Innovative Closed Loop Referral Tool for Diabetes Management

Connecting patients with relevant and timely community resources at the point of care

CRISPeR—Community Resource Inventory Service for Patient e-Referral—is an electronic referral (e-Referral) system capable of searching a resource database from an electronic health record, receiving patient-relevant results and making closed-loop referrals with selected community-based resources. At this time, the system is used for diabetes management referrals, but additional use cases are being discussed.

CRISPeR includes:

• Community Resource Inventory (CRI) that is comprehensive, searchable, easily maintained, accurate and current
• Query and response process that supports customized queries to the CRI and returns a list of relevant resources to an EHR
• An e-Referral hub to exchange standardized electronic referral and feedback messages between an EHR and identified community resources

The CRISPeR program is a multi-organization collaboration between Colorado Department of Public Health and Environment, Denver Public Health, CORHIO, Mile High United Way and HDConsult. Participants include Clinica Family Health, STRIDE (formerly MCPN), Denver Health, Boulder County Area Agency on Aging, YMCA of Northern Colorado, YMCA of Metropolitan Denver, VUELA for Health, Tri-County Health Department, and Outreach Wellness.

CORHIO manages the Referral Hub, which takes in the patient referral, matches it to the correct CBO, sends the information in the way the CBO prefers to receive it, and after the patient has been followed up with, sends progress reports back to the referring provider.

For an informative video about CRISPeR, see https://www.youtube.com/watch?v=jckdtfGyCuo&feature=youtu.be