Supporting Your Referring Physicians Using the Internet

by Randale Sechrest

So now your practice has a website that begins to let people know that you're wired and moving into the 21st century in style. Perhaps you're looking for ways to leverage that investment into a more useful tool and beginning to explore ways to turn that initial website into a true "Extranet". What's an Extranet? Simply put, an Extranet is an Intranet made available to outside customers that allows them to use your Intranet to serve themselves - sort of like self-service gas pumps designed for information. You give your patient, or referring physician, access to your Intranet to answer their own information needs. The key to turning a simple website into a functional Extranet is in providing useful tools to meet the needs of your customer - in this case your referring physicians.

Traditionally, specialist physicians have marketed their practices by traveling to outlying communities to give presentations to medical staff the medical staff of the outlying facility. These presentations serve a dual function. They provide continuing medical education for the facility staff but more importantly, they serve to build name recognition and establish a referral base for the speaker. Your Extranet may provide a similar vehicle for accomplishing similar goals - and may be much more efficient in establishing a communication channel to referring providers. Let's look at what sort of tools can take your website to the next level.

Referral Information Tools

Providing referral providers with a group of resources to deploy when referring patients to your practice can be a powerful tool to distinguish your practice from the competition. Imagine providing your referral providers with a set of resources designed to streamline the process of referral. Most practices present the new patient with a myriad number of forms to fill out while sitting in the waiting room. Why not make these forms available for download and printing by your referring physician? This is extremely easy using a cross platform software package such as Adobe Acrobat. This software allows you to create a document, such as a new patient form, which can be made available for download from your website and printed on a Macintosh, PC, or Unix computer in the referring providers office. The patient can be given this form at the time of referral and can spend time before the visit - and can obtain the correct information beforehand.

But why stop here? Removing the barriers in the process of referral also means providing the new patient with office policies, insurance plan information, contact information and maps. Why not create a set of downloadable, printable brochures and make this available to your referring providers via your website. You not only have provided this resource for their use 24 hours a day, but you also have just eliminated your costs of printing and distribution of hardcopy. Medical records releases? They are only a mouseclick away.... In fact, any print materials that you currently make available to referring providers, patients, or anyone interacting your practice should be migrated to an electronic file and archived on your website. The result will be lower costs of creation and distribution, easier modification, and greater availability to those who need access to the information. (Keep in mind that this step is simply a transition stage in the path to electronic acquisition of the same information.)

Patient Education

Several events over the last several years have made it possible to offer individual customization of patient education for each practice. The Internet has given us a public transport mechanism and a "virtual space" that is becoming populated with a critical mass of the audience that we as healthcare providers are trying to reach. The software tools have become standardized so that we can develop content without concern for proprietary constraints, and color printers for a low cost have become ubiquitous.

Here at Medical Multimedia Group (This is the company that Dr. Sechrest owns that is devoted to helping to bring physicians and healthcare companies into the electronic age - Editor), we are continuing to develop a content library that it can be deployed in multiple ways:

1) Webpages customized for delivery via the Internet, Intranet, or simply from the standalone computer - complete with multimedia elements. This presentation is far richer than what can be delivered in print and can be used as an interactive teaching tool in the exam room, a kiosk setting in the waiting room, or provided to referring providers and patients via the Internet. The browser interface is becoming the standard delivery mechanism for computer based multimedia, and we are developing our material to fit this standard.

2) Downloadable, printable documents using the popular Adobe Acrobat (.pdf) format (more cost effective than pre-printed documents in bulk). This approach allows the creation of a high quality print-on-demand patient education booklet using a consumer grade color printer. Low cost (under $500) inkjet color printers produce an acceptable color booklet and are becoming ubiquitous in the home as well. The resulting resource is "transportable" for the referring providers' use at a remote site on a "just in time" basis. These downloadable booklets can be easily customized for the individual practice.

3) Pre-printed booklets, done in short runs using a commercial color laser printer for cost effective custom printing in small numbers. This gives higher quality AND lower cost for the booklets that are used frequently enough to justify having a stack of booklets on hand. Over the next two years, color laser printers will begin to appear in physician's offices. Currently, the cost of a color laser is about $5000.00 and the ongoing costs of printing each page is about $0.12. Eventually, it will be more cost effective and efficient for the practice to simply purchase custom software and content and do all the printing onsite.

One major benefit of this approach is the development patient education resources customized for the individual practice and delivered in multiple distribution formats. Each page that is made available for download carries the unique practice logo and contact information. Referring primary care providers that begin to utilize the resource will constantly see the practice's name as a provider of the resource. Patients who download and print the materials and presented the information to their primary care provider will be, in effect, introducing your practice to their primary care provider. One of the subtle ramifications of this approach is that once the resource has been developed, each use of the resource becomes, in effect, advertising - and the enduser has borne the duplication and distribution costs for that advertising!

Finally, development of these interactive software tools can be leveraged by integration into a comprehensive clinical care pathways program for orthopedics. By creating individual software pieces which can be interchanged to serve a host of functions, these tools can be used throughout the healthcare system - from the hospital floor, from the office and from the home (i.e., home health nurses).

Post Operative Care Pathways

One of the common complaints from primary care providers who refer patients to specialists physicians is that the continuum of care is lost. Most primary care providers, for the most part, would prefer to remain involved in the care of "their" patients. In the rural setting, where referral to a specialist in another town means driving a significant distance, the primary care provider may provide a considerable amount of the follow-up care by necessity, or as a convenience to the patient. Development of an information framework to "jointly" care for these patients can be a tremendous asset in marketing your practice to your referring providers.

Imagine providing your referring providers with a gameplan to help them understand what you expect to occur in the post-operative period. This concept is similar to the concepts embodied in the clinical care pathway, but is in the form of an "outpatient clinical care pathway" that is specific for your practice pattern and the common problems for which you provide care. Making these Outpatient Clinical Care Pathways available on your website makes them accessible to your referring physicians 24 hours a day. For example, if the referring provider is providing follow-up care, or is simply seeing the patient in the office for incidental care, he or she can refer to the pathway to respond intelligently to the patients needs. This can help reduce conflicting advice and create a more consistent presentation to the patient. This resource, once deployed is working for you 24 hours a day....

Interactive Consultation

If your practice members are each Internet savvy, you may want to consider providing interactive consultation to your referring providers. In the past, acquiring and transmitting radiographs electronically was an expensive time consuming process. Today, this can be easily accomplished by utilizing one of the new digital cameras that are now available, allowing low cost teleradiology via email over the Internet. These cameras are being used nearly every day on the orthopod mailing list (orthopod@mailbase.ac.uk) to obtain informal consultation on a global scale. This practice is becoming increasingly acceptable to jointly make decisions with remotely situated primary care providers. It is definitely better than listening to a description of a X-ray over the phone and trying to make an informed clinical decision.

Leveraging the Resources

These resources can be password protected and made available to select group of providers, giving you a mechanism for controlling access. More importantly, restricting access allows you to leverage the resource as a value added feature to those who refer to your practice.

Summary

In the past, implementation of a tool such as described here was simply too expensive, and even worst, usually required coordination of proprietary software among each provider to create a common communications platform. Today, due to the presence of the open standards that have arisen with the near uniform acceptance of the Internet based technologies, we have well accepted software, digital imaging standards and a cost effective public transport system (the Internet). These key occurrences over the past four years have made this approach accessible to any orthopedic practice, for a fraction of the costs previously. The benefits are hard to ignore.

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