Online Referral System Research Articles

Contribution of Online Referral Systems to Health Services: Systematic Review

The online referral system (eReferral) is designed to improve waiting times and efficiency by standardizing information and online communication in the referral process. Online referral is the automation of the referral process in which appointments and other information regarding the outcome of a consultation are transferred between two or more healthcare providers. This study was designed to identify the implementation of online referrals at various levels of health care. This systematic review was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) statement. Of the 10 articles included in this review, 6 studies were conducted in the USA, 2 studies in Canada, and one each in the UK, and Saudi Arabia. The studies used a variety of designs, including Quasi-experimental (n=5), longitudinal (n=2), qualitative (n=1), and Research and Development (n=2). This study provides a clear picture of the use of an online referral system, starting from the work process, effectiveness, barriers, and development possibilities for a wider reach. This system is very helpful in easing the workload of specialist doctors and for patients who are referred users get the benefit of shorter waiting times/queues, making it possible to reduce medical costs further.

Contribution of Online Referral Systems to Health Services: Systematic Review

The online referral system (eReferral) is designed to improve waiting times and efficiency by standardizing information and online communication in the referral process. Online referral is the automation of the referral process in which appointments and other information regarding the outcome of a consultation are transferred between two or more healthcare providers. This study was designed to identify the implementation of online referrals at various levels of health care. This systematic review was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) statement. Of the 10 articles included in this review, 6 studies were conducted in the USA, 2 studies in Canada, and one each in the UK, and Saudi Arabia. The studies used a variety of designs, including Quasi-experimental (n=5), longitudinal (n=2), qualitative (n=1), and Research and Development (n=2). This study provides a clear picture of the use of an online referral system, starting from the work process, effectiveness, barriers, and development possibilities for a wider reach. This system is very helpful in easing the workload of specialist doctors and for patients who are referred users get the benefit of shorter waiting times/queues, making it possible to reduce medical costs further.

Establishing The Role Of The Clinical Nurse Specialist For The Older Adult In A Model 2 Hospital

Abstract Background On average 87.5% of inpatients in our Model-2 Hospital are aged sixty-five years or above. Equally 57.5% of inpatients have medium to maximum dependency care needs. In order to meet the needs of this cohort of patients a new post “Clinical Nurse Specialist (CNS) For The Older Adult” was established in September 2023. Methods Using an online referral system, criteria for referral included i) new onset confusion or delirium, ii) clinical frailty score (CFS) of six or greater, iii) known Parkinson’s disease and iv) nursing or medical team clinical judgement. All reviewed patients received a comprehensive geriatric assessment using the Geriatric 5M framework (Mobility, Medications, Multi-Complexities, Mind and Matters Most) ensuring all aspects of patient care were assessed and promoting timely input from our multi-disciplinary team (Physiotherapy, Dietitian, Speech and Language Therapy, Occupational Therapy and Pharmacy). Results Over a period of 207 days the newly established CNS service received a total of 317 referrals. Two thirds (n=206, 65%) received CNS review, one third (n=111, 35%) did not; 45 (14%) were under the care of a consultant Geriatrician and not reviewed to avoid duplication and 66 (21%) were discharged before review could occur. Conclusion Referral numbers received since the established of the CNS post emphasises the need for the service in our hospital inpatient population. Development of the post has ensured that two-in-three referred patients receive a CNS lead CGA. Results from this pilot highlights the need to further develop and expand the service to target the one-in-five who missed review and further extension of the referral criteria.

