From Paper to Pixels: Greening the Referral Process

Year Submitted: 2025
Published Date: 19 December 2025

Tags: Scheduling ＆ Planning, Environmental Sustainability, Paper Waste, Care Process ＆ Redesign, Operational Management

About this Content

Aims

To transform the laborious referral triaging process into a streamlined digital workflow that enhances clinical efficiency and reduces environmental impact, while accelerating patient access to specialist care.

Background

The management of Outpatient referrals at TTSH Specialist Outpatient Clinics (SOCs) faced significant operational challenges before implementing In-basket triaging within the Next Generation Electronic Medical Records (NGEMR) system. Patient Service Associates (PSAs) in SOCs relied on a labour-intensive, paper-based workflow that consumed substantial time and resources. This involved multiple time-consuming steps as PSAs printed each referral document, physically sorted according to speciality and urgency, created paper files for doctors triaging before retrieving them to schedule appointments. Key issues included resource inefficiency, wastage, misplaced referrals, delay in access to patient care and appointment scheduling, of which were ultimately magnified during peak periods when high volumes of referrals required processing.

These challenges highlighted an urgent need for a digital workflow transformation within the SOCs. Following several clinic engagements and staff trainings, 21 out of 26 SOCs have successfully transited into the In-basket triaging system. A post-implementation user survey celebrated a reduction in operational inefficiencies and enhanced patient care by enabling faster appointment scheduling. Therefore, Paper to Pixels in TTSH aligns with Singapore's Green Plan 2030 through the digitisation of referrals via NGEMR. By streamlining communications between clinic staff, In-basket triaging has improved access to patient care, resource efficiency and staff satisfaction. A comparative analysis between 2019 (pre-digital) and 2024 (post-implementation) demonstrates significant improvements.

Methods

Using SusQI, identify the existing Environmental, Social and Financial cost and converting the referral process from paper to digital and derive the carbon and financial savings.

Results

New process rolled out in 21 SOCs, deriving annual savings of:

1. 444 reams of papers
2. 19.8 ink cartridges
3. 1,569.68 kg CO2e (carbon emissions reduction from papers and ink cartridge usage)
4. $7,683.36 (from reduced use of papers and ink cartridge)

Conclusion

The new process is rolled to SOCs only for now. As SOCs also manage referrals from Inpatient settings, these gains can be further extended by incorporating Inpatient referrals into the digital workflow.

Lessons Learnt

Engagement is key when rolling out changes.
Pursuing environment sustainability not only is friendlier to the environment but speeds up processes.

Keywords

SOCs referrals triaging process, converting paper to digital process

Innovators' Details

Connect with this contributor!

Bavani Deyvi Periasamy Assistant Director (Nursing) - bavani.deyvi@nhghealth.com.sg

Lim Hui Pin Senior Manager - hui.pin.lim@nhghealth.com.sg

Project Attachment

20250624-SHM_ES019-Environmental-Sustainability-Bavani-Deyvi-Periasamy-TTSH-From-Paper-to-Pixels.pdf