discussion-The San Francisco General Hospital & Trauma Center

The San Francisco General Hospital & Trauma Center (SFGH) includes community health centers, clinics and affiliated partners, serving residents of San Francisco and northern San Mateos. Along with SFGH being the only public hospital and Level 1 Trauma Center, the hospital serves as an educational facility for the University of California, San Francisco (Improving Chronic Illness Care, 2006-2021). Considering the fact that it is such a beneficial and medical hub for the population, many faced the troubles of appointment making regarding those who would need it. Poor communication and coordination of patient care between physicians and specialty care providers are prominent in healthcare. These issues create an inefficient and confusing setting for the demand in specialist services (Bell, 2012). Dr. Hal Yee, chief of the Gastroenterology and Hepatology Division, developed a solution, where technology would be involved in creating eReferrals. Along the way, Dr. Alice Chen, a medical director for San Francisco Generals Adult Medical Center, teamed up with Dr. Yee. and both worked to efficiently spread the new technology management system throughout the multiple hospitals and clinics within SFGH. The use of eReferrals should help decrease wait times for new patients and improve quality of care. The eReferral system would focus on time efficiency, being in contact with patients, helping with patients needs, creating appointments as needed, and so much more. Before the new eReferral system, the San Francisco General Hospital and Trauma center (SFGH) had a paper based referral system that was subpar when compared to the efficiency of the eReferral system. There were many issues with the paper based referral system and some of these issues include backlogs for certain appointments. According to the study, patients had a wait time of 11 months for a gastroenterology appointment. Another issue with the paper based referral system was due to communication. Some patients referrals are never received and this led to the patients never being scheduled for an appointment. These communications issues and long wait times for appointments were two prominent problems for the San Francisco General Hospital and Trauma Center (SFGH).

Patients at the Richard Fine Peoples Clinic (RFPC) were selected and assigned to a primary care provider, ensuring continuity of care and opportunities for residents to build long-term relationships with patients. RFPC provides a broad range of services to patients, including primary care, emergency care, phone counseling, nurse triage, nutrition counseling, pharmacy counseling and behavioral health services. This clinic uses an electronic medical record that integrates hospital data, including notes on medications, allergies, laboratory diagnostic studies, electronic referrals and counseling systems. (UCSF, 2021). With that in place organizations can be more efficient, with less medical errors and resulting in saving many patients’ lives. Furthermore, the purpose of the electronic referral program, which was trialled in Gastroenterology Services at the SFGH in 2005, is to improve primary care (PCP) and specialist communication, reduce patient waiting times for specialist knowledge and avoid unnecessary appointments. The current system for referral of specialists to PCPs and specialists is based on an electronic platform embedded in EMR. There was an investigation on how specialists used an electronic referral and counseling system to perform specialized treatments, identified determinants for high-quality electronic specialist communications, and measured the impact of feedback on quality of specialist communications. The results of this investigation, along with an analysis of the new systems promulgated within other departments at SFGH, provide a clear picture of both the benefits and drawbacks of utilizing electronic referral programs. While local PCPs are satisfied with the eReferral system, those with intermittent internet access are benefiting less compared to those with great internet access. Overall, the goal of lowering wait times has been successful and the eReferral system has helped to improve specialty access. 

(WC:618)

Questions:

1. What was the cause of the severe backlog that patients experienced in making appointments at San Francisco General Hospital (SFGH)?

2. What would ensure the security of patient information with these electronic records? 

3. How do we know that patients will keep their electronic records up to date?

4. How does the old referral system differ from an electronic referral?

5. Why was the use of technology important and beneficial to solving the backlog problems at SFGH?

6. What are some of the drawbacks regarding the utilization of the electronic referral programs?

References

Bell, D. S., Straus, S. G., Wu, S., Chen, A. H., & Kushel, M. B. (2012, February). Use of an electronic referral system to improve the outpatient primary carespecialty care interface. Final Action Contract Report. 

Improving Chronic Illness Care. (n.d.). San Francisco General Hospital.  

UCSF. (2021). ZSFG Primary Care. ZSFG Primary Care | UCSF Division of General Internal Medicine at ZSFG. 

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