How Clinical Leadership is Modernizing the Referral Process in Ontario | The Clinical Compass

Referrals are a routine part of care. When the referral process works well, patients move smoothly and swiftly from primary care to the right specialist. But referrals can still rely on fax and require manual administrative work, which can make it difficult to track the referral’s status and result in avoidable back-and-forth between health care providers.

Through Patients Before Paperwork (Pb4P), Ontario Health is modernizing this process with eReferral and Central Intake – two digital innovations designed to work together.

eReferral is a digital health tool used to send and track referrals electronically, while Central Intake is an approach that manages referrals centrally to better match patients with the appropriate care. Together, they aim to standardize referrals, reduce administrative burden and create clearer pathways to care.

Dr. David Urbach, Provincial Clinical Lead for Central Intake, and Dr. Stephen Pomedli, Provincial Clinical Lead for eReferral, are helping to shape this work. Through their clinical leadership, they help to make sure that these changes work in real clinical practices and fit day-to-day workflows.

Two Clinical Leads, One Shared Goal: Better Referrals

Dr. Urbach is also the head of surgery at Women’s College Hospital in Toronto, a professor of surgery at the University of Toronto and a health services researcher focused on access to care and surgical wait times. Over his career, he has seen how system barriers can contribute to inconsistent wait times, inequitable access and fragmented referrals. It was through these experiences that motivated him to take on the clinical lead role with Ontario Health.

“I’ve always been interested in health system improvement and innovation,” says Dr. Urbach. “What excites me the most about this role is knowing that we are at the precipice of change, where long standing issues like access, coordination and inefficient use of resources can finally be addressed.”

Dr. Pomedli brings a primary care lens to the same challenge. In addition to his role at Ontario Health, he practices as a family doctor in community-based settings and has worked at a system level with Ontario Health Teams and primary care networks, as well as in consulting roles across digital health.

His motivation to become a clinical lead is rooted in the day-to-day realities of referrals and the belief that meaningful improvement requires system level changes.

“Referrals to specialists and medical imaging are everyday challenges for so many clinicians, and this has direct impacts to patient care as well,” says Dr. Pomedli. “I’d come to the realization that significantly changing the referral process for the better across Ontario requires working at a system level. So, to have that opportunity to get involved with Ontario Health when there’s a strong focus and motivation to improve referrals is very exciting.”

Practical Clinical Experience Helps Drive System Change

Clinical leads play a key role in Ontario’s health system – translating system level ideas into changes that work in real clinical settings.

For Dr. Urbach, clinical context is essential when designing change at a large scale.

Centralizing referral management through Central Intake is a big undertaking that benefits from real-world, clinical application – especially when it comes to gaining clinician support.

“When I speak to other providers about Central Intake, there’s often an initial hesitation,” says Dr. Urbach. “Concerns usually relate to change itself, fear of losing referrals or losing control over their practice. Once specialists try Central Intake, they see that they receive appropriate referrals, maintain strong workloads and benefit from better coordination and flexibility.”

Dr. Pomedli sees a similar pattern with eReferral, where trust and engagement need to be built deliberately. Clinician input isn’t a “nice to have” – it’s part of the adoption strategy.

“We have advisory groups that provide ongoing clinician input,” he says. “If there are questions or concerns, we’ll often take it to those groups.”

Engaging clinicians in this way helps ensure everyone sees the bigger picture when it comes to the benefits of digital health tools.

“It’s about understanding that we’re building toward something important and meeting clinicians where they’re at,” Dr. Pomedli adds.

As practicing clinicians, clinical leads bring lived experience and credibility into the design and rollout of new initiatives. That helps ensure solutions reflect how care is delivered in practice and not only how it is intended to work in theory. Their success depends on whether clinicians trust them and choose to adopt these tools.

Working Toward a More Connected Health System

For both leads, the point of their work is bigger than any single initiative. It’s about building a more connected and responsive system; one where referrals are easier to manage, care is easier to navigate and system design reflects real clinical practice.

As Ontario Health continues advancing digital modernization with Pb4P, clinical leadership remains a key ingredient that helps new innovated models move from theory to practice.

Find out more about Ontario’s digital health transformation.