Perhaps the strongest case to be made for indeteminacy of translation is the plethora of emerging interpretations of Quine's work. In the belief that Quine is not so inscrutable as all that, we should like to try to separate and develop one important strand in the extant Quine - that which is properly called the indeterminacy of translation - and consider its role in Quine's case against linguistics. A translation is a theory that the sentences of a given language map in a specified way onto sentences of a home language under a certain relation called synonymy. Given a translation, classical semantics would posit for each translation relation a meaning or idea shared by the alien sentence and its home translate. Now, three distinct theses appear in Quine regarding translation and meaning: (1) Applying all the canons of good scientific methodology, the totality of possible evidence supports equally well more than one translation of a given language. (2) There are no translation relations except relative to a given manual of translation, or translation theory. (3) There are no translation relations, period. (Thus there is nothing there, no fact of the matter, for translation to be right or wrong about.)

Background

Referring patients to specialty care is an inefficient and error-prone process. Gaps in the referral process lead to delays in patients' access to care, negative patient experience, worse health outcomes, and increased operational costs. While implementation of standards-based electronic referral options can alleviate some of these inefficiencies, many referrals to tertiary and quaternary care centers continue to be sent via fax.

Objective

We describe the design process and architecture for a software application that has been developed and deployed to optimize the referrals intake process by automating the processing and digitization of incoming specialty referral faxes, extracting key data elements and integrating them into the electronic health record (EHR), and organizing referrals.

Methods

A human-centered design approach was used to identify and describe the inefficiencies in the external referral process at our large, urban tertiary care center. Referrals Automation, an application to convert referral faxes to digital referrals in the EHR, was conceptualized based on key stakeholder interviews and time and motion studies. This application was designed using Substitutable Medical Applications and Reusable Technologies (SMART) and Fast Healthcare Interoperability Resource (FHIR) platforms to allow for adaptability into other healthcare organizations.

Results

Referrals Automation software was developed as a healthcare information technology solution to streamline the fax to referral process. The application was implemented into several specialty clinics. Metrics were built-in to the applications to evaluate and guide the further iteration of these features.

Conclusions

Referrals Automation will enhance the referrals process by further streamlining and organizing the patient referral process.