Monthly Archives: December 2016

Referral Software To Reduce Medical Errors & Repeated Efforts

With time and a strong push from Information technology, the healthcare industry is evolving. Every year, health IT companies bring new devices and tools aimed at reducing the burden on healthcare providers.

One particular healthcare industry problem that still seems to be elusive to the prowess of technology is medical errors. Essentially, Medical Errors are preventable negative effects of diagnosis or treatment.

Previously errors occurred because of improper utilization of data. Nowadays errors are made due to over-utilization of data. Physicians who preferred to use hi-tech devices are now afraid to use it. They are afraid because practices now use Electronic Health Record (EHR) and if one fails to update, the entire people involved in care will face difficulties.

In the USA, except for few practices, others have already implemented EHR system. These records are used to treat, refer, and to make all important clinical decisions. Physicians are put in a situation to handle too many data having a chance of causing errors. Most of the medical errors are made by physicians while utilizing these records in their busy schedule and these mistakes are directly tied up with patient records.

Likewise, errors are also made while referring a patient. Sometimes there is a possibility of sending wrong data while referring a patient. These incorrect referrals are found when referral coordinators call the wrong patient to confirm the appointments. At the same time, the concerned patient who needs a specialist visit will be waiting for the call to fix an appointment. This small error adds up over-time to cost-time, effort and money.

Repeated procedures are also another problem that contributes to the additional cost to patients which is not yet addressed by many hospitals. Patients are often requested to run repeat diagnosis and tests.

As requested patients will also repeat certain tests multiple times unknowingly by putting themselves in danger. Tests like CT scan and other imaging causes exposure to some radiations. By taking these tests multiple times they will end up with the high risk of getting cancer. Procedure repeat could be avoidable when all scanning image records are synced with an EHR. Timely update of all the patient-relevant details into their EHR will help to develop a better workflow.

The poor integration of EHR technology or medical device within a hospital is also noted as a potential cause of medical errors. Also, patients keep switching the network when they don’t find the right specialist. A practice with referral software will help to solve this problem.

A referral software enables smooth communication between the specialist and the PCP, PCPs will receive information back from the specialists. Improved communication with the help of referral solution could reduce medical errors and curb repeated tests and diagnosis.

A Referral Management Solution can Help the practice too,

1. Identify the right specialist
2. Closes communication gaps if any by enhancing the doctor-patient communication
3. Increase the utilization of medical records
4. Makes process simpler and effective
5. Reduce effort, time and repeated tests
6. Decrease wait time and scheduling problems

3 Reasons Why A Referral Process Goes Incomplete

15 billion faxes are sent out for referrals every year and 50 percent of it never ends up in doctor visits. A referral cycle starts and ends with a general practitioner to ensure referral completion. When the loop is not closed then the referral is incomplete. Following are the reasons for incomplete referrals:

No Show

Referrals are made to provide better care for patients. It is their responsibility to meet the specialist to whom they are referred. Consider, if every 1 out of 3 patient referrals doesn’t turn up, there will be a huge loss to hospitals and to the consultant who spends their valuable time on this. In some cases, patients meet the specialist but fail to follow up with their referring physicians which makes them unable to close the referral loop they initiated. An incomplete referral means incomplete medical records.

Physicians who refer a patient to a specialist will send the detailed medical history of the patient which helps the specialist to identify the problem while diagnosing. After treatment, the specialist will send the report back to the physician and the physician will update the EMR. When this process is not completed then the patient record will not be updated. So closing the loop is an essential step because sometimes important details may be missed. If a patient wishes to see an outside provider with this incomplete record it may lead to medical errors.

Poor Physician Network

In a day, a physician makes a minimum of 10 to 20 referrals. But do you know whether your physician is making a correct referral or not? It is found that over 19 million clinically inappropriate physician referrals occur each year. The reason for a referral mistake is lack of secure and reliable communication channels between practices. Physicians should be more aware of their referral habits which will be useful in monitoring the problems in their workflow.

More than 65 percent of the physicians lack information about the specialists. Some physicians don’t even know that they have a specialist within their network and they refer their patient to outside providers resulting in losing their valuable patients which are called as referral leakage.
Relationship and networking are important in making correct referrals which helps to build trust and reduce leakage. Relationships and expertise will always help to provide excellent care.

No Improvement in Technology

Most of the hospitals still follow the paper-based method in their practice. To increase the revenue, hospitals should adapt to latest technologies. With technology, it is easy to overcome the above two problems.

Most of the follow-ups don’t happen because patients have forgotten about the scheduled meeting or they do not have time to meet the specialist. This problem can be solved by sending reminders about appointments and allowing them to fix their own appointments. Similarly, updating the specialist list will help physicians to identify the specialist availability and they can perform correct referrals.

