Automating 340B Referral Capture: Streamlining Clinical Consult Note Collection

Conclusion and Key Findings Upfront

Our study confirmed that referral capture solutions can indeed use an automated mechanism to collect clinical consult notes directly from the Electronic Health Record (EMR). Within our pilot, we were able to match over one-third (35%) of the documents we needed to qualify referral prescriptions. This finding underscores the potential for healthcare providers to enhance operational efficiency, reduce manual labor, and improve 340B compliance through strategic data integration with referral solutions and TPA’s, as well as the use of internal EMR tools to streamline or eliminate manual reviews.

Our next study will focus on the collection of 100% of documents from an RxTrail API service. The ability to collect 100% of documents could theoretically eliminate the need for human intervention and allow us to create a 100% fully automated process for referral prescriptions.

Manual Processes to Automation Study

In the rapidly evolving healthcare sector, the automation of referral capture services is proving to be a game-changer particularly for entities participating in the 340B program. RxTrail embarked on a new study to investigate the feasibility and effectiveness of automating one part of the slow and manual aspect of these types of programs – clinical consult note collection.

While not all programs require consult note collection to “close the loop” on the referral prescriptions, many programs still do.

Our research aimed to quantify the potential for automation of consult note collection and its impact on streamlining processes and ensuring compliance with 340B program requirements. Leveraging Consolidated Clinical Document Architecture (CCDA), “consult note documents” and communications found in the Electronic Medical Records (EMR) we sought to redefine the efficiency of referral capture mechanisms.

Background on CCDA and Care Coordination Networks

The Consolidated Clinical Document Architecture (CCDA) is a standardized format for the exchange of patient information across different healthcare systems, facilitating improved care coordination and decision-making. Care coordination networks, including the Care Quality Network and CommonWell, play a crucial role in the seamless exchange of health information, enabling better communication among clinicians and supporting the continuum of care.

Our Study on Automating Referral Capture

At RxTrail, we recognized the challenges faced by our team and clients in manually capturing and reconciling referral documents for 340B compliance. To address this, we conducted a study analyzing 400 known referral prescriptions, all of which had previously been confirmed to contain a Clinical Consult Note within the EMR through manual inspection. By comparing these confirmed cases against the CCDA documents available in the EMR, we aimed to assess the feasibility of automating referral capture processes.

Our methodology, which could be described as a regressive approach, focused on evaluating the availability and accessibility of necessary documents within the existing systems of our study customer. This approach allowed us to systematically determine the extent to which automation could alleviate the burdensome manual processes involved in referral capture.

Study Outcomes and Implications

The outcomes of our study were overwhelmingly positive. We discovered that approximately 35% of the required documents for automating referral reconciliation were already present within the EMR systems of our pilot customers. This revelation not only validates the potential for significant efficiency gains but also highlights the importance of leveraging existing data more effectively.

Our conclusion emphasizes the critical role of improving internal tooling and data integration within EMRs to facilitate the automation of referral capture. By doing so, healthcare providers can achieve a more than one-third reduction in manual efforts associated with 340B referral document reconciliation, streamlining operations and bolstering compliance.

Conclusion and Further Information

RxTrail’s study offers compelling evidence that automating referral capture solutions is not only feasible but also significantly beneficial for healthcare providers engaged in the 340B program. By capitalizing on the capabilities of CCDA and care coordination networks, and by enhancing internal EMR tooling and data integration, entities can substantially reduce manual labor, improve efficiency, and ensure compliance.

Our next study will focus on the user of document exchanges to attempt to capture 100% of required documents.

Book a Meeting: We invite interested parties, be it Covered Entities or technology companies interested in exploring the potential of automating their referral capture processes to book a meeting with us. Discover how RxTrail’s innovative solutions and expertise in EMR data automation can transform your 340B compliance and referral capture strategies.

Reiterating our key finding, automation in referral capture can dramatically reduce manual efforts and streamline 340B compliance, marking a significant step forward in healthcare efficiency and patient care coordination.

This CCDA use is being integrated into our February 15th referral software release.