UCSF Referrals Automation Application Improves Speed of Patient Access to Specialty Care


Deployments Also Realizing >40% Operational Efficiency Improvements in Referral Processing

Though UCSF leverages fully electronic referrals wherever possible, nearly 50% (180,000 annually) still arrive by fax. Upon receipt, a referral coordinator typically types the faxed information into UCSF’s electronic health record (EHR) system, a 13-screen process. Each referral coordinator processes approximately 12 referrals per day requiring an estimated 57 full time equivalents (FTEs) to process faxed referrals across the organization. In further analyzing the manual fax entry process, UCSF found that 43% of specialty referrals took more than 5 days to schedule. To address timeliness and efficiency, CDHI worked with a range of specialty practices representing more than 20% of fax referral volume to test the impact of automating the labor-intensive, manual processing of multi-page faxed referrals.

The Referrals Automation Solution

Part of the Patient Access Suite, Referrals Automation is a SMART-on-FHIR web application hosted on AWS. It converts incoming faxes to structured referral leveraging an optical character recognition (OCR) service to recognize and extract demographic and referral information. The Referrals Automation application bi-directionally connects to the EHR to read patient data for verification and writes back a digital referral object in the EHR.

When it is time to process a referral, the referral coordinator launches the Referrals Automation application from the EHR. The coordinator views the faxes that are ready for processing and organizes the faxes by receipt date, priority, and specialty. After the coordinator verifies the data elements, missing information can be easily identified, and patients can be contacted more quickly to complete the required information for scheduling.

The Referrals Automation application runs in the cloud, requiring no installation on an end-user’s computer.

Sample Data Entry Screen in the Referrals Automation Application

Sample Data Entry Screen in the Referrals Automation Application


“I’m already halfway through the workload I normally do in a day and it is only 10am!”

Referral Coordinator, UCSF Pediatric Access Center

 "My team’s efficiency directly impacts how quickly children with cancer can receive treatment at UCSF Benioff Children’s Hospital. Referrals Automation is helping us process more referrals with a higher degree of accuracy. At the same time, it provides me the transparency I need to gauge the productivity of my team and make adjustments in our workflow." — Referral Access Center Manager, UCSF Pediatric Access Center


Referrals Automation Results

After implementing the Referrals Automation application in specialty access centers, UCSF was able to realize the following improvements:

  1. Increased referral processing capacity in access centers

    • 55% Increase in the average number of referrals processed per FTE per day

    • 40% Reduction in referral processing time

  2. Enhanced the ability to measure the patient experience

    Referrals Automation allows access centers to accurately measure the true patient experience – the length of time from receipt of the referral to appointment scheduled and to the time the patient receives care. A fax sitting unrecognized and unmeasured on a fax machine represents unmeasured patient waiting time. The ability to measure the patient experience will enable targeted quality improvement and application enhancements that will improve the satisfaction of the patient, referring provider, and the access coordinator.

  3. Improved referral coordinator job satisfaction

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Additional Reading

Design and development of referrals automation, a SMART on FHIR solution to improve patient access to specialty care (JAMIA, October, 2020)