RSD included consideration for functions outside referral management and greater uptake across Queensland Health systems and services.

The solution

After the tender process was completed, Alcidion and their enterprise identification solution partner NextGate, signed a contract with Queensland Health to roll out the RSD as part of the state-wide iRMS program.

Adopting a new digital approach to the referral workflow meant that the current process needed review. For example:

  • When a GP wanted to refer a patient, they would determine the most appropriate HHS service based on their existing knowledge or a website search
  • When completing the referral, there would be limited controls to ensure the information provided was adequate for assessment
  • When a HHS received the referral, it was reviewed and if the necessary information was included, it was triaged and allocated to the relevant service

The RSD provides the linkage between the referral system at the GP practice and the specialty service provided by the HHS. The RSD holds detailed information about each HHS (disciplines, conditions treated, services offered and capabilities, location, etc.) to help GPs and their systems identify the most appropriate HHS to direct their patients.

The HHS services needed a definition and structure to ensure the solution would achieve the objective of streamlining the referral processes. A comprehensive data model was developed to identify the relevant characteristics and relationships of each service. The services were configured in NextGate’s MatchMetrix software which facilitates the RSD.

The solution is hosted in the AWS cloud environment. Integration was established with several national, statewide and GP systems to ensure data was available to be shared as part of the electronic referral process.

At a state level, the partnership has seen NextGate’s Provider Registry software established as a centralised authoritative regional registry / index that is a source of truth for services, providers and systems that deliver health care across participating Queensland Health care providers, for example, specialists and non-specialist outpatient services.

The RSD provides accurate and timely information to GPs while also allowing them reliable, up-to-date information, about these entities and access to referral information which means more informed decision making, enhanced workflows and increased patient and clinician satisfaction.

Alcidion’s Managing Director, Kate Quirke commented “The outcome of the RSD project acknowledges the strong partnership between Queensland Health, Alcidion and NextGate and realises the benefits of our combined expertise to successfully deliver this key component of the Queensland Health iRMS program.”

The result

The benefits being identified from the implementation of the RSD for the HHSs, GPsand Queensland Health are:

  • Streamlining and modernising referral processing
  • Allowing referrers to easily find the most appropriate HHS for their patients care requirements
  • Improving and standardising information included in referrals so that the quality and speed of triage is improved and timelier and more effective patient care can be planned and delivered
  • Providing referrers with the ability to better assess waitlist times and direct referrals accordingly, therefore improving overall system efficiency and delivering better patient outcomes
  • Facilitating better communication with the patient’s usual GP regardless of the Provider initiating the referral
  • Reducing the re-work and inefficiency associated with incomplete referral details
  • Improving the ability of referrers to access status information and receive updates about their referrals
  • Providing information that will improve equity and consistency in accessing services

NextGate’s Chief Executive, Andy Aroditis said “Made possible through our partnership with Alcidion, we are delighted to support Queensland with an accurate, up-to-date RSD to give GPs and other providers timely, reliable access to referral information for improved clinical effectiveness and workflow efficiencies. We believe this foundational capability will continue to deliver benefits to the delivery of healthcare in Queensland well into the future.”

The future

The longer-term roadmap for the RSD includes consideration for functions outside of referrals management, and greater uptake across Queensland Health systems and services.

The solution went live in October 2019 at two of the 17 HHS. In addition, 100 GPs were able to retrieve data from the RSD to streamline the referral direction process.

The onboarding of new entities was relatively seamless and now includes:

  • 339 GP Practices live referencing the RSD in their referral process
  • Nine (9) of the 17 HHS services registered in the RSD: Metro North, Metro South, Mater Health, Children’s Health Queensland, Sunshine Coast, Central Queensland, Darling Downs, Townsville and West Moreton

Queensland Health has confirmed it is committed to implementing Smart Referrals as an important step in digital healthcare and creating a connected, modern health system for Queenslanders. Partnering with Alcidion and NextGate enabled the delivery of the RSD forming an integral part of the integrated Referral Management Solution

About Queensland Health

Queensland Health provides a range of services aimed at achieving good health and well-being for all Queenslanders.

Key statistics

  • Inpatient separations: 2,621,843
  • Same day acute separations: 1,520,223
  • Overnight acute separations: 881,513