Note for Ontario Users: In Ontario, Ocean eConsults are currently in a limited release. For more information on eConsult in Ontario as part of the Ontario eServices Program, please review the Overview of eConsults in Ontario article.
What is a Rapid Access Clinic?
Rapid Access Clinics (also known as Assessment Centres) are commonly used in the Musculoskeletal care (MSK) pathway. Patients referred to these listings are booked in for an assessment with an advanced practice physiotherapist (APP), who determines whether surgery is appropriate for the patient and may forward the referral downstream (e.g, to a surgeon/specialist). This configuration allows for a special set of "assessment" analytics to be captured on referrals that are directed to, and booked at, these listings.
What makes a Rapid Access Clinic unique in Ocean?
There are three main elements that differentiate Rapid Access Clinic sites from standard Ocean sites:
Directory Listing Configuration
Rapid Access Clinic sites have unique Directory Listings that are specifically configured by OceanMD. The 'Listing Type' field is set to 'Rapid Access Clinic'.
- Once configured as a Rapid Access Clinic by OceanMD, a more prominent 'Forward' button appears in each referral received.
- This provides Rapid Access Clinic users with the ability to forward the referral to the appropriate service provider (e.g., forwarding the referral to a surgeon after the advanced practice physiotherapist deems surgery necessary).
Sites designated as a Rapid Access Clinic on their Directory Listing capture additional analytic values. Please see the 'Rapid Access Clinic Analytics' section at the bottom of this article for in depth information.
How do Rapid Access Clinics receive referrals?
Since the Rapid Access Clinic (RAC) concept was developed specifically for the musculoskeletal (MSK) pathway, RACs typically receive referrals that have been forwarded from a Central Intake site.
While it is technically possible for a RAC site to exist and receive referrals from non-Central Intake sites (e.g., an independent healthcare provider referring directly to a RAC via the Ocean Healthmap), there are currently no sites or organizations using such a process.
The typical flow for a referral reaching a RAC is as follows:
Original Referral Sender --> Central Intake (triaging occurs) --> Rapid Access Clinic (in-depth assessment occurs with APP to determine best course of clinical action) --> (If applicable) referral is forwarded to a Surgeon/Specialist for more invasive procedure.
Rapid Access Clinic Process
- The RAC receives a referral from a Central Intake site. The referral is found in the RAC's 'New' folder.
- The RAC decides whether or not to accept or decline the referral (based on appropriateness). Most often, it is appropriate and accepted.
- The RAC books an appointment for the APP to see the patient, making use of the 'Scheduling' pane of the referral.
The APP conducts an assessment of the patient, and uses the 'Review...' functionality within the 'Notes' pane of the referral to complete the 'Assessment Outcome Form'.
The Assessment Outcome Form is a specially configured eForm used to document the APP's decision, while also capturing specific values to be used in the referral analytics.
Based on the assessment outcome:
1) The patient may continue to see the APP for a conservative approach for rehabilitation
2) The APP may forward the referral to another service provider (e.g., community physiotherapist) to continue a conservative rehabilitation approach
3) The APP may forward the referral to a surgeon/specialist for a more invasive surgical procedure
Note: If the referral is manually forwarded (i.e., to a listing that is NOT accepting eReferrals), the RAC must indicate which stakeholder in the process receives the onus of updating the referral. See the 'Manual Forward Policy' section below.
- The APP uses the 'Email Note' functionality in the Notes pane to email the note generated by the Assessment Outcome Form back to the original referral sender.
Rapid Access Clinic Analytics
When a Directory Listing is configured as a Rapid Access Clinic, Ocean makes use additional data columns in the eReferral analytics report. A full breakdown of all analytics can be found in the Supporting Analytics in eConsults and/or eReferral eForms article.
The following analytics are automatically captured for listings configured as an RAC:
- The date/time of the initial assessment if the referral is booked at an assessment centre.
- The name of the initial assessment site listing.
- The site number of the initial assessment site the referral was directed to.
- The unique listing consult and/or reference id of the initial assessment site.
- The unique Health Service Offering (HSO) reference assigned to the referral, at the time it was sent to the RAC.
- The date the referral is forwarded from a listing of type Rapid Access Clinic.
Rapid Access Clinics use customized 'Outcome Assessment Forms' (an eForm wit the ref = 'referralNotes') used with the 'Review' functionality in the referral to generate the Review note. Outcome Assessment Forms used by RACs often include eForm items with the following item references to populate additional fields in the analytics report.
Common item reference examples used in RAC Outcome Assessment Forms include the following:
- ax_decisionToConsult (Note: Important as this column is used in wait time calculations.)
Keep in mind that the semantics behind each is arbitrary and you can "co-opt" them for the purposes of a particular pathway as long as the consumers of the analytical data understand the data values.
Manual Forward Policy
If an Ocean Site decides to forward a referral following an assessment, they have the option of forwarding to a listing that is accepting eReferrals on the Ocean Healthmap, or they can choose to manually forward the referral (e.g. via fax) to a service provider who is not accepting eReferrals.
- If they decide to manually forward the referral, they are prompted to choose the site that should be responsible for follow-up scheduling of the forwarded referral.
While this functionality has been purpose-built for the MSK pathway in which the RAC is the third sequential stakeholder in the referral process, this functionality technically applies to any Ocean site that is: 1) the third site to handle the referral and 2) manually forwards the referral.