On the path to UHC, digital healthcare transformation with Karnataka’s online referral framework

BackgroundKarnataka, a trailblazer in Universal Health Coverage (UHC) initiatives, has implemented various features under the Ayushman Bharat-PMJAY-Arogya Karnataka scheme to improve the access to health. This study provides a thorough exploration of Karnataka’s innovative Online Referral System (ORS) within the framework of achieving UHC.MethodsThe study analyses the performance of the ORS using cross-sectional data from June 2022 to November 2023, providing insights into the distribution of referrals, strategic purchasing from private healthcare providers, and the top medical procedures referred. The article delves into the unique features of Karnataka’s Online Referral System, implemented in 2019, which has streamlined the referral process and enhanced communication among healthcare providers.ResultsThe findings underscore the positive impact of Karnataka’s ORS on healthcare efficiency, patient satisfaction, easy access to care and strategic purchasing from private healthcare providers. ORS demonstrates improved efficiency in referrals, mitigating the challenges associated with traditional manual process and is an important aspect in improving healthcare services. The system also provides insights on the specialities requiring more capacity building, the volume, completeness, and processing of referrals through the ORS.ConclusionKarnataka’s innovative ORS, presents a transformative solution for improving healthcare access, coordination, and outcomes, reinforcing Karnataka’s commitment to continuous innovation in healthcare delivery and progress towards Universal Health care. The system also offers valuable insights into specialties that require increased access, identifies gaps in the healthcare system, and outlines areas that need strengthening. The article concludes by advocating for the replication of Karnataka’s ORS model across India and suggests potential avenues for further research and improvement.

Clinical implementation of 177Lu-PSMA-617 (LuPSMA) at a major academic center: Initial experiences.

108 Background: LuPSMA received FDA approval in March 2022 for patients with PSMA-positive metastatic castrate-resistant prostate cancer (mCRPC). Clinical implementation of this treatment requires multidisciplinary team (MDT) involvement and has been beset by challenges in drug supply. We established a joint DFCI GU/Nuclear Medicine Tumor Board (GU-NM TB) to review patients for therapy, and our initial experiences are described. Methods: A joint GU-NM TB was established. All patients with mCRPC who had received at least one prior chemotherapy and a novel hormonal agent were considered eligible and referred to TB through an online referral system after undergoing PSMA-PET/CT. Case details, including prior treatment history, performance status and organ function, and PET/CT imaging were reviewed at TB, with patients either being approved, deferred, or declined for LuPSMA therapy. Patients were scheduled for therapy on a first-come first-served basis. Treatment was delivered per standard-of-care at 180-200 millicurie doses every 6 weeks within NM. A questionnaire was sent to 25 referring physicians 2 months after implementation of the TB to evaluate the referral process. Results: Between May-September 2022, a total of 108 patients were referred for LuPSMA therapy. Median age at time of referral was 73 (range 52-93), and 90% of patients were Caucasian. Median duration between PSMA-PET/CT and TB review was 10 days (IQR 6-17). 84 patients (78%) were approved for therapy, 16 (15%) were deferred and 7 (6%) were declined (reasons including absence of prior chemotherapy, high risk for toxicities, poor performance status); 1 patient died before TB review. Prior therapies included docetaxel (84%), cabazitaxel (56%), abiraterone (67%), enzalutamide (57%), darolutamide (23%), radium-223 (21%) and apalutamide (7%). Median number of prior treatments was 4 (range 2-12). Sites of disease on PSMA-PET/CT included bone (81%), pelvic lymph nodes (42%), extrapelvic lymph nodes (88%), lung (27%) and liver (22%). As of September 2022, a total of 40 patients (48%) have received at least 1 cycle of therapy and 17 (20%) have received 2 cycles; 6 patients (7%) approved for therapy died before receiving 177Lu-PSMA-617. Of the patients that have received 1 cycle of therapy, median duration between TB acceptance and C1 was 52 days (range 32-114). Out of 13 survey respondents, all 13 (100%) reported that their overall experience of the referral process was positive or very positive, and 12 (92%) noted that the Tumor Board had provided additional clinical insights on occasion or frequently. Conclusions: Due to drug supply shortages, <50% of patients approved for LuPSMA therapy have started treatment to date. Median time between TB approval and start of therapy was 7-8 weeks, with 7% of patients dying before receiving therapy. Establishment of a GU-NM TB to review cases and facilitate treatment was viewed favorably by treating physicians.

