CIAQ Home Programs eReferral

An integrated referral and consultation program designed to streamline and enhance the primary care – specialty care interface in San Francisco’s safety net.


eReferral is a web-based referral and consultation program developed by UCSF and ZSFG for San Francisco’s safety net system. Clinics and services that use eReferral require electronic submission of all referral requests that are reviewed by a specialist clinician, who can communicate with the referring provider in an iterative fashion until the clinical issues have been resolved, with or without an appointment. Evaluation of the system demonstrates that eReferral has improved the timeliness of specialty care, specialist assessment of the appropriateness and completeness of referrals, and primary care providers’ ability to track referrals and receive pre-visit guidance. Moreover, eReferral is a tool to engage many of the key stakeholders across San Francisco’s health care safety net to collaborate on improving specialty care.

eReferral has been recognized nationally and internationally as an innovative model for improving specialty care, and has received multiple awards and more than $2 million in grant funding. We have served as advisors, consultants, or collaborators with numerous safety net systems including Los Angeles, Denver, Orange, Alameda, San Diego and San Mateo counties. Health systems in Alabama, Colorado, Wisconsin, Georgia, Minnesota, Tennessee, Massachusetts, Washington DC, Connecticut, Chicago, New Orleans, India and the United Kingdom have expressed interest in adopting aspects of eReferral.



  1. Tuot DS, Murphy EJ, McCulloch CE, Leeds K, Chan E, Chen AH -- Leveraging an electronic referral system to build a medical neighborhood. Healthcare 2015 Apr (pdf)
  2. Scheibe MM, Imboden JB, Schmajuk G, Margaretten M, Graf JD, Chen AH, Yelin EH, Yazdany J -- Efficiency Gains for Rheumatology Consultation Using a Novel Electronic Referral System in a Safety Net Health Setting. American College of Rheumatology; Accepted Article, doi: 10.1002/acr.22559 2015 Jan (pdf)
  3. McGeady JB, Blaschko SD,Brajtbord JS, Sewell JL, Chen AH, Breyer BN -- Electronic Preconsultation as a Method of Quality Improvement for Urological Referrals. Urology Practice Vol. 1, 172-175; 2014 Nov (pdf)
  4. Chen AH, Murphy EJ, Yee HF. eReferral -- A New Model for Integrated Care. N Engl J Med. 2013 June 27: 368;26. (pdf)
  5. Chen AH, Rittenhouse D. The Un-managed System of Medicare Referrals. J Gen Intern Med. 2012 Feb 29. (pdf)
  6. Straus SG, Chen AH, Yee H, Kushel MB, Bell DS. Implementation of an electronic referral system for outpatient specialty care. AMIA Annu Symp Proc. 2011; 2011:1337-46. (pdf)
  7. Chen AH, Yee HF. Improving primary care-specialty care communication: lessons from San Francisco's safety net: comment on "Referral and consultation communication between primary care and specialist physicians". Arch Intern Med. 2011 Jan 10; 171(1):65-7. (pdf)
  8. Kim-Hwang JE, Chen AH, Bell DS, Guzman D, Yee HF, Kushel MB. Evaluating electronic referrals for specialty care at a public hospital. J Gen Intern Med. 2010 Oct; 25(10):1123-8. (pdf)
  9. Chen AH, Kushel MB, Grumbach K, Yee HF. Practice profile. A safety-net system gains efficiencies through 'eReferrals' to specialists. Health Aff (Millwood). 2010 May; 29(5):969-71. (pdf)
  10. Bindman AB, Chen A, Fraser JS, Yee HF, Ofman D. Healthcare reform with a safety net: lessons from San Francisco. Am J Manag Care. 2009 Oct; 15(10):747-50. (pdf)
  11. Chen AH, Yee HF. Improving the primary care-specialty care interface: getting from here to there. Arch Intern Med. 2009 Jun 8; 169(11):1024-6. (pdf)
  12. Kim Y, Chen AH, Keith E, Yee HF, Kushel MB. Not perfect, but better: primary care providers' experiences with electronic referrals in a safety net health system. J Gen Intern Med. 2009 May; 24(5):614-9. (pdf)
  13. UCSF Frontiers of Medicine. eReferral: Connecting Primary and Specialty Care. Spring 2009. (pdf)
  14. San Francisco Health Plan Newsletter. Fall 2006. (pdf)


Guides and Documents

  1. eReferral Implementation Handbook (url)
  2. eReferral training video for Referring Providers (url)
  3. eReferral training video for Specialist Reviewers (url)
  4. eReferral training video for Schedulers (url)


Link Directory

  1. San Francisco Chronicle, July 23, 2013: Electronic referrals streamline S. F. General care
  2. Healthcare IT News, July 11, 2013: 3 benefits of eReferral systems
  3. Center for Care Innovations, Innovation of the Month, October 2012: eReferral in San Francisco Safety Net
  4. AHRQ Innovation Profile: Electronic Referrals and Communications Reduce Wait Times for Specialty Appointments and Improve Clinician Communication and Quality of Care: eReferral AHRQ Innovations Exchange



eReferral Program Director: Delphine Tuot, MDCM, MAS

eReferral Specialty Lead: Elizabeth Murphy, MD, DPhil Profile

eReferral Program Manager: Amanda Aguilar

Specialty Care Innovations Program Manager: Iguehi James, MPH

Specialty Care Data Analyst: Francesca Long, MA

DPH Internal Application Manager: Kjeld Molvig

DPH Senior Software Engineer, Radiology: Peter Cheng

DPH Decision Support Manager: Tina Lee, MPH

DPH Infrastructure Manager: Greg Woelffer

CIAQ Co-Director: Alice Chen, MD, MPH Profile


ZSFG eReferral Adult Medicine Reviewers

Allergy Naveena Bobba, MD

Cardiology – Mary Gray, MD

Chest Specialty Services/Pulmonary – Adithya Cattamanchi, MD and Antonio Gomez, MD

