The following challenges were identified through extensive engagement with care providers, administrative staff, and patients from across BC:

• Fax-based referral and ordering processes are inefficient and subject to errors, creating significant work for physicians and admin staff
• Patients and requesting physicians have little or no visibility into the status of referrals and orders
• Referrals/orders often lack sufficient/appropriate information, causing rework and potential delays
• Significant overhead in managing forms (referral, diagnostics, etc.) and keeping up with changes

The Digital Referrals and Orders (DRO) program is intended to address the above issues, creating a seamless, efficient experience for patients, health care providers, and administrative staff.

Extensive consultation took place with care providers across the province to better understand the challenges they faced in delivering care.

As part of the Digital Health Strategy Refresh, workshops were scheduled by Doctors of BC in summer 2022 to gather input and requirements for a Clinical Service Request for Proposal (RFP).

Several physicians and other clinicians were actively involved throughout the RFP process, including evaluating and selecting the chosen vendor, Ocean.

The DRO program is currently approving user licences for receiving clinics in the lower Vancouver mainland.

Sending providers do not need a license and so can be located anywhere in the province, however implementation is currently focused in the same geographic area.

The program will begin adding licences in more regions over the coming 12 – 24 months. The DRO Program is planning to implement eReferrals across the province.

The benefits to specialists include streamlined referral process, reduced use of fax, tracking of referral status for sending and receiving providers, secure messaging between providers/clinics, and the ability to update and maintain digital referrals and automated referral status updates.

Specialists (receivers) who participate in the DRO program will also receive access to the patient engagement tools for (optional two-way) secure patient communication, online patient forms/questionnaires and soon Ocean website forms.

Enables sending sites/providers to receive real time status updates about the referrals they send and seamless communication and information exchange with receiving sites.

The system also enables patients to consent to receive automatic updates about the status of their referrals. Sending sites also have access to a dashboard to manage all referrals.

The Healthmap will also always have the most up to date referral form and so sending sites will no longer need to manage changes or updates to forms in their EMR.

Currently there are approximately 300 Ocean users in BC, using the Ocean Patient Engagement platform at their own cost.

eReferrals, eOrders and eConsults will be available to all community providers at no cost.

Ocean Patient Engagement tools will also be available at no cost to providers who are receiving referrals using the DRO Program.

There are many resources available to explore. A good place to start is with these videos.

To send eReferrals, users must have an Ocean account.

Receivers require a listing on the Ocean Healthmap and a license to participate in the program.

The DRO team is working strategically to build capacity in specific geographic regions to increase the available network to send and receive referrals.

Currently eReferrals listings for receiving locations are being implemented in the Vancouver Lower Mainland area.

If you use one of these integrated EMRs or are willing to use the Ocean web portal to send or receive eReferrals, please contact us at: DRO.Program@phsa.ca.

Yes, Ocean is mobile ready.

There is no cost for providers, administrative staff, or patients to use this platform as it is funded through a provincial contract via Ministry of Health.

The DRO Program powered by Ocean is promoting a digital referral standardization approach to deliver value to providers early while addressing core referral workflow issues.

The DRO program is supporting the eReferral creation by speciality area through Specialty Working Groups (SWGs), whose members:

• Provide clinically rooted direction-setting
• Define build requirements, design, and development for provincial digital referrals
• Are comprised of subject matter experts (SMEs) from both the sending and receiving side of the speciality referral and their office assistants
• Can articulate their needs, offer workflow insight, formulate usability considerations
• Evaluate the build prior to release into production

The Doctors of BC are supporting the identification of physicians to these working groups and will also cover all sessional fees for participating for DoBC members.

Over time, the DRO program will develop a repository of digital referrals that embody the same look and feel and take advantage of the full capability of the Ocean functionality.

Specialty working groups (SWG) are supported by Doctors of BC which is helping facilitate physician involvement and input and provides funding for Doctors of BC members and staff to participate.

If you are a Doctors of BC member interested in participating in a SWG, please contact the Doctors of BC Digital Health team at digitalhealth@doctorsofbc.ca. You can also learn more about Doctors of BC’s digital health advocacy and upcoming engagement opportunities.

Once the digital referral is created and published in the PHSA digital referral library, a receiver that wishes to use one of the available digital referrals may be implemented with Ocean.

During implementation, the clinic will be supported to create a directory listing on the Ocean Healthmap.

At this time, implementation is limited to geographic areas in the lower Vancouver mainland however, these restrictions will be lifted gradually over the course of 2024 and 2025 as the program expands across the province.

All providers are encouraged to participate in the process to create digital content for the system so that its ready for your site/service/program when the system is being implemented in your area.

As part of the PHSA Digital eReferrals Library, a Standard Referral is available immediately for any receiving site to use.

This referral contains essential information and is specialty agnostic; it can be leveraged by any specialty either on a permanent basis or until a specialty/service focused referral can be developed.

This will enable faster deployment across the province while the DRO program continues to build up the BC Ocean Library of digital referrals.

The Digital eReferrals Library includes currently available PHSA referral forms. Additional eReferrals will be added as they are created through specialty working groups.

Please note these links show the referral content, but do not show the standard header (patient demographic and contact information) or footer (sender information) that are standard for every eReferral.

Standard header:

Standard footer:

‎

eReferral forms are stored in Ocean’s central repository of clinically validated documents. The DRO team is responsible for updates and maintenance. Any changes to these forms get updated instantly for all clinics using the form. Therefore, all forms visible on the Healthmap in Ocean are always the most current version.

The DRO team will work with providers to consider the best solutions for the eReferral for their listing. Digital forms provide different functionality than static paper forms. eReferrals in Ocean use logic and can require specific fields and reminders for attachments.

PHSA is committed to creating a BC library of digital referrals that developed by users with a consistent format to streamline workflow on both the sender and receiver side.

Some of the benefits of consistent eReferrals are improved user experience, reduced cognitive burden, ability to support best practices, and capability to gather analytics.

Development of a manageable library of digital referrals will also enable more rapid implementation provincially.