Utilization Review (Preadmission) Dental Services Before And After Implementation Online Referral System

Problem statement : The online tiered referral system is a digitalized referral system which has been implemented since October 1, 2018. The objective of this research is to find a general overview of the dental and oral health services in the era of national health insurance, before and after the online tiered referral system is implemented by looking at the diagnoses of Social Security Administrator for Health patients at Raden Mattaher Regional Hospital in Jambi Province. Method : Descriptive analytic research was conducted in this research by analyzing preadmission form and referral data of Social Security Administrator for Health patients at Raden Mattaher Regional Hospital in Jambi Province, which were received before and after the implementation of online tiered referral system. Results : Based on the distribution of patient referral data that came to Raden Mattaher Regional Hospital, it was shown that the number before the implementation was higher compared to after, with a total of 135 referrals and 85 referrals. In addition, the value of p 0.05 showed that there was no effect of the online tiered referral system on dental and oral health services at Raden Mattaher Regional Hospital which had been tested by SPSS Paired T-test with a significance value of 0.311 ( 0.05). Conclusion : The conclusion of this research is that the implementation of the online tiered referral system does not affect the dental and oral health services, especially in Raden Mattaher Regional Hospital in Jambi Province Keyword : Online Tiered Referral System; Utilization Review; Preadmission Certification

The impact of National Health Insurance online referral system on the access and quality of health services in Gianyar District, Bali, Indonesia

Background and purpose: The introduction of an online referral system aims to improve the quality and costs control of the National Health Insurance (NHI) or Jaminan Kesehatan Nasional. This study aims to determine the impact of the NHI online referral system implementation on access and quality of health services in Gianyar District. Methods: This is an explorative qualitative study conducted in Gianyar, Bali, Indonesia. Data was collected through semistructured in-depth interviews to a total of 26 informants recruited purposively. They were including policy makers in the health office and the NHI implementing organization (BPJS), heads of public health centres (puskesmas), private health facilities and referral healthcare facilities; and 13 NHI participants. Data collection was undertaken from May to August 2019. The interview results were thematically analysed based on the Health Care Reform Control Knobs Framework. Results: The study identifies several positive impacts of the online referral system, which include: the closer distance of patients accessing services, the easier it is to obtain information on services at referral health facilities, and the easier the hospital to promote its service products, the higher assurance of patients being accepted by the referral hospitals, patients with special conditions are better accommodated, the easier the administrative procedure, improved time, cost and working procedure efficiencies, increased punctuality of the services, and guaranteed data security that reduces the risk of lost or damaged referral documents. On the other hand, the online referral system has also resulted in negative impacts, some of them were system inconsistencies, information and communication technology (ICT) constraints, service discontinuity, service injustices and loss of patients’ loyalty. Conclusion: NHI online referral system generally have positive impacts on access and quality of health services, however, it is necessary to improve several aspects of the online referral system to better accommodate user needs and to optimize service.

Machine learning-based improvement of an online rheumatology referral and triage system.

IntroductionRheport is an online rheumatology referral system allowing automatic appointment triaging of new rheumatology patient referrals according to the respective probability of an inflammatory rheumatic disease (IRD). Previous research reported that Rheport was well accepted among IRD patients. Its accuracy was, however, limited, currently being based on an expert-based weighted sum score. This study aimed to evaluate whether machine learning (ML) models could improve this limited accuracy.Materials and methodsData from a national rheumatology registry (RHADAR) was used to train and test nine different ML models to correctly classify IRD patients. Diagnostic performance was compared of ML models and the current algorithm was compared using the area under the receiver operating curve (AUROC). Feature importance was investigated using shapley additive explanation (SHAP).ResultsA complete data set of 2265 patients was used to train and test ML models. 30.5% of patients were diagnosed with an IRD, 69.3% were female. The diagnostic accuracy of the current Rheport algorithm (AUROC of 0.534) could be improved with all ML models, (AUROC ranging between 0.630 and 0.737). Targeting a sensitivity of 90%, the logistic regression model could double current specificity (17% vs. 33%). Finger joint pain, inflammatory marker levels, psoriasis, symptom duration and female sex were the five most important features of the best performing logistic regression model for IRD classification.ConclusionIn summary, ML could improve the accuracy of a currently used rheumatology online referral system. Including further laboratory parameters and enabling individual feature importance adaption could increase accuracy and lead to broader usage.