Diabetes – Sarah Kim, MD, Charlotte (Mimi) Kuo, NP, Audrey Tang, NP and Deborah Heuerman, NP

Direct Access Endoscopy – Lukejohn Day, MD

Endocrinology – Elizabeth Murphy, MD, DPhil, Jennifer Park-Sigal, MD and Sarah Kim, MD

Gastroenterology – Justin Sewell, MD, MPH and Stanley Goldberg, MD

Geriatrics – Anna Chodos, MD and Edgar Pierluissi, MD

Hematology – Bradley Lewis, MD

Liver – Mandana Khalili, MD and Miranda Surjadi, NP

Neurology – Sean Braden, NP, Claude Hemphill, MD and Cheryl Jay, MD

Oncology – Judith Luce, MD and Donald Abrams, MD

Renal – Sam James, MD and Ramin Sam, MD

Rheumatology – John Imboden, MD

TB Clinic – Julie Higashi, MD and Chris Keh, MD


ZSFG eReferral Surgery Reviewers

Breast Surgery – Diane Robbins, NP and Kelly Ross-Manashil, NP

General Surgery – Danielle Berthold, NP, Meghan White, NP and Peggy Knudson, NP

Interventional Radiology – Ryan Sincic, NP

Neurosurgery – Sean Braden, NP and Geoffrey Manley, MD, PhD

Orthopaedics – Diane Putney, NP and Dorothy Christian, NP

Otolaryngology (ENT) – Marika Russell, MD

Plastics – Esther Kim, MD

Podiatry – Erica McDaniel, NP with Monara Dini, DPM and Michelle Afzali, NP

Urology – Benjamin Breyer, MD

Vascular – Shant Vartanian, MD and Allicia Elias, PA


ZSFG eReferral Diagnostic Services Reviewers

CT – Nancy Omahen, NP, Ryan Sincic, NP

Diagnostic Breast Imaging – Diane Robbins, NP and Kelly Ross-Manashil, NP

Fluoroscopy – Nancy Omahen, NP and Ryan Sincic, NP

MRI – Nancy Omahen, NP and Ryan Sincic, NP

Sleep Study – Adithya Cattamanchi, MD and Antonio Gomez, MD

Ultrasound – Nancy Omahen, NP and Ryan Sincic, NP


ZSFG eReferral Women's Health Reviewers

Breast Evaluation – Kristen Sligar, NP, Kelly Ross-Manashil, NP and Dana Russ, NP

Gynecology – Rebecca Jackson, MD, Abner Korn, MD and Jody Steinauer, MD

Obstetrics – Rebecca Jackson, MD and Naomi Stotland, MD


ZSFG eReferral Pediatrics Reviewers

ADHD Behavior – Janis Mandac-Dy, NP, Peter Ferrer, MD and Shonul Jain, MD

Child and Adolescent Services – Caren Schmidt, PsyD

Developmental Pediatrician – Janis Mandac-Dy, NP and Shonul Jain, MD

Medical-Legal Partnership – Amy Whittle, MD

Multidisciplinary Assessment Center (MDAC) – Janis Mandac-Dy, NP and Shonul Jain, MD


ZSFG eReferral Other Programs Reviewers

Cancer Risk Program (Genetic Counseling) -- Robin Lee

Comprehensive Pharmacy Care – Jaekyu Shin, PharmD

Health At Home – Morgen Elizabethchild, RN, PHN and Jane Drobot, RN

Neuropsychology — David Pope, Christina Weyer-Jamora, Lauren Mai, and Jary Larsen

Respite Program – Shannon Smith, RN, MSN, CNL, Elizabeth Gatewood, NP and Eric Bellfort

Transgender Health Services – Barry Ervin, MD


Laguna Honda Hospital eReferral Reviewers

Cardiology –Priscilla Hsue, MD

Ethics Grace Dammann, MD, Anne Hughes, NP and Colleen Riley, MD

Infectious Disease – Sarah Doernberg, MD, MAS

Nephrology Anitha Toke, MD

Neuropsychology – Erika Zipf-Williams, PhD, Tera Bonora, PsyD, Brenda Austin, PhD, and Jilliann Daly, PhD

Otolaryngology (ENT) – Marika Russell, MD

Pain Clinic – Anne Hughes, RN, PhD and Grace Dammann, MD

Psychiatry – Vera Chow, MD, Michael Coleman, MD, and James Prince, MD

Psychology – Erika Zipf-Williams, PhD

Pulmonary – Laurence Huang, MD

Substance Abuse Treatment Services (SATS) Program – Mitchelene Walker and Tamara Orzynski


MRI Nancy Omahen, Ryan Sincic
CT Nancy Omahen, Ryan Sincic
Fluoroscopy Nancy Omahen
Ultrasound Nancy Omahen, Ryan Sincic