Existing referral systems are inefficient. Most referrals are done by phone, fax or on paper. It is slow, inefficient, and does not always get patients to specialists with the urgency that is needed. One phone call can take hours and specialists are overwhelmed by phone referrals. They often choose tending to patients over answering the phone - with the result that referring doctors can spend hours trying to get through: “I once made 37 phone calls from my cellphone to try to transfer one patient. I know that colleagues sometimes have to send patients without being able to get hold of a receiving doctor.” said a rural doctor in Sutherland, Northern Cape. Transport is hard to come by, distances are vast and access to transport is a challenge. Some people make unnecessary trips to tertiary facilities, while others can’t get there as quickly as they need to.
Vula is an Android and iOS app that facilitates referrals between primary health workers and medical specialists. It was founded by Dr William Mapham (previous vice-chair of RuDASA and currently an ophthalmology registrar at Tygerberg Hospital) following his experiences as a rural doctor and as a specialist. Vula has been developed with inputs from specialists and health workers within the Department of Health. Vula currently offers referral forms for burns, family medicine, cardiology, dermatology, ENT, family medicine, HIV, ophthalmology, oncology, neurosurgery, internal medicine and orthopaedics.
How the app works: with Vula, a primary healthcare worker uses her/his cellphone to fill in an appropriate form and send it to the specialist on call at the referral facility. The specialist can use the app’s chat feature to ask for more information or photographs before advising on treatment, or facilitating an appropriate (urgent or otherwise) appointment at a referral hospital. Vula’s referral forms collect the right clinical details from the start, guiding the primary health worker through the examination. This means the specialist receives the right information about the patient and ensures the health worker has completed the necessary preliminary examination:
1.When making a new referral, the primary health worker chooses the correct specialist from the relevant team at their referral facility. The person on call is clearly indicated.
2. The primary health worker fills in a form that is specific to the speciality that is being referred to: e.g ophthalmology. At the top of the form, the app shows who the referral is going to, whether that person is on call, and their phone number.
3. The app can be used to send pictures in addition to clinical information - In specialities like Ophthalmology, Dermatology and Orthopaedics this is extremely valuable. Once all relevant clinical details are captured, the primary health worker taps on “Refer patient” to send the referral. The specialist is immediately notified of the new referral with a sound and notification message. This means more time for patients. Unlike phone calls, the primary health worker can see the next patient while waiting for specialist feedback, rather than spending an hour on the phone trying to get through to someone.
4. If the specialist has further questions after receiving the referral, they can use the chat feature to communicate with the referrer. This feature is also used to give the primary care worker advice on treatment, or an appointment date. Treatment protocols can be sent as photo attachments. All chat information is saved with the referral on the Vula database, for record keeping and medico-legal accountability. With Vula’s secure instant chat system, the primary health worker gets quick feedback from the specialist. In around 25% of referrals, that means the patient can be treated at the primary facility.
One platform, multiple solutions. Vula makes it easy to add referral forms for new specialties. This means that primary health workers do not need to remember multiple different methods for referral to various hospital departments. A full-scale adoption of Vula nationwide will mean that health workers need only reach for their cell phones for all referrals. Vula keeps health workers accountable & gives access to information that’s currently invisible: • Accountability of the specialist. Because all Vula exchanges are captured on a dashboard, senior doctors can use the system to ensure the right advice is given in a polite manner. ‣ ‣ • Makes referral data digitally visible. Vula saves all referral data and makes it easy to access. Unlocking this “hidden data” is powerful for a health care administrator. For example we know that in June / July 2016: ‣ 69% of referrals to Tygerberg Dermatology got a response within 15 minutes 34% of referrals to Tygerberg Ophthalmology came from rural areas Around 25% of referrals were treated at the primary health facility with specialist advice, saving the patient a trip to hospital.