Impact of COVID-19 on breast cancer diagnostic and surgical services at a South African academic hospital

BACKGROUND: The purpose of the study was to describe the impact of the COVID-19 pandemic on diagnostic and surgical breast cancer services at Groote Schuur Hospital (GSH) and affiliated hospitals. METHODS: All patients, newly diagnosed, awaiting surgery, and listed for neoadjuvant chemotherapy (NACT) by the breast surgical service from 23 March-23 June 2020 were included. A historic control was used where appropriate consisting of patients presenting in the same period in 2019. Clinic attendance records and surgical waiting lists were used to identify patients in the three months and data were extracted from hospital records including hospital admission records and surgical operative notes. RESULTS: The number of patients who presented with a new breast symptom to the diagnostic breast clinic decreased from 1 094 in 2019 to 299 in 2020, representing a 72.6% decrease. Telemedicine use as a function of the total follow-ups increased from 53% (n = 1 350) in 2019 to 75% (n = 735) in 2020. The overall number of new breast cancers diagnosed decreased from 146 in 2019 to 79 in 2020, but the proportion of patients seen with a new breast symptom who were diagnosed with breast cancer increased from 13% (n = 1 094) in 2019 to 26% (n = 299) in 2020. Eighteen per cent (n = 105) fewer breast cancer surgeries were performed in 2020 compared to 2019, with immediate breast reconstructive procedures representing the largest decrease of 40%. CONCLUSION: The impact of COVID-19 on breast cancer services has been both at the diagnostic level and in delays to surgery. A new online referral system improved referral efficacy translating to more cancers being diagnosed as a function of total referrals. The drop in absolute numbers of cancer diagnoses, however, represents an unmet health need. An expansion of our telemedicine service mitigated COVID risk in the outpatient setting. The greatest impact on our treatment decisions was seen in the cohort of patients placed on neo-adjuvant endocrine therapy (NET). We saw a global decrease in breast surgeries performed, with the greatest decrease being in reconstructions.

A Comparison of Self-Referral and Referral via Primary Care Providers, through Two Similar Digital Mental Health Services in Western Australia.

Digital mental health services (DMHSs) deliver mental health information, assessment, and treatment, via the internet, telephone, or other digital channels. The current study compares two DMHSs operating in Western Australia (WA)—The Practitioner Online Referral System (PORTS) and MindSpot. Both provide telephone and online psychological services at no cost to patients or referrers. However, PORTS is accessed by patients via referral from health practitioners, and is designed to reach those who are financially, geographically, or otherwise disadvantaged. In contrast, MindSpot services are available to all Australian residents and patients can self-refer. This observational study compares characteristics and treatment outcomes for patients of PORTS and MindSpot in WA. Eligible patients were people who resided in WA and registered with either clinic from January 2019 to December 2020. Results showed that PORTS patients were more likely to be older, male, and unemployed. They were less likely to report a tertiary education and were more likely to live in areas with higher levels of socioeconomic disadvantage. Despite these differences, treatment outcomes were excellent for patients from both clinics. Results provide further evidence for the accessibility, acceptability, and effectiveness of DMHSs regardless of referral pathway or patient characteristics.

Teledentistry and Online Referral System in Indonesian Primary Health Care Center During the COVID-19 Pandemic: A Narrative Review.

ABSTRACTAims:This review aims to map the needs and challenges in the application of teledentistry and online referral system encountered by dental health care professionals in Indonesian primary health care centers (puskesmas) to provide safe dental health service to the population during the COVID-19 pandemic.Materials and Methods:Literature search was undertaken of both in Indonesian and overseas context related to teledentistry. Narrative review of the literature was written to present the challenges, solutions, and application of teledentistry at Puskesmas to optimize oral health services during the COVID-19 pandemic.Results:Online referral system and teledentistry are options to help dental health service delivery in the pandemic era. While it has been adopted in many private clinics, there are many challenges to adopt it at the puskesmas level due to a lack of infrastructure, human resources, and budget allocation. While the Indonesian government has plans to support the digitization in the education and health sector, this pandemic shall pose an opportunity for Indonesian health department to develop and facilitate the use of teledentistry and online referral system. During this situation, health cadres can bridge the relationship between Puskesmas and the poor community through the help of teledentistry.Conclusions:The government commitment in applying online referral system and teledentistry in Puskesmas is needed. Dental education institutions can help to supply human resources, who are capable of developing and carrying out the most suitable teledentistry application for all stakeholders.

