Led by Mollie Forrester, MSW, LICSW, and Ryan Kimmel, MD, we have started work on a new access project to create a unified, patient-centered behavioral health referral system across UW Medicine.
For years, referring a patient for behavioral health care has been frustrating for everyone. Currently, when a primary care provider types “psychiatry” or “psychology” into Epic (UW Medicine’s referral system) they face a confusing list of clinic options — many of which sit outside our department. They encounter undefined acronyms — GPS, STEP, CORP — and receive little guidance on which program is right for their patient.
Unsure what to choose, providers often cast a wide net, selecting multiple clinic options in hopes that one will stick. This creates duplicate work for clinic staff across UW Medicine who must manually reroute referrals, restarting the cycle. Most importantly, patients get caught in the middle. Even savvy patients can get lost in this triage process and face long waits. At their peak, our psychiatry outpatient clinics at UWMC Roosevelt and Harborview carried waitlists of 1,000 and 800 patients, with many simply stuck in the wrong queue.
Fortunately, this referral optimization project is not starting from scratch. It builds upon the hard work and previous improvement efforts of many in our department and across the behavioral health service line. With valuable input from department leadership including Denise Chang, MD, Carolyn Brenner, MD, and Amanda Focht, MD, we are ensuring this new system reflects the reality of our clinical landscape. And, thanks to advocacy from our executive sponsors Jürgen Unützer, MD, MPH, MA; Mark Snowden, MD, MPH; and Ryan Kimmel MD, we have secured the necessary IT resources to move this effort forward including support from a highly skilled UW Medicine Ambulatory Access & Access Innovations group with experts in optimizing Epic functionality.
The project kick-off in September saw enthusiastic engagement from faculty and staff across Harborview Medical Center, UWMC-Montlake, UWMC-Northwest, and UW Medicine Primary Care. The project team is currently meeting with all 15 department clinics and teams included in the current referral order to understand their specific criteria and workflows.
A major hurdle in our current system is the lack of a central, up-to-date list of exactly what outpatient behavioral health services are available, where they are located, and who is eligible for them. Therefore, the project also aims to build a comprehensive inventory — a “source of truth” — for outpatient behavioral health services at UW Medicine. This inventory allows us to do two critical things: First, when a patient meets the criteria for a specific UW program, they are routed there on the first try, reducing delays and “referral bounce.” And second — just as importantly — this system will clearly identify when a patient’s needs are better met by services outside our system. Instead of letting a patient sit on a waitlist for services we do not offer, we hope to provide a centralized library of reliable community partners that can be shared with patients. No wrong door!
The project will roll out in three phases, leveraging Epic technology to reimagine the referral itself:
- Structure Updates — Organizing the overall structure of Epic referral orders to reduce confusion.
- Decision Support — Providing real-time guidance to help referring providers understand and select the correct order.
- Enhanced Order Guidance — Replacing jargon with targeted clinical questions and embedded branching logic will ensure proper triage to the right clinic on the first try or flag complex cases for expert review.
The goals of this effort include shorter patient waits, faculty with more time to care for patients, and less staff frustration when the system matches reality. By using data to intelligently route referrals, we hope to streamline intake, improve visit volumes, and ensure equity. With our efforts to shape demand, streamline intake, improve visit volumes, and provide patients with more timely access to care, we hope to improve the system of outpatient Behavioral Health Services across UW Medicine.
