Introduction
Australia’s healthcare system, like that of Canada, Ireland, New Zealand, and the United Kingdom, faces increasing challenges due to rising patient demand and fiscal restraints. In 2023–24, 903,500 patients were added to public elective surgery wait lists, a 5.6 percent increase from the previous year. In many cases, the volume of referrals is now exceeding the capacity of the antiquated workflows and technologies being used by Australian public hospitals to process, triage, wait list, and schedule patients. In addition to the increased number of referrals, hospitals are burdened by duplicated requests, errors, and manual administrative workflows that lack the ability to apply structured, algorithm-based, or criteria-driven assessments. Often patients queue for a service that is not indicated and will not benefit them. As a result, the patient and the referring physician wait for a reply that could be delivered sooner, improving access without compromising overall health outcomes.
Despite ongoing capacity management efforts, patients often experience long queues for many hospital-based types of care, including endoscopic services, which are crucial for early diagnosis of cancer and other diseases.
This white paper tells the story of how the Central Adelaide Local Health Network’s (CALHN) high volume multi-site endoscopy department partnered with Novari Health to implement a digital referral management solution, improving organisational efficiency and enabling the modernisation of workflows. This implementation continues to demonstrate how internationally proven state-of-the-art referral and wait list management technology can be successfully applied in Australia.
Background
Novari eRequest is a software solution designed to streamline and optimise referral and wait list management processes for hospitals, regional health networks, and state health systems. By shifting hospitals from a mix of paper-based referral management systems to a fully digital platform, Novari eRequest centralises and digitises patient referrals, enabling efficient triage and prompt direction to the appropriate provider. The system enables real-time tracking of every referral, reducing delays and administrative burdens while improving patient flow.
With the ability to integrate with electronic medical record (EMR) systems, patient administrative systems, eReferral systems, patient engagement systems, and others, Novari’s technology enhances care coordination, enables early detection of duplicate referrals, and provides comprehensive wait list visibility. The digital platform also manages internal workflows efficiently for both clinical and administrative staff, improving communication and patient care coordination across the healthcare system.
CALHN Demonstration Project
the need for a more efficient and standardised approach to referral management, CALHN initiated a transformational project to modernise their endoscopic referral workflows. Led by a clinical leader who conducted an international scan for best-practice technologies, the organisation identified Novari eRequest as an ideal solution to address inefficiencies. To implement this strategic vision, CALHN entered into a three-year demonstration project with Novari to deploy the eRequest platform in order to reduce administrative burden, enhance transparency, and provide real-time analytics on the volume of patients in the queue.
Since its implementation in October 2023, Novari eRequest has been successfully managing endoscopic referrals at South Australia’s Royal Adelaide and Queen Elizabeth Hospitals. Now in its second year of operation, the system has eliminated reliance on outdated, manual tracking methods, improved resource allocation, and provided real-time visibility into the status of every referral. Staff report enhanced operational efficiency, more structured patient management, and a more predictable and equitable referral process, ultimately leading to better patient outcomes and more effective use of healthcare resources.
The Problem to Solve
Previously, the Royal Adelaide Hospital and Queen Elizabeth Hospital in South Australia used separate, site-based processes to manage endoscopic referrals through a paper-based system. Referrals were received through multiple entry points across seven separate clinical units, resulting in varied triage approaches and inconsistent wait time experiences. Paper-based systems are known to facilitate inconsistencies in referral management. These variations introduced risks, contributed to inequitable access, increased staff workload, and impacted patient satisfaction.
Requirements Gathering & Implementation
Novari Health conducted an in-depth, on-site review of CALHN’s existing workflows to understand the challenges staff faced in managing endoscopy referrals. As is common in many healthcare settings, clinicians and administrators had been compensating for inefficient workflows and outdated technologies by relying on spreadsheets, paper, and Post-it notes to track referrals and manage wait lists. These manual workarounds added complexity, increased administrative burden, and potentially introduced patient safety risks.
A multidisciplinary review at each site identified the key decision points necessary to create a standardised workflow. This new process was designed to align with best practices, evidence-based criteria, national standards, and the Colonoscopy Clinical Care Standards. Novari’s eRequest software was then tailored to support these workflows by automating routine tasks, eliminating paper forms, and enabling real-time tracking of patient progress.
This initiative established a unified, multi-site service model with nurse-led triage at both entry and exit points. Supported by Novari’s eRequest software, the system streamlined processes, enhanced real-time visibility, and strengthened accountability.