Literature Review: Analysis of Factors Related to User Satisfaction on The Online Reference System for BPJS Health Participants in Semarang City

An online referral system is an innovation from BPJS Health in digitizing the tiered referral system. An online referral system is expected to increase the participants' satisfaction and convenience in obtaining the referral service. However, there was no evaluation in satisfaction measurement on an online referral system until this time, especially in Semarang City. This study aims to evaluate the implementation of an online referral system by analyzing factors related to the satisfaction of BPJS Health participants in Semarang City. This was a quantitative research with a cross-sectional approach involving 100 respondents chosen by accidental sampling technique. The results of the study showed that the percentage of respondents who felt satisfied was only 54%, which was caused by the administrative efficiency and system effectivity of an online referral system that is still not optimal in reducing queues. Besides that, there is a relationship between performance expectancy, effort expectancy, facilitating condition, information quality, and user satisfaction towards the implementation of an online referral system in the BPJS Health of Semarang City with a p-value < 0,05. The results of the study suggest for BPJS Health determine the participants' satisfaction indicators towards the implementation of the online referral system and integrate the online referral system with the registration system at secondary and tertiary health facilities in Semarang City.

Penerapan Sistem Komunikasi Rujukan PSC 119 – Satria Oleh Fasilitas Pelayanan Kesehatan Di Kabupaten Banyumas

Referral Communication System of Public Safety Center 119 SATRIA is an integrated maternal, neonatal and other emergency referral communication system in Banyumas Regency and has been used in all health service facilities in Banyumas Regency. The purpose of this research is to find out the problems that occur in its implementation conducted by the Health Service Facilities in Banyumas Regency. This research was conducted using the in-depth interview method with 6 respondents from 5 agencies, and it got 4 themes that were discussed, namely the Difficulty Level of Application Usage, Internet Connections, Human Resources, and Solutions as well as Anticipation. Qualitative research with a descriptive case study approach that is the implementation of the PSC 119 SATRIA referral system application by the Health Service Facilities in Banyumas Regency. Results from the 4 themes in the discussion conducted to 5 respondents stated that there were no problems in 3 themes, except the Internet Connection. The speed of the internet connection in the referral process through the online referral application system is very influential on the speed of the referral response time. In other words, it also affects the development of patient health, reducing mortality due to late referral. Problems that occur in each institution where respondents work are due to slow internet connection so that the process of referral communication from referrers to recipients is hampered.
 
 Keywords: Referral, Referral System, Response Time

Algorithm-Based Online Software for Patients' Self-Referral to Breast Clinic as an Alternative to General Practitioner Referral Pathway.

