What does ezReferral do?

ezReferral is a web based program, run through any browser. It allows health care professionals to communicate quickly, securely and effectively. For instance a family doctor can quickly log in, refer a patient to the selected specialist and immediately see when the referral has been opened, accepted and then scheduled by the other office. Patients are automatically notified. They can easily track, respond to and confirm their appointments via their computers or smart phones.

Can you share the story of how the company started?

ezReferral is the fruit of innovation born from a tragic patient story: A young mother was seen at the emergency and found to have a tumor. A referral was faxed to a surgeon’s office. That fax was lost. By the time things were back on track (months later) her cancer had just started spreading. Long story short, after several difficult rounds of treatment she eventually died. That was the sad wake up call I needed to finally spark this effort to fix a longstanding problem: the notorious unreliability of fax machines resulting in patients falling through the cracks. This problem causes painful, even deadly delays in patient care; more than we dare to admit.

I presented this problem at a forum called Hacking Health Edmonton.  Over the course of a weekend “hackathon” a team of computer enthusiasts built a working prototype that essentially solved the problem.

Spurred on by this breakthrough we started our social enterprise and we have since built what we consider the best referral management software available.

What are the company’s objectives/goals?

Simply, we want to save lives. We want to avoid tragic situations like our patient’s. The team of seasoned IT experts we’ve assembled is fully committed to this mission. These people have engaged from the patient perspective. All of us understand, either personally or through a family member, what it feels like to be standing on the sidelines, not knowing when we will be seen for needed care.

Our goal is to eliminate the fax machine in health care across Canada. We strive to make our process as easy as possible: easy to set up, easy to learn, easy to use, so that everyone who has to share care for a patient can easily collaborate with other professionals.

We want to do all this by running a viable, self-sufficient social enterprise, a service which will improve our health care system and not cost the tax payer more money. In fact we know we can save our system a lot of money.

Our dashboard offers the medical office staff easy tracking ability of all incoming and outgoing referrals. Alerts automatically flag referrals for urgency, missing information, or stagnation. Prompts are made for any required action. Offices using ezReferral are fully compliant to the requirements of the College of Physicians as well as the Privacy Commissioner.

Who are your current target customers?

We are committed to disseminating a low cost solution to all professionals who share patients under their care, whether they be medical doctors, dentists, optometrists, physiotherapists, psychologists, homecare nurses, social workers, long term care facilities etc. All these people need to collaborate in the care of their shared patients. Anyone can send referrals to anyone and everyone.

What impact has your company had on patients?

Patients are often sidelined by the antiquated faxing process. Waiting and not knowing soon results in frustration, escalating to irritation, on to anxiety and finally sometimes even harm and loss of life. Understandably many patients don’t want to be squeaky wheels forced to pester office staff to find out what is going on. Patients need to be involved in their care, every step of the way.

Several thousand referrals have been sent through our system so far.  Not a single referral was lost. Patients have expressed their satisfaction on immediately receiving notifications. The question they typically raise is “When can everyone else start using this?”  The answer is NOW.

What can patients/Albertans do?

Albertans need to know that there exists today a much better, inexpensive way for health care professionals to communicate. Albertans should talk to their doctors and demand that better communication happen. There is no valid reason to continue faxing and losing patient information. The solution is here. Let’s just do it.

What changes in the system have you seen since you started?

Change in large systems always starts slowly. We accept that challenge. We are finding resistance is softening and interest is growing. At first many people are overwhelmed by the magnitude of the problem. How can a start-up so easily devise a solution that Alberta Health had not found? If they did, and even when impressed, skepticism would be raised about our viability. Well we did, and we are still here. Our software just keeps getting better and we are more determined than ever to solve the problem. Now it seems everyone agrees that out-dated referral processes have to go. We have since earned the support of key high level people in government who want to help us make our way into the health care system.

What is or will cause change in healthcare today?

