Boston Medical Center, plus its 15 community healthcare centers, which together make up Boston HealthNet, provides outpatient care to more than 1 million patients a year. The majority of those patients are "underserved," meaning they are low income, disabled, or elderly and qualify for Medicaid or Medicare, or sometimes don't have insurance at all.

Boston HealthNet patients seen by primary care doctors at community health centers need referrals to see specialists, like orthopedic or cardiologists, at the medical center.

But until recently, only about 30% of those referrals ended up with patients actually seeing a Boston Medical Center specialist. That's because the referral process, which involved paper, faxes, phone calls or other mostly manual steps handled by office coordinators, often fell through the cracks. Specialists did not always receive a referred patient's medical information in time, appointments didn't always get set up, and patients didn't always show up.

But a new portal-based eReferral system provided by Carefx Corp., along with a new clinical information exchange, recently deployed at Boston HealthNet by GE Healthcare, has already doubled the percentage of referred patients booked by coordinators and seen by Boston Medical Center specialists.

The new system is projected to save Boston Medical Center about $7 million over the next five years through improved efficiencies. Revenue is expected to grow via a dramatic increase in the number of patients who actually follow-through with their specialist visits.

The new portal provides coordinators at the community health center and specialty departments at the medical center with a standardized workflow for setting up patient appointments, as well as making sure those specialists are provided with the patient's pertinent electronic medical record information at the time of the appointment. The portal also helps coordinators contact patients to remind them about scheduled appointments.

In the past, referrals often took 30 days to process. Now referrals take only two days. The eReferral portal presents coordinators with a workspace that includes a list of tasks that need to be completed in a set amount of time for each patient referral. Among the tasks is sending electronic packages of key patient medical information to specialists before patients' scheduled appointments.

"If information doesn't get to the specialist by the time of care, the specialists don't know why the patient is there, what tests have been done, etc.," said Joel Vengco, executive director of clinical information systems at Boston Medical Center. "The process of doing this is cumbersome," he said. In addition, on the back end of patient visits with specialists, there was difficulty in providing primary care doctors with the new information and updates about the individuals.

That information dearth has been addressed with the eReferral portal and a new clinical information exchange (CIE) launched in June by Boston HealthNet.