IntroductionThe study aimed to assess the accuracy of online software in the use of self-referral to breast surgery clinics for patients with new signs and symptoms. The study also evaluated the appropriateness of GP referrals to breast clinics and evaluated patients' perceptions of an online self-referral portal to the breast clinic for the assessment of breast signs and symptoms. Design and methodsThe pilot study was divided into two phases. In the first phase, prospective questionnaire-based data was collected from patients who were referred by a GP and presented to the regional breast unit with new signs and symptoms for breast conditions, Princess Alexandra Hospital NHS Trust (May - October 2018). The questionnaire assessed the time at each stage required by the patient to have a visit at the breast unit. It also asked the patient's opinion about an online self-referral portal to the surgical clinic. They were given hypothetical scenarios to evaluate their understanding of breast conditions. In the second phase, the patients presenting to symptomatic breast clinics were provided with the iPad to fill in their medical information in the online software. The data was collected between July and October 2019. The software algorithm was based on the National Institute of Clinical Health and Excellence (NICE) guidelines for breast conditions (2015). Breast surgeons’ recommendations acted as a standard to evaluate the accuracy of GPs' referrals and software outcome for each patient. ResultsThere were 80 patients (mean age 49.1 [SD: 17.7], all females) included in the first phase of the study. The most common clinical presentation was a breast lump (47.6%), followed by breast pain (26.9%) and nipple changes (7.9%). Breast surgeons considered appropriate 75.6% of the referrals made by the GP. Seventy-two percent of the patients got an urgent appointment to see their GP, and 94.8% of the patients were urgently referred by their GP to see the breast surgeon. Only 37.8% of the urgent referrals were correctly referred as urgent. Having a direct online referral system for breast conditions will be beneficial for patients was agreed by 78.4%. The majority (98.1%) of the participants answered correctly for the hypothetical questions requiring breast surgeon review. In the second phase, there were a total of 86 patients with a mean age of 43.9 (SD: 13.3). The most common presentation was breast lump (n=68, 79.1%) and other presentations included breast pain, nipple changes, and discharge. The GPs' accuracy of correct referral was 69.1%. One third (30.9%) of the referrals could have been managed in the community or as a routine review by the breast surgeon. In comparison, the online software's accuracy was 85.1% accurate (p=0.001). The accuracy for detecting patients who needed urgent breast clinic review was 100% for online software. ConclusionA large proportion of referrals could have been dealt with in the community or referred routinely. Patients would prefer a direct online referral system to the breast clinic. They understand red flag signs and symptoms. Online software has the potential to streamline patients for symptomatic breast clinics. It can reduce the burden on the GPs who are constantly under pressure to diagnose patients accurately and refer to the correct specialty appropriately within a short time.

A Nationwide Network to Provide Supervised Exercise Therapy and Lifestyle Counseling for All Patients with Non-Communicable Diseases: Chronic CareNet.

Non-communicable diseases (NCDs) are a major cause of disability and mortality worldwide. Physical inactivity is an important contributor to the development of NCDs. Increasing physical activity through supervised exercise therapy (SET) is proven to be effective, and is a key component in both the prevention and treatment of most NCDs. However, only a minority of patients with NCDs receive this treatment, mainly due to an insufficient number and poor accessibility of specialized physical therapists. The aim of this article is to describe a solution that, if indicated, enables all patients with NCDs in the Netherlands to receive SET by a specialized physical therapist: Chronic CareNet. Chronic CareNet is a nationwide network of specialized physical therapists, providing high quality SET and lifestyle counselling to patients with NCDs, initially focusing on peripheral arterial disease, chronic obstructive pulmonary disease and coronary heart disease. The network evolved from ClaudicatioNet. In order to monitor quality of care, therapists enroll in a continuous educational program, and process and outcome indicators are collected by all therapists, which can be compared with a nationwide benchmark (quality system). A robust infrastructure of information and communication technology provides an online care finder and referral system to locate and refer to nearby therapists. All elements of Chronic CareNet are essential, to ensure that all patients in the Netherlands have access to a nearby specialized therapist.

The impact of National Health Insurance online referral system on the access and quality of health services in Gianyar District, Bali, Indonesia

Background and purpose: The introduction of an online referral system aims to improve the quality and costs control of the National Health Insurance (NHI) or Jaminan Kesehatan Nasional. This study aims to determine the impact of the NHI online referral system implementation on access and quality of health services in Gianyar District.Methods: This is an explorative qualitative study conducted in Gianyar, Bali, Indonesia. Data was collected through semi-structured in-depth interviews to a total of 26 informants recruited purposively. They were including policy makers in the health office and the NHI implementing organization (BPJS), heads of public health centres (puskesmas), private health facilities and referral healthcare facilities; and 13 NHI participants. Data collection was undertaken from May to August 2019. The interview results were thematically analysed based on the Health Care Reform Control Knobs Framework.Results: The study identifies several positive impacts of the online referral system, which include: the closer distance of patients accessing services, the easier it is to obtain information on services at referral health facilities, and the easier the hospital to promote its service products, the higher assurance of patients being accepted by the referral hospitals, patients with special conditions are better accommodated, the easier the administrative procedure, improved time, cost and working procedure efficiencies, increased punctuality of the services, and guaranteed data security that reduces the risk of lost or damaged referral documents. On the other hand, the online referral system has also resulted in negative impacts, some of them were system inconsistencies, information and communication technology (ICT) constraints, service discontinuity, service injustices and loss of patients’ loyalty.  Conclusion: NHI online referral system generally have positive impacts on access and quality of health services, however, it is necessary to improve several aspects of the online referral system to better accommodate user needs and to optimize service.

