How to Improve Your Medical Referral Process

Millions of patient medical referrals are sent every year between primary care providers and specialists, but there are often technology barriers that make the process difficult and time-consuming, causing frustrations across the board. Without a standardized process, referrals are frequently sent to out-of-network providers making care coordination and communication difficult. The patient often finds themself in the middle of the referral, unsure of where they are in the scheduling, follow-up, and next step process. 

To provide the appropriate care, patients must be seen by providers other than their PCP, and it’s in their best interest for referrals to be made and received and appointments to be attended without issues. For healthcare providers, keeping referrals in-network creates transparency and improves overall patient care.

Challenges of Referrals in Health Care

To understand why standardized and streamlined processes are necessary, it’s important to recognize the magnitude of referrals and what makes sending and receiving so difficult. According to the Centers for Disease Control and Prevention, there are over 860 million physician office visits each year, many of which happen as a result of referrals from one provider to another.

Disparate EHRs between practices mean referrals are often sent via fax or scheduled over the phone creating workflow issues and missing information for patient visits. Implications of fragmented communication include:

  • Out-of-network referrals lead to increased costs for patients and providers
  • Harder to coordinate patient care
  • Duplicative testing

Satisfaction takes a hit as the patient may be highly pleased with the care provided, but the disjointed communication leaves them feeling out of the loop and unsure of the next steps in their care and can lead to no-show appointments. Furthermore, if faxed referrals are lost, misplaced, or not received, care coordination is significantly impacted.

How To Upgrade Your Medical Referral Process

Updating any process in healthcare can feel daunting and intimidating, especially related to technology. After all, healthcare professionals are inundated with tasks, including administrative ones, that consume valuable time that could be given to patients. It’s also no secret that there are hurdles to cross when it comes to the adoption of new technology. However, modernizing how you send and receive referrals simplifies the process and helps patients access the services they need. 

Using a referral management solution that integrates with your EHR will streamline and improve communication within your organization and with referring practices by bridging internal and external networks, systems, departments, facilities, and providers. Proficient Health’s referral management solution, PH Exchange, helps to enhance visibility throughout the entire referral process while eliminating phone tag and paper faxes. 

Referrals are most often sent to certain specialists for two reasons:

  1. A provider knows the specialist they are sending the referral to
  2. The referring provider office is easy to communicate with

Both reasons come with their challenges – if the specialist is out on vacation, then the patient appointment may be pushed weeks and weeks out. The specialist could unknowingly have a several-month wait for referred patients, again causing the patient to wait to receive care. Using a standardized referral management process that involves interoperable technology removes the care and time barriers by creating transparency for both the primary care provider and specialist. 

This transparency will ensure that referrals are received the first time they are sent, save time and create efficiencies for staff, increase provider satisfaction and improve patient care delivery. 

Optimize Your Internal Referral Process

Improving your medical record process doesn’t always mean starting over. The goal of referral management solutions is to enhance and improve processes that are already in place. For example, rather than faxing the referral to the referring provider and making follow-up phone calls to check on the status, a referral management solution can electronically make this same process seamless.

Referrals are sent online to the receiving practice, even if they are using different EHRs. Rather than a phone call, statuses are changed in the system (referral received, scheduled, waiting on the patient, etc.), eliminating the need for long hold times and being transferred around a provider’s office. 

Ensure EHRs are Complete

EHRs are the source of truth for anyone in healthcare, and we know they are the backbone of interoperability; however, EHRs simply do not work together if they are different. Using an integrated electronic referral management solution is the key to having complete patient data live in your EHR. 

Rather than printing and scanning patient records that are sent over, seamlessly transfer them from the referral management solution into your EHR. Patient information is often siloed and unlocatable until it is scanned into the patient record. When a patient arrives for an appointment and their information isn’t available for the specialist, duplicate testing is likely increasing costs and frustrations for the patient. 

Utilize Referral Management Software

Referral management software has saved healthcare practices and organizations millions of dollars by better coordinating patient care through connected providers. The software is comprehensive and simple to use for sending, receiving, and tracking referrals. 

Tailored to the workflows and needs of your organization, utilizing and integrating referral management software into your processes will help keep referrals in-network, understand referral gaps and patterns and optimize your current technology investments. 

Learn more about Proficient Health’s referral management solution, PH Exchange, here.