Interoperability Proving Ground (IPG) submissions within the ONC Tech Lab are submitted by healthcare, technology and development organizations that are invested in Health IT and Interoperability and want to share, learn and collaborate with similar stakeholders in the US, and around the world.

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Closed loop specialty referrals

To improve the quality and operational efficiency of specialist referrals within a major academic partner (UCSF), One Medical utilized the Direct protocol to handle outbound transmission of referral requests and inbound transmission of consultation reports, through a single Direct address. The EHR was updated to automatically include a C-CDA, selected insurance information, and insurance authorization status with outbound referrals. Referrals were sent to a dedicated address at the partner institution, UCSF. The One Medical clinical task management system was updated to automatically route inbound Direct messages containing consultation reports to the ordering providers’ task queue. The implementation of Direct message enabled both One Medical and UCSF to enhance practice efficiency and save a very large amount of administrative time spent processing faxed referrals and eliminated the need to manually route faxed consultation reports to patient charts.
Start Date
Projected End Date
Project Tags
  • C-CDA
  • closed loop referral workflows
  • Closed-Loop
  • Direct Interoperability
  • direct secure messaging
  • EHR
  • interoperability
  • Interoperability
Project Point of Contact:
Project Results
The implementation of direct message enabled our partner institution, UCSF, to save a very large amount of administrative time which was being spent processing faxed referrals. The savings were in large part due to automatic transmission of pertinent records and data, and facilitated creation of new patient charts in their EHR.
For One Medical, the closed-loop transmission of referrals eliminated the need for administrative staff to manually route faxed consultation reports to patient charts, which was a time consuming and error-prone process at our current referral volume.