EFEKTIVITAS RUJUKAN ONLINE BAGI PASIEN RAWAT JALAN DALAM PROGRAM JAMINAN KESEHATAN NASIONAL (JKN) DI KOTA SOLOK

This study aims to determine the effectiveness of online referrals for outpatients in the National Health Insurance Program (JKN) in the city of Solok and describe the constraints and efforts that realize the effectiveness of online referrals for outpatients in the city of Solok. This research is motivated by the obstacles in FKTP as well as complaints from participants or the community when the online referral system was implemented. This research uses a qualitative method with a descriptive approach. The instrument of data collection was through interviews, observations and documentation. The results of this study were the effectiveness of online referrals in the national health insurance program in the city of Solok. It was not effective because there were still some obstacles, both constraints from BPJS, FKTP, FKRTL and also complaints felt by the participants.

Hospital strategy in Gianyar regency facing the era of national health insurance

Premagana Gianyar Hospital as a private hospital has participated in the JKN program since the end of 2015. In its participation, Premagana Gianyar Hospital has experienced several problems due to the existing JKN system. Problems experienced are due to the fact that the number of costs incurred by the hospital is greater than the costs that come out, outpatient patients still need to be supported which certainly makes the costs incurred higher than the cost of the claim, and the latest on the BPJS Health online referral system is very detrimental, because, since the enactment of the online referral system, outpatient visits to the Premagana Gianyar Hospital polyclinic began to decline. A mature strategy is needed to face the era of BPJS Health in the future amid various issues and changes that occur. This study aims to determine the strengths, weaknesses, opportunities, and threats of Premagana Gianyar Hospital is facing the era of national health insurance and to find out the Business Strategy of Premagana Gianyar Hospital in Gianyar Regency in the face of the era of National Health Insurance.

Online referral and immediate appointment selection system empowers families and improves access to public community paediatric clinics.

We aimed to introduce a low-cost combined online referral and immediate appointment selection system (CORIAS) to empower referrers and parents by allowing them to schedule an appointment at a time and location of their choosing in conjunction with the referrer at the time of referral. This was because an unacceptably high rate of reported lost referrals, combined with a high rate of failure to attend initial appointments (FTAs), was noted at a six-site community paediatric clinic service. We aimed to analyse the impact of CORIAS on important outcomes including timely appointment scheduling, attendance, loss of referrals, user acceptance, overall cost and administrative burden. For 3-month periods before and after the implementation of CORIAS, data were collected regarding all new referrals received and initial appointments scheduled, as well as reports of lost referrals. The number of attended initial appointments, FTAs, failures in successfully scheduling appointments, referrer background, CORIAS cost and qualitative feedback received from relevant parties was collated and analysed. The proportion of referrals reported lost was 6% following the implementation of the combined online system in comparison to 17% pre-implementation. The FTA rate for scheduled initial appointments pre-implementation was 16%; post-implementation, the FTA rate was 9%. Qualitative benefits included a decrease in the administrative burden associated with appointment scheduling and increased service access for culturally and linguistically diverse families. Appropriately designed and implemented novel online systems may improve timely and equitable access to health care by providing secure, reliable pathways for referrers and by empowering and improving communication with patients and families.

Giving Families Choice: A Combined Online Referral and Appointment Selection System Improves Attendances at Public Community Paediatric Clinics

Giving Families Choice: A Combined Online Referral and Appointment Selection System Improves Attendances at Public Community Paediatric Clinics