You can use Internet to speed referral process

Two-way communication ability is best

In today's fast-food society, a speedy response often determines which agency gets the referral. By taking advantage of the speed of the Internet to secure and process referrals, Swedish Home Care in Seattle was able to boost referrals by 80% and slash referral processing time by 75%.

Moving to a web-based system for the agency has been a multistep process, says Debby Ramundo, RN, BSN, MSIT, senior project manager for the home care division of Swedish Medical Center. "Our first version of an electronic referral system relied upon faxed referrals and follow-ups," she says. The next version was a simple system accessed through a web page on which the name and contact information was captured in a spreadsheet. "The significant increase in referrals appeared when we developed an in-house program that enabled two-way communication so that we could better coordinate care," she says.

While the agency was developing its own in-house referral system, the hospital system was developing a system as well, says Terri Wallin, BSN, MHA, executive director of Swedish Home Care Services. The hospital system's program uses Extended Care Information Network (ECIN) software from Allscripts in Chicago, she says. It enables communication between all hospitals and departments throughout the system, she explains. The ECIN system includes information on home health, skilled nursing facilities, durable medical equipment providers, transportation, and more, she explains. Now that the hospital system is up and running, home care is moving to the ECIN system, Wallin adds.

Ramundo says, "We are ratcheting down our use of our homemade service, and I'll admit that it lasted longer than I ever thought it would last." Referrals are now coming primarily through the hospital system's ECIN program, and only a few referrals from providers outside the hospital system come through the home care web-based system, she says.

When moving to a web-based referral system, be careful about "who owns the referral," points out Wallin. With the first versions of the home care system, once discharge planners, physicians, or social workers sent the referral to the home care agency, they considered themselves finished with the case, she points out. "Even if the referral wasn't appropriate for home care, it took time to track the referral source and get them to handle the patient," she says. "With the hospital-based system, it is clear that it is the hospital's patient until home health has accepted the patient."

As part of developing each of the referral systems, Wallin and Ramundo talked with discharge planners, physicians, and social workers to identify what makes a home care agency stand apart from others.

The cost of implementing a web-based referral system doesn't have to be enormous, Ramundo says. "Our first version cost about $10,000 for development and testing, and we used existing computers," she says. "The second version cost about $29,000 for development and testing and did not require new hardware." The ECIN system costs the hospital system a fee based on number of users, but it includes software development and updates as well as ongoing support.

"The important thing to remember is that there is an option for almost any budget," says Ramundo. The investment is an important way to differentiate yourself from your competitors, she adds.

When asked if there is anything she would have changed about the development or implementation of the electronic referral system, Wallin says, "I wish we would have included home care in the ECIN system from day one. Having to disassemble and transition to a new system can be done; it's just not the easiest way to go."

Need More Information?

For more information about electronic referral systems, contact:

  • Debby Ramundo, RN, BSN, MSIT, Senior Project Manager, Home Care Division of Swedish Medical Center, 747 Broadway, Seattle, WA 98122-4307. Telephone: (206) 215-3902. E-mail:
  • Terri Wallin, BSN, MHA, Executive Director, Swedish Home Care Services, 747 Broadway, Seattle, WA 98122-4307. Telephone: (206) 386-6602. E-mail: