3. Research for Easy Referral
Learning from the previous mistake and feedback, we have decided to continue researching first and gain enough insights where the insights would be suitable enough to support the new idea. In order to do that, we went to the UQ Centre for Online Health and met Professor Anthony Smith. UQ Centre for Online Health has contributed to improving the health care in rural areas in Queensland. They keep innovating new ways to help to remodel a better healthcare system. One of the examples is they created a robot for child care where doctors could do consultation online with a child. Professor Anthony Smith also mentioned that telehealth not only has helped people in remote areas, but it has also helped people in urban too. Another work that they did is to travel throughout Queensland rural areas with a van that has medical equipment in it. Here, we found that there are techniques that they conduct throughout the year to support the telehealth itself.
Although telehealth keeps improving, Professor Anthony Smith mentioned that there are bigger issues that relate to the telehealth. There are barriers like clinician resistance, licensure, reimbursements, infrastructure, clinician availability, etc. These barriers are often forgotten and neglected by people where it might decrease the telehealth development in Queensland. People usually assume telehealth as just simple skype where it is more complex than that. Interconnecting people seemed easy but to be effective in doing that is hard. These ignored issues or barriers might bring to the lengthy process of telehealth, thus, it results in time and quality loss of the healthcare itself.
This issue brings attention to our group. One of the issue Professor Anthony Smith mentioned is the fact that each hospital has their own system of registered patient and doctors. The process of getting a specialist, if people in rural areas need a specialist from the city, is to have a referral from the General Practitioners (GPs). GPs must create the referral to the nearest specialist based on the patient's need. Afterward, the patient needs to go to the hospital and make an appointment based on the referral doctors. With a different system that each hospital has, it would make the whole system more complicated and uneasy to use. This would cause a loss of time and also very disadvantageous for the patient side and also for the hospital side. Knowing this issue, we would like to know the reason that affects the outcome and also the real-life impacts.
Long Referral for Cancer Confirmation News This news indicate that there are several occasions where people need to wait for months just to get to the specialist and receive the result. In this case, the patient wait for 8 months just to get the confirmation that the patient has cancer. And with time growing, the prevention treatment the patient could take also being on hold.
Long Referral to see specialist news This news also indicate that some patients happened to wait for years to see the specialist and have surgery. As none action happened between in the referral waiting list, the patient condition might worsen throughout the time waiting to see a specialist.
Long Referral in QLD and VIC to see specialist This news indicate that there are other aspects that might affect the waiting time which is the availability in public hospital. Orthopedic surgeons and rheumatologists spend more than 70% of their time in private practice instead of in public hospital.
With these published documents, we are discovering the impact of the referral issue could bring dreadful consequences. One mentioned that most doctors are practicing their time privately instead of in a public hospital, thus, they have little time to serve an enormous number of people. Metro South show the Telehealth Activity in 2015-2016 which has almost twice significant progress from 2014-2015. As the telehealth keeps progressing, our group think it is very important to improve the quality of barriers mentioned above. With the quicker supporting system, it would also produce a better healthcare system. As this issue feel important to be solved, before our group makes any decisions, we are very keen to explore more about how the hospital systems work where it may establish the referral issue. Thus, in the next practice, we are interviewing people.
We decided to choose an interview as our method of research in order to know qualitative information about the hospital system. We want to learn new information from doctors that have experience from making or receiving referrals. The questions are:
- What decisions influence you to choose a physician to refer a patient to?
- Is the information in the referral section adequate, if yes, what have we missed?
- Is there any legal entities involved, or we missed in for the website?
- What would make you use the website?
- Do you have any comments or questions about the system?
We sent this interview to five doctors and out of five, we got three responses. This interview helped us get more insights into what works best for the doctors, your participation is highly appreciated. There are several insights that we gain from the overall interview:
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From the responses, we learnt that general practitioners choose physicians based on their level of experience as the more experience they have been in in the field the more they are likely able to make better decisions, the reviews or feedback from patients, how the hospital facility they worked for is ranked, availability and their location. The information we provided in the referral section was adequate but we could include information like years of experience when choosing a physician and also have an area where it would show their rating, and for the patient, we would add their medical record number.