I think a different attitude about innovation has to take hold. It is kind of funny but we always hear about how health care professionals are called upon to lead and innovate.  We hear big talk about “disruptive innovation” but when someone does try to innovate, they may get little support or worse opposition; especially if they upset and show up important people in the system. “Disruptive innovation – yes, but don’t disrupt too much!”

Particularly in health care, providers are afraid to try something new not knowing if it will work out. Health care professionals are understandably risk averse, meaning that we are fearful of making mistakes that could harm the patient.  We want solid evidence, certainty that what we try will work. That means the status quo usually wins the day. That makes innovation much more difficult than in other industries.

Where are the current opportunities?

We are about to start a pilot study with a hospital and a related group of specialists.  We are also putting together a major pilot study with a Primary Care Network. We will measure the impact our streamlined process will have on improving communication and gather the evidence to show better patient outcomes. We are confident these two projects will provide the evidence to show that our process works. We also look forward to the valuable feedback which will help us improve the service even more.

We have started to work with Netcare so that consultant reports can be posted onto their system.  Netcare is a fantastic resource. It is a collection of very useful patient information including medications prescribed, lab/x-ray results and hospital reports.  We want to add the correspondence exchanged between professionals out in the community. We are uniquely positioned to tap into that valuable information source.

What barriers exist?

To this day referral pathways across Canada are still being built around faxing, simply because the concept of an alternative can’t yet be grasped.  The human tendency to resist change is natural. Like any bad habit one needs to rid themselves of, today is rarely the day one wants to start. For that reason many busy offices prefer to continue doing the same thing the same way rather than consider a new solution.

It can be most challenging when dealing with a larger entity like a hospital where there are more stakeholders and committees. Multiple meetings between administration, legal, IT departments bog things down to the point no one can make a decision. It can be quite time consuming and frustrating.

We also have to deal with the challenge of building a critical mass. We face the chicken and egg problem of needing more family doctors to have more specialists and needing more specialists to get more family doctors. Physicians as a rule are very cautious and conservative. The first question often asked is “Who else is using it?” Followed by: “Let us know when my favourite surgeon has embraced your system.”

ezReferral  addresses  the security, stability and privacy issues that all the involved “stakeholders” have to account for. We have also just completed some ground breaking changes that enables ezReferral to handle both faxed and online referrals. This allows use of ezReferral as a hub for all referrals.

Who has been the most supportive?

We have had tremendous support from several sources.

First of all there are a few deeply committed physician champions, people who aren’t afraid of searching for better ways of providing patient care. The pilot projects we are about to start are led by champions of this sort. For the vision, leadership and commitment they have shown we are very grateful.

The Health Quality Council of Alberta has been very encouraging and supportive. As the leading advocate for improvement in patient care this organization has effectively identified significant systemic problems in our health care system. In their landmark report from 2013 they clearly detailed the deficiencies in continuity of care resulting in Greg Price’s death.  We at ezReferral challenged ourselves to address all the gaps identified. That report gave us a key starting point to design our software. We owe a lot to the Price family and to the HQCA for having shared this story.

Members of the Edmonton business community have been very supportive, namely through TEC Edmonton and also the Venture Mentoring Service sponsored by the University of Alberta’s Office of Alumni Relations. Leading business people have been generously mentoring us through our progress, helping us towards achieving success and sharing our goal of improving patient care and saving lives. That support means a lot to us.

What has surprised you the most?

How difficult it actually is to bring change to the health care system. Based on the reaction we received when we first showed people our software, we thought this would be a no-brainer. But it is amazing the degree of inertia and resistance exists, even when we know that patients are dying from this problem. We spend huge amounts of money on beautiful hospitals, advanced medical equipment, the latest treatments only to drop the ball completely with a lost fax. Communication is the weakest link and it seems so hard to recognize that fact.

Anything else you want people to know?

Today it should be just as easy for a patient to track their medical referrals as it is to track their package being shipped by UPS. It’s not only doable, it’s necessary. It is your right to demand it.


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