Implementing Bi-Directional Clinical-Community Linkages: The Community e-Connect Project
The National Association of Chronic Disease Directors (NACDD) piloted the Community e-Connect (CeC) project with five state health departments from 2018-2023 to support new bi-directional referral partnerships between clinical groups and CBOs.Â
- NACDD led partners through a detailed implementation process to support clinical and community partnerships, including partner readiness assessments, project management tracking, data element determination, workflow creation, and training. NACDD evaluated referral rates and system use and documented lessons learned to create best practice recommendations.
- After completing the implementation process, utilization of the referral platform remained low, with three of the five partnerships sending fewer than 10 referrals each. The fourth and fifth states exhibited robust system use, sending 93 pre-diabetes referrals and 171 other referrals across 6 referral types, respectively.
- The development and implementation process yielded many best practice recommendations, notably careful clinical and community partner selection, securing organizational buy-in, and exploring web-based referral mechanisms.
NACDDâs CeC experience led to the creation of a Toolkit, which provides a step-by-step process for implementing bidirectional, electronic referrals between clinical and community-based organizations using the Community e-Connect (CeC) platform and approach:Â
- One-pagers that provide an orientation to Community e-Connect goals and approach; can be used on introductory calls with potential partners, as well as during the kickoff meeting
A presentation deck to be modified and used for partners to obtain buy-in and provide an overall implementation roadmap
Community e-Connect Kick Off Presentation available here (pptx.)
A document to be completed when assessing potential partnersâ capacity to participate in CeC
Partner Readiness Assessment (available here).
- An introduction to and example of potential legal agreements to be established between partners sharing patient information
- A template for tracking process progress across partners
- A comprehensive list (multiple tabs) of data elements to be exchanged, including standards for patient, organizational, provider, and referral-type specific data
- A presentation to explain workflow creation with examples
- A detailed user guide specific to the Community e-Connect system
For more information about Community e-Connect, please contact Susan Svencer, ssvencer_ic@chronicdisease.org.