September 4, 2024
Headquartered just blocks away from scenic trails and parks that line the San Francisco Bay, Ravenswood Family Health Network has served the East Palo Alto area of California for more than 20 years. Though the area is considered “resource-rich,” many community members are not and have been systemically marginalized for generations. Ninety percent of Ravenswood patients are low-income and many experience obstacles to care such as lack of reliable transportation or language barriers.
Specialty care, in particular, has been challenging for patients to access. However, an eConsult partnership between two local organizations and the seamless communication afforded by OCHIN Epic has helped patients get the specialized care they need and deserve—regardless of their income or medical insurance status.
“As an FQHC serving patients who typically have fewer resources, we’ve been really grateful to have this opportunity to collaborate on a service that increases access for our patients regardless of their insurance status,” said Julia Tse, MD, Ravenswood’s associate medical director of family medicine, in a joint presentation with Stanford Health Care at this year’s OCHIN Learning Forum.
Bridging the gap between primary and specialty care
Ravenswood opened its doors as a temporary clinic in 2001 to care for low-income Bay Area community members. After gaining support from their community and partners, they were able to establish a permanent Ravenswood Clinic location in 2015. They then merged with another organization to establish the larger, Federally Qualified Health Center (FQHC) now known as Ravenswood Family Health Network. In 2020, they implemented their OCHIN Epic electronic health record (EHR) system.
Though Ravenswood provides comprehensive health care services including primary care, behavioral health care, optometry, chiropractic, and dental care, they found that many patients needed access to specialty care. Specialty care, such as a dermatology, neurology, or cardiology, provides services from a physician trained in a particular area of medicine. It’s critical for patients with complex medical needs to achieve their full health potential, and it reduces visits to overcrowded emergency rooms. But for patients in rural or medically underserved communities, such as the patients served by Ravenswood, unique challenges prevent them from completing a traditional, in-person specialist visit even when their primary care physician (PCP) has referred them.
“Along with language barriers, there is a low literacy rate with almost 70% of the population speaking another language (besides English),” said Moses Taufalele, referrals supervisor at Ravenswood. “Because of that, patients have a hard time navigating the health care experience … Even with bilingual staff speaking Spanish, it affects our communication efforts …”
Even when these barriers are overcome, limitations in medical insurance coverage or health networks create another barrier for even an insured patient to complete a specialty care visit. Ravenswood’s dedicated referrals team, which Taufalele calls “the bridge from our primary care to outpatient specialty care,” are experts at helping patients navigate the system. But despite their commitment to helping patients complete a referral, their hands can become tied due to structural barriers entirely outside of their health centers’ control.
“Even though we are located in such a resource-rich part of the Bay Area, we do face more challenges like limited options with health plan networks and an increase of redirected referrals due to limited capacities,” he explained.
The experience of Ravenswood patients reflects national data and OCHIN network trends showing limited access to specialty care. A recent OCHIN network analysis found that the average wait time to see a specialist has increased to 60 days, and significantly delayed referrals had only a 40% likelihood of being completed. As clinician shortages continue to coincide with an aging population and systemic barriers, it is expected that these wait times will continue to increase.
Unlocking access through collaboration and integration
As they grew more and more familiar with the integration options that OCHIN Epic affords following their 2020 go-live, Ravenswood mobilized to get the most out of the system and leveraged it to further help their patients achieve good health. In 2022, using tools already built into their OCHIN Epic EHR system—such as Epic SmartPhrase abbreviations to automatically and succinctly send reminders to providers and Epic’s Haiku application to securely share photos—they began partnering with Stanford Health Care to pilot eConsults in a dozen specialties ranging from dermatology to pulmonology. Today, eConsults are incorporated into workflows and onboarding training and are the norm for the team with more than 900 have been completed to date.
“OCHIN offers great integration options that makes offering eConsults to community partners that much easier," said Debbie Kim, MPH, PMP, digital health program manager at Stanford.
The idea is simple, but the impact is significant. Enabling providers at Ravenswood to remotely consult with specialists at Stanford allows them to offer more specialized care for their own patients without a costly and burdensome referral.
For example, according to Tse, one patient reported to her primary care doctor that she had been experiencing chronic thumb irritation for 6-8 months and it had not improved through multiple treatment methods. With the eConsult partnership and the interoperability enabled by OCHIN Epic, the patient’s primary care provider at Ravenswood was able to seamlessly and securely share a photo and notes with a Stanford dermatologist. Within three days, the dermatologist diagnosed the patient with two dermatological conditions and recommended a specific treatment plan that the primary care provider was able to execute—at no cost to the patient.
“If we didn’t have this eConsult program, we may refer this patient to dermatology where it could be a four to six month wait,” Tse said. “And the eConsults at Stanford does not depend on a type of insurance. The patient doesn’t get billed.”
Deepening learning and connection
The eConsults between Ravenswood and Stanford have proven to be valuable for patients and providers alike. In addition to expanding timely access to specialty care, eConsults also serve as a learning tool for providers.
“Our PCPs love eConsults … they can get specialty input in a timely manner, it’s a great learning tool, they’ve really learned a lot about different conditions, and they help affirm what they knew in their existing plan of care,” said Tse.
“Our specialists have been a key part of moving this program forward … they don’t want patients to run into delays when receiving care,” said Kim.
Patients still receive the high-quality care they’ve grown accustomed to at Ravenswood, but now they’re able to receive additional and specialized medical advice from their trusted primary care provider. They’re also reassured knowing that if the specialist advises that the patient be seen in-person at their specialty care practice, they already have an established connection and record with Stanford.
“Patients are able to get the (specialty) medical advice or recommendation from their PCP. As a result, the patient-provider relationship has strengthened as has their trust with our organization,” said Taufalele.
eConsults also help avoid unnecessary in-person visits and reduces strain on specialty care patient queues. By enabling primary care providers to provide some level of specialized care, they are ensuring that the in-patient specialty care visits at Stanford are saved for those patients who genuinely require a higher-level of specialized care—ultimately streamlining the process and reducing burden in the system as a whole.
“We are working together to level the playing field, making sure everyone has access to the healthcare they need and deserve,” said Kim, digital health program manager at Stanford.
Learn more
A virtual network like the one embodied by Ravenswood and Stanford is essential to overcoming health disparities and increasing access to specialty care. For more information about new congressional legislation designed to expand specialty health care options, read a recent OCHIN media advisory and consider signing a letter to express support for the legislation.
