Interview: Insights from a Referral Technology Expert

In this last installment of NNSI’s #SystemsofCare series, we interviewed Yuri Cartier, a research associate at Social Interventions Research and Evaluation Network at the University of San Francisco California, and an expert on referral technologies. Cartier’s research includes studying the dimensions of navigator systems and community referral technologies. Cartier has reviewed these technology platforms in her research and published reports on the implementation of these platforms. This interview can help organizational leaders gain insight into the process of considering, adopting, and implementing community referral technologies.

What are community referral technologies, and why are they important for the integration of health and human services?

Community referral technologies are a software tool that combines a directory of community resources, such as food banks, shelters, utility assistance providers, and social service agencies, with a system that allows users to send referrals electronically to participating agencies. Health care organizations, in particular, are excited by the potential for such technologies to streamline the process of identifying resources that can help address patients’ social needs and connecting patients to services. Another big selling point of these technologies has been the promise that they will enable referral-receiving organizations to let referral senders know about the outcome of the referral, which is commonly referred to as “closing the loop”. 

From a broader perspective, the promise of these technologies is that they allow health and human services organizations to better coordinate services for community members. If widely implemented in a community, they would also provide useful data about the needs of the community and areas where more resources are needed.

What led you to research the integration of health and human services systems?

The health care sector’s mounting interest in how social conditions affect health and what roles the sector can play in addressing those conditions at both individual and community levels makes it an exciting time to do research in this area. I jumped at the chance to join SIREN and support its research in effective interventions at the intersection of medical and social care. I see a huge opportunity for the field to move the needle on population health, and a huge risk is that if we don’t pay attention, we could actually worsen inequities.

You were part of a team that completed a review of the current community referral technology systems. For states or municipalities considering adopting one of these systems, what are the key features they should consider?

I think it’s important to frame the question in another way: First, what is the problem you are trying to solve? The technology tool is just that: a tool. Bringing together your community stakeholders, you should define a common goal, the intervention(s) needed to meet that goal, and then as a group, you can decide whether a technology tool would advance that goal and what kind of features a technology tool should have in order to support the implementation of your intervention. That will help you not only to select a tool but anticipate how different partners will use it, leading to better conversations with the vendor on how the tool can be adapted to different contexts. 

The second major consideration is what other platforms are already in use in your community. Which is not to say that you should necessarily go with one of those technologies, but rather, it helps you understand where there may be some duplicative systems and opens the door to conversations about how to build more interoperability between platforms. At the end of the day, we want an infrastructure that improves how quickly and how well community members can access services and resolve their needs, and adding yet another silo in the form of a referral network won’t necessarily help us meet that goal. 

In your research, you’ve examined some common obstacles to implementing community referral technologies. What are some of the common challenges, and how can adopters overcome them?

We’ve found that the biggest barriers are related to engagement of partners and end-users. Implementation was moving a lot more slowly than anticipated for many of the organizations we spoke with because it takes time to build relationships and buy-in among the community partners you would like to exchange referrals with and beyond, to sitting extensively with potential end-users of the tool to understand their workflows and how the tool can be used. The strategy we’ve heard to overcome that barrier is no secret: go slow to go fast. Invest in early, sustained, purposeful engagement with your community partners. 

Other common challenges revolved around data security, privacy, and associated legal issues, and on the technical side, building data integrations with Electronic Health Record (EHR) software and other systems. To some extent, those challenges have eased slightly as more and more communities have gone through the process of adopting one of these tools and vendors have developed more robust processes; however, it can still be hard to build community consensus on which data should be shared among whom. 

How would you define “success” in the implementation and use of community referral technologies?

That is a great question that I think to some extent depends on the community’s goals that the technology is supporting. Generally speaking, success can be defined through multiple lenses at the client/patient, staff end-user, organization, and community levels. 

Is the client/patient accessing more relevant services, faster than they would have otherwise, with better results? Does that, in turn, lead to decreases in stress and illness and increases in their health and well-being? Does use of the technology allow staff end-users to do their job more efficiently and effectively than their previous practices? Are they able to help more clients as a result? Does this improve their experience of their work? Does the technology enable the organization that is using it to coordinate more effectively with other organizations and increase its own impact? Does the community benefit through a better use of available resources and improved communication between community organizations? And does the platform help provide data about gaps in services and community needs that are not being addressed? 

From a research standpoint, it’s important to point out that, as of yet, very few papers in the academic literature answer these questions. We have a long way to go towards understanding if and how these technologies are successful, and so we encourage everyone adopting one of these tools to evaluate their impact and share their results.