The Advantage of Going Digital
The implementation of Novari’s eRequest system has enhanced transparency, trust, and efficiency in the referral process at both hospitals by providing real-time visibility into bottlenecks, wait times, and processing times. Standardised triaging, aligned with gold-standard medical guidelines, has further streamlined the process. Previously, there were two separate wait times: one from referral to outpatient department (OPD) and another from OPD to procedure. These timeframes were managed independently, with no way to monitor them as a single, continuous patient journey. With Novari technology, staff can now view and manage wait times across the entire referral process, from the initial referral through to pathway exit. This visibility enables staff to monitor patient flow in real time, providing hospital leadership with valuable insights to identify bottlenecks, optimise processes, and support more informed decision-making.
By digitising all referrals, including those received via fax, the hospitals have eliminated inefficiencies and improved coordination across departments. The system has shortened the overall time from referral to pathway exit, with built-in mechanisms to flag anomalies that require immediate attention.
With access to accurate, real-time data, managers and clinicians can make more informed decisions, optimise resource allocation, and enhance overall system performance.
Novari eRequest has also enabled load balancing between sites, particularly in anaesthetic lists, helping to manage long waits and optimally distribute resources across facilities. The platform standardises patient referrals across sites, allowing for more accurate comparisons and insights into referral volumes and bottlenecks. With real-time tracking and analytics, CALHN now has access to crucial data that supports informed decision-making and continuous improvements in service delivery. The success of this implementation sets a benchmark for other healthcare networks seeking to enhance efficiency and patient access through digital transformation.
Figure 1. The diagram above illustrates CALHN’s customised workflow for managing endoscopic referrals using Novari eRequest. Unlike rigid, one-size-fits-all solutions, Novari eRequest is designed to accommodate complex, site-specific workflows. Its ability to visually model intricate processes ensures that even the most detailed and unique workflows can be accurately represented and optimised. This flexibility empowers organisations like CALHN to build workflows that reflect their exact needs, improving efficiency and patient access without requiring them to compromise on their established processes.
Dashboards
Since the Novari software has been implemented at CALHN, the staff have been able to quickly and accurately see their work lists at a glance. The software’s fully customisable dashboards offer an intuitive interface that allows users to track, analyse, and optimise different stages of the referral, triage, and booking process.
By leveraging these real-time dashboards, frontline staff can swiftly check appointment availability, reduce scheduling conflicts, and enhance patient flow. Managers gain deeper visibility into booking trends, resource utilisation, and system bottlenecks, enabling data-informed decision-making. Additionally, staff can monitor key performance indicators (KPIs) such as wait times, cancellation rates, and referral processing efficiency, ensuring continuous improvement in service quality and compliance.
This enhanced transparency and accessibility of critical operational data has empowered CALHN to proactively manage demand, optimise resource allocation, and maintain a high standard of patient care.
Measurable Impact at CALHN
Since implementing Novari eRequest, CALHN has observed significant improvements in patient flow, operational efficiency, and overall service delivery. Within the first six months, there was approximately a 40 percent reduction in referrals requiring OPD assessment. Additionally, within the first 12 months, around 25 percent of patients exited the pathway without needing a procedure. These improvements have ensured that patients receive the most appropriate care sooner while avoiding unnecessary interventions.
As shown in Figure 2, the number of completed appointments has increased substantially, rising from 144 in November 2023 to 571 in February 2025, highlighting the system’s ability to accommodate more patients efficiently.
Figure 2. This stacked bar and line graph illustrates the number of endoscopic pathway patients treated at CALHN from November 2023 to February 2025.
Conclusion
The implementation of Novari eRequest at CALHN demonstrates the value of digital transformation in high-volume healthcare settings. By streamlining referral management and enhancing workflow efficiency, the technology has improved patient access, reduced wait times, and optimised hospital resources. As CALHN continues to monitor performance and leverage analytics for further insights, Novari’s solution presents a scalable model for broader system-wide adoption, helping to address the ongoing challenges in elective surgery management across Australia.
Want to learn more about how CALHN has transformed their endoscopic workflows?
Register for our upcoming webinar, How a South Australian Hospital Network Transformed Care With Referral & Wait List Management Technology.
Featured Speaker: Professor Jane M. Andrews, MBBS, FRACP, PhD, AGAF, FGESA, MAICD, 2024 GESA Distinguished Researcher Prize Winner, Chair and Medical Director, Crohn’s Colitis Cure
