Closing the Loop: How e-Referral Is Transforming Developmental Screening in Colorado

Developmental Screening & Referral (DSR): The e-Referral Project is an interagency collaboration to establish a closed-loop electronic referral process between pediatric health systems and Early Intervention Colorado (EICO). This project is a Maternal Child Health funded initiative in partnership with Early Intervention Colorado at the Colorado Department of Early Childhood (CDEC) and Assuring Better Child Health & Development (ABCD). Technical support for this project is provided by Health Data Consults and Contexture; one of Colorado’s largest health information exchange (HIE) organizations. 

Why e-Referral?

Young children, birth-to-three, with or at risk for developmental delays often do not successfully connect with early intervention services. Data indicates a high percentage of these referrals were closed prior to completing the evaluation process. Additionally, primary care providers, the largest referral source for early intervention, frequently report that they don’t always know the outcome of their referrals. 

The e-Referral project was designed to pilot a more effective coordinated intake and referral system by enhancing accurate and timely referrals, increasing evaluation rates and successful referral outcomes, and improving workflow between systems that serve young children and their families through electronic bidirectional communication. 

Project Goals

• Establish a closed-loop electronic referral process between health systems and EICO to support effective referral systems and coordination of services for children (birth to three) and their families.  

• Provide health care professionals the ability to easily connect patients with community resources-specifically early intervention services at the point of care.  

• Referring providers will receive progress notes, which closes the communication loop and gives the provider a better picture of the care and support the patient receives outside of the healthcare setting.

“e-Referral is a technology solution that improves referral outcomes, communication and system collaboration.”

How Does It Work?

Referrals are made through the electronic health record system (EHRs) via a direct message interface with Contexture (HIE) to share pertinent referral data with EICO’s centralized intake data system (Salesforce). Progress notes with the current status of the referral are sent back using the same process to the health system within a few days after receiving a referral. This closed bidirectional loop enhances and improves communication and workflow between the two programs. 

What health systems have implemented e-Referral?

• Phase One (2022-2023): 

  • Salud Family Health Centers (piloted the e-Referral process)

• Phase Two (2023-2024):

  • Children’s Hospital Colorado (scale pilot with a larger health system)

• Phase Three (2024 -2025): 

  • Valley Wide Health Systems, Stride Community Health Centers, and the larger UCHealth System (additional health systems are in the implementation process)

Phase Four (2025-2026):  

Plans are underway to continue onboarding new health systems while developing sustainable infrastructure for ongoing post-pilot implementation and technical support.

What we have learned

Notable and promising project outcomes include: 

• 82% of families were contacted successfully (vs 61% via faxed referrals) 

• Families were contacted in 3.9 days (on     

   average, vs. 4.6 days via faxed referrals) 

• 13% of families refused services (vs 16% via 

  faxed referrals) 

• Evaluations were scheduled in 23 days (on 

  average, vs 32 days via faxed referrals) 

• 48% of families scheduled evaluations (vs. 

  35% via faxed referrals)

*data is from a six month period with Children’s Hospital during Phase Two

Progress notes shared at multiple points between referral and evaluation have improved connection and established trust between critical systems of care for young children and their families. Initial pilot evaluation results demonstrate high rates of provider satisfaction with ease of referral and the simplification and enhancement of provider workflow. EICO reports there is a decrease in closed referrals due to missing/incorrect contact information and overall better outcomes for children and families which include successful contact and completion of the evaluation process.

Pilot to Process

With 5 health systems and more than 40 clinics currently using or piloting e-Referral,  implementation partners are currently planning for Phase Four which includes continued scaling of the e-Referral Project across the state in addition to the development of a post-implementation sustainability plan for all participating health systems. Project data collection and evaluation are ongoing as we continue to learn more about project outcomes and impact. 

This project has translatable outcomes for supporting State and Health System partnerships to enhance communication and data transfer through electronic referrals. This is relevant to families with young children at risk for developmental delay as timely and consistent communication builds trust between families and their primary care provider and trust between the systems serving families. 

Michele Coates, MA,  Early Childhood Systems Specialist, Children and Youth with Special Health Care Needs (CYSHCN) Section