Order Entry Rules Engine Scheduling and Patient Routing Document Exchange and Results Sharing Patient Messaging Appointment Preparation Interoperability Business Intelligence

At Proximare our sole focus is on enabling a more effective and efficient referral process. We are fortunate that many organizations have trusted us to process millions of referrals on their behalf over the last decade and with that experience we have and will continue to make enhancements to solidify our position as the only rules based full cycle referral management platform on the market.

Proximare's core product IRIS (Internet Referral Information System) is a web-based patient referral system that incorporates powerful in-line rule technology. Clients use sample rule sets provided by Proximare to tailor their own rules, which IRIS incorporates into daily workflow. Rules are currently used in a number of different ways to support the referral process:

  • Direct referrals to the most appropriate service(s) with your preferred providers
  • Validate the appropriateness for the referral via an on screen decision support dialog with the ordering provider
  • Verify health plan eligibility and authorization
  • Assign priorities to individual patients based on clinical conditions
  • Identify and manage all clinical documentation requirements
  • Results tracking and sharing across the patient's clinical team

IRIS was developed to allow communities of providers to interact easily across enterprise boundaries by removing obstacles such as IT system incompatibilities, operational policies, and training procedures. IRIS is a fully HIPAA compliant service that only requires a workstation with Internet access.

The intuitive design of the user interface capitalizes on our sole referral management focus as a company. This has been a key factor in the rapid deployment of IRIS across thousands of users at multiple organizations with minimal formal training.

Why Our Approach Is Unique

IRIS revolutionizes the patient referral process by dynamically incorporating clinical and administrative rules directly into the referral selection by the provider. This capability allows issues like clinical appropriateness, provider/insurance acceptance, preauthorization requirements, appointment scheduling, documentation requirements and clinical priority determination to be addressed at the time of referral order entry. This 'intelligent' way of handling referrals avoids all the costs and delays due to the duplication and rework steps prevalent in today's referral processes. The IRIS design results in no net increase in the workload on the clinician. After entry of the patient's ID, the only provider interaction is with the clinic rule that appears as an on screen dialog between the specialist and primary care clinician. The use of clinical rules in this manner is yielding higher quality care and lower costs. Typical use cases and related successes from our customer base include the following:

• Physician education regarding best practices for treating the patient’s condition

Providing clinicians with immediate treatment recommendations based on the clinical rules means better care for the patient and attainment of lower costs as inappropriate, misdirected and duplicate referrals are avoided. Clinicians interact directly with the clinical rules while making referrals, providing them with immediate feedback. As an ‘intelligent’ referral ordering system, IRIS ensures selection of the 'right' service for the patient's condition. Based on information provided by the referring physician, IRIS will engage the appropriate clinical rule and prompt the referring physician with questions regarding the patient's condition. IRIS then assigns the appropriate urgency and routes the referral to the appropriate clinician.

Prioritize the referral based on the patient’s clinical acuity

A classic problem in healthcare is ensuring that clinically acute patients are properly prioritized. Often times today, this is dependent on the ordering provider calling the specialist to get a priority appointment for their patients. In addition to having a significant time impact on both providers, this process yields inconsistent results. IRIS brings standardization to this process. Interaction between the referring provider and the clinical rules allows IRIS to assign the appropriate urgency and route the referral to the appropriate clinic with the heightened priority noted.

Instant appointments for patients

IRIS Stand-in-Scheduling allows patients to select their specialist/diagnostic appointments and book their follow up appointments before leaving their provider's office. Better customer service plus the avoidance of all the communications costs prevalent in today's referral process are just two of the benefits provided by IRIS.

• Ensure all the proper workup is performed before the encounter

Far too often, patients arrive for a specialty consultation with incomplete or unavailable clinical workup information for a productive consultation. This leads to wasted appointments, delayed medical care for the patient, and increased cost as the appointment is often times rescheduled until the proper workup is performed. IRIS ensures a productive consultation by allowing each provider to clearly delineate their workup requirements and enforces the compliance of the ordering provider. As a result, the cost and lost time associated with these problems are avoided.

• Provide actionable reporting to improve performance

Often times organizations are made aware of their referral management opportunities at a level that is not actionable. For example, you might receive a report that indicates a large amount of a given clinicians care for a particular service category is provided by a competitor. What the report does not tell you is that the nearest specialty clinic in your network has a backlog of over 6 weeks. With IRIS you can track information for each and every referral and get answers to the following:

  • Where are my various clinicians referring patients for each type of service
  • What clinical reason(s) necessitated the referral
  • Where did the patient end up receiving care and what care did they receive
  • Which clinicians are more responsive to our referral requests and protocols
  • What are the demand patterns of my primary care clinicians
  • What is the backlog of each and every specialty/diagnostic service
  • Are specialists rejecting our requests and for what reasons