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All of them responded to accepting that they would use the system, the system seemed to be easy to use and helpful. Other comments we got were that, there usually just clinical officers in the rural areas because of poor resources, and these clinical officers do not have as much education as the doctors would.
After analyzing the feedback, a conclusion was made that our new idea could be usable and helpful in real life scenario. We also pitch the idea to Lorna where she also gives us feedback that we need to do further research about how and what factors do the GP made when they choose a specialist.
As we feel we have enough insights to make a decision of our topic, we decided to take referral issues into our domain problem. From our interview and research with Professor Anthony Smith, our group feels like the domain problem is suitable to solve the higher degree of rural healthcare where most of the referrals happened. Although the issue in rural healthcare is distance and availability, this issues is mostly solved by telehealth by now. What is left is to bring telehealth into a better version. One of the solutions to it is to bring the referral system more thoroughly and effectively.
As the idea narrowed down to find a solution to fix the issue in the referral system, we will continue developing and making a prototype based on overall research that we have conducted since the beginning of the project. The issue of poor referral system has caused bad outcomes that might cause further harmful effects to the patient. Like examples above, this could cause the patient condition to become worse than the initial meeting with GP. One of the reason is that the referral system is unstructured and unordered where each hospital has a different system that is difficult to be integrated into one system. Our idea is to provide a simple integrated referral systems from GPs to a specialist that could be used on all hospitals.
In this case, we chose to narrow down the specialist type to the physician as some of our team members have several relatives with a physician, thus, it will be easier for us to conduct research. The platform also will include the feature to book an appointment with the physician. We feel it is very important to include this feature as it will make the whole process quicker on both medical and patient sides.
Below is what was suggested in our group to be in the new solution after carrying out the research, analysis, and brainstorming. We named the new platform Easy Referral, the aim was to make referrals easier by making sure that the general practitioners are able to find are able to find physicians, check their schedules, book the patients in and send them referrals for the patients. The patients will have a mobile app that is only used for getting notifications and reminders about their appointments.
- We changed the name from Medical Network Platform to EasyReferral
- General Practitioner to be able to create referral by searching nearest Physician that match the Patient needs
- Mobile application to be the connection between the general practitioners and the physicians
- Physicians to be able to post their availabilities and experience
- The general practitioner and the physicians would be able to chat.
- The referrals can be digitally sent by the general practitioners.
| Questions | Medical Team 1 | Medical Team 2 | Medical Team 3 |
| What decisions influence you to choose a physician to refer a patient to? | I'm not sure I understand the question. But I choose a specialist based on their level of experience in the field. The longer they have practiced, the more likely they are to make better decisions |
would look at other people’s reviews of them, what qualifications they hold, how much experience they have, what clinic/hospital they work for (and how that medical facility is ranked), and if a trustworthy source recommended them to me |
Experience and their location, their specialty |
| Is the information in the referral section adequate, if yes, what have we missed? | Yes | somewhat but I would recommend also including the specialists specialisation in their description, years of experience and at least a peer review by colleagues if possible | The information is adequate but you could add more information under the specialist, as there are four types of specialties: surgeon, internal specialists, gynecologists and pediatrics. |
| Is there any legal entities involved, or we missed in for the website? | None that I have noted. Looks ok | for the patient, probably a MRN (medical record number) so any health professional can access their history on the MyHealthRecords online system |
It usually needs to be approved by a committee that deals with that, usually called Ethics committee. |
| What would make you use the website? | Looks good. If our health system incorporated an electronic platform, I would use this |
yes, it’s easy and straight forward |
I would definitely use it, it seems helpful. |
| Do you have any comments or questions about the system? | Looks good and innovative. However the visibility of the prototype on my mobile device is poor in the sense that the display is too small relative to my screen. If that's how the interface looks, It may need improvement) | maybe on page 5 make the sections more distinct (waiting for approval should be like light orange and the approved section should be light green so I don’t get the two mixed up) also for the first part, maybe before choosing physician if I could choose what specialisation I’m looking for first then the physicians in that area | There usually no doctors in the rural areas rather clinical officers, who have low education because of poor resources. |