Working at Ocean we are continuously inspired by what our clients are able to achieve with our tools. And recently, no project has been more inspiring to watch blossom than Nova Scotia eReferral. Comprised of multiple government, medical and technical groups, including Nova Scotia Health, IWK Health and the eHealth Centre of Excellence, the project officially went live on April 1, 2023 following several months of planning. A little over 12 months later and the project has already made a meaningful impact on the lives of patients and providers across the province—and it keeps getting better.
This article provides a brief summary of what the province has been able to achieve in such a short time, and reflects on several factors contributing to the success, including: the importance of provincial mandates, the utility of central intakes, and the need to keep patients top-of-mind.
Note: The views expressed in this case study are solely those of OceanMD. As with all complex, system-level projects, success required the close collaboration of multiple expert groups, and we have not attempted to articulate all of their specific contributions or perspectives in this piece.
The Results After 1 Year
14K+ eReferrals Per Month and Growing
90%+ Primary Care Onboarded as Senders
95%+ Surgeons Onboarded as Receivers
Simply put, the results at this point are nothing short of incredible. Bringing over 90% of primary care providers onboard with a new paperless process can feel like a daunting challenge for any change management team. However, Nova Scotia made primary care a priority from Day 1, going as far as selecting Ocean because it is the only platform seamlessly integrated with the most commonly used EMRs in the province (Accuro and Med Access).
The results are even more compelling when you consider that Nova Scotia’s population hovers around 1 million, meaning that the eReferrals sent per-person likely already place the province among the most digital-forward jurisdictions in North America.
“We now have new insight into the number and types of referrals being sent and their status, which is improving our ability to plan, co-ordinate referrals, communicate with patients and providers, and support more timely access to surgical consults.”
– Dr. Greg Hirsch, Senior Medical Director with Nova Scotia Health (source)
A Winning Strategy
Start with a single pathway
While there is certainly no one-size-fits-all strategy for effecting large-scale change— especially in healthcare—the decision in Nova Scotia to start with only the surgical referral pathway has proved prescient. Thanks to the laser-focus on this critical primary care:specialist engagement, the project teams were able to manage the many unknowns, optimize their Ocean tooling and establish repeatable processes for onboarding additional pathways down the road. Given the inherent complexities, projects attempting to launch multiple pathways simultaneously may risk becoming stalled due to competing priorities and perspectives.
Scale with central intakes
A second lesson that other jurisdictions can learn from Nova Scotia’s rapid ramp-up has been their strategic decision to double-down on Ocean’s central intake functionalities. The concept of central intakes, which provide a singular endpoint for all primary care providers to refer to, dramatically simplified the referral process for providers who no longer had to rely on their mental rolodex of surgeons. It also provided peace-of-mind for physicians, knowing they can rely on central intake staff to get their patient the care they need as quickly as possible.
Today, there are two primary central intake Healthmap listings in Nova Scotia: one for General Surgery (pictured below) and one for Diagnostic Imaging (MRI, ultrasound). As more pathways are added, this central intake model can be replicated with increasing ease thanks to growing familiarity with the systems by all users.
Critical Considerations
Commitment from the highest levels
The best-laid plans can still be derailed if high-ranking officials are not on the same page as project teams. Thankfully, this was never the case in Nova Scotia, where the Minister of Health & Wellness herself repeatedly voiced strong public support for the project and was featured in prominent news outlets including CBC.
And the commitment wasn’t just theoretical: One short year after the first eReferrals were sent, Nova Scotia Health announced a mandate requiring primary care physicians to adopt eReferral for all their surgical and DI referrals. The mandate, which came into effect April 1, 2024, reinforced the government’s commitment to eReferral and made it crystal clear that the time for change is now.
“We really want to move toward these e-referral processes — so much safer for patients, more efficient, so we really are pleased with this step and think it will make a big difference for providers and patients.”
– Michelle Thompson, Nova Scotia Health & Wellness Minister (source)
Communicating clearly and consistently
Shifting critical workflows for thousands of physicians and medical administrators is no small feat. And the complexity is compounded by the variety of existing technologies (or lack of technology) in use across the province, each with its own quirks and capabilities. To successfully transition at this scale, the importance of clear and consistent communication is paramount.
To facilitate mass communications and provide a cohesive set of training materials, the Nova Scotia teams developed a universal resource hub in collaboration with Ocean. Since launching, the hub has served as a flexible digital destination for a variety of content types and feedback forms. Everything from recorded webinars to PDF guides to patient testimonials are hosted there, simplifying the co-ordination of change-management efforts. You can see a selection of materials by sliding through the gallery or visiting the link below.
Compassion for the patient experience
The importance of keeping patients in mind during digital transformation projects cannot be overstated. When technical challenges arise, or difficult decisions must be made, focusing on the potential patient benefits helps inspire the strong sense of purpose necessary to make magic happen.
By engaging directly with patients and sharing stories of their eReferral experiences across multiple channels and platforms, Nova Scotia’s teams have helped consistently demonstrate “why” this work is so important to everyone across the province. An example of their compelling patient perspectives can be found here: Patient perspective: New eReferral system will ‘benefit everyone’ and ‘save lives’
eReferrals “take away the anxiety because you don’t know, often, if a referral has gone through, if the receiving clinic has in fact received it, and often you don’t know when your appointment is going to be for months.”
– Patient and mother (source)
What’s Next in Nova Scotia
The Nova Scotia eReferral project is continuing to scale while bringing new, high-impact pathways online. Currently, the teams are working on adding CT scans to the high-volume Diagnostic Imaging pathway that already handles eReferrals for MRIs and ultrasound. Beyond that previously announced effort, the world will have to wait-and-see what the East Coast Innovators do next!