It is not only technology and hospital processes that change time to time, but also patient’s mind changes due to external influences. Maintaining a correct patient record is important to give right treatment.
HealthviewX Referral Management Solution is an end-to-end referral workflow management platform which will keep PCPs in the referral loop and specialists can access all the necessary information they may require.

Why Referral Matters for Population Health?

Population Health has been the buzzword for some time now and is used excessively by healthcare providers of all kinds and large employers amongst others. One reason for this is, of course, the concept is in itself broad and can include many things.

The basic concept of population health can be defined as understanding healthcare needs of a patient population and proactive intervention based on group variations of healthcare requirements to achieve population health quality outcomes.

Population Health Management proposes a holistic approach to healthcare delivery and better outcome, that is the reason why managing referral network becomes important in the process.

Ensure Continuity of Care

The Providers participating in a population health model have a bigger stake in the continuity of care their patient population has been receiving.National statistics on referral indicates more than 40% of the referred patients do not go to recommended specialists therefore maybe unsettling to general providers. A referral Management solution can most definitely improve those numbers or at least identify the reasons why patients are reluctant to see a specialist.

Keeping the PCP in the Loop

An intelligent medical referral solution allows PCPs to consult with the specialist and make an informed decision in directing patient care. Referral management solution will ensure a good level of communication during and after the referral is complete. Primary providers in the absence of a medical referral solution have no means of knowing the status of the referral at regular intervals. After a referral Primary provider may not be able to know the specialist’s diagnosis and understand the outcome of the process closing the referral loop

Patient Population Requirements

The PCPs who consult several patients a day have no reliable well-documented source to understand the various needs of the population that they serve. The result of lack of capabilities will push PCPs to refer patients to specialists outside of their network to serve and address the needs of a patient.

Employing Analytics

Identifying the right data set from different sources to achieve the measureable outcome is not an easy task. Healthcare industry is slowly adapting to new age technologies and leveraging data insights from the information gathered by analytics tools. For example, if a PCP is able to evaluate the data from the past 6 to 12 months, it will help him understand the strength, weakness and yield more revenue opportunities for the practice and prevent revenue leakage through referrals made outside of the network.

Referral Leakage And Ways To Prevent It

Referral leakage (also called as Network Leakage) happens when primary care physician (PCP) refers their patients to health care provider or specialist (outside the network). When this referral process tends to take place repeatedly it will lead to loss of revenue.

Referrals are made to provide better care to patients by avoiding medical complications. PCP’s will not refer patients to other practice specialists until there is a necessity. The PCP send patients to outside providers because they don’t have proper facility, or lack in quality equipment, resource to treat them and in some situation, the patient wishes to get referred or there is a medical emergency.
Referral leakage not only eats up the revenue but also results in patient leaving your network. So if organizations are making many referrals to outside providers then you need to identify why the physicians are referring them out. Because the patients whom you are referring out may not return back which means you are losing your valuable patient. Followings are some reasons why health organizations lose their patients due to referral leakage:

  • Not enough resources available or when the organization has limited access
  • Patients who want to seek a second opinion from the specialist
  • When geographical location or distance is a concern
  • When patient-physician meeting did not happen at the scheduled time
  • Expensive specialist
  • Poor facility and service
  • The gap in patient-provider communication

To have a tight hold of your patients, you will need an effective software system which must have the capability of capturing or tracking data to disclose all the referral network pattern. Implementing referral system into your practice will make your practice management steps easier.

Identify a software with following capabilities:

  • Ability to track the referral network pattern (both inside and outside)
  • Identifies patients who leave your organizations
  • Captures reason for being referred out (i.e. lack of resources or specialist, emergency etc.)
  • Records all details related to a referral made (such as outside provider name, location, referred physician, the reason for referring)
  • Dashboard which has all detailed about IN & OUT referral that help to get better insights

Tools will give all required patient details which will also help to update patient information within the network. Using data analytics will help to get insights about data that will help prevent leakage by focusing on three key areas: Network Pattern, Network Optimization, and Growth Planning.

Understanding current network pattern
Analyze and understand the behavior of patients both inside and outside of the network across practices, physicians, and locations. Using web-based solutions, track these data to reveal the referral pattern. Using that pattern to educate in-network providers to minimize the referral leakage.

Perfecting current process to prevent leakage
Daily reporting on patient’s health status and usage of tools help to gather information to trace patient behavior pattern. So providers need to improve physician awareness with reporting tools.

It is providers’ responsibility to keep their loyal patients. To retain their patients they first need to identify what’s patient expectation from competitors practice. Identify the gaps and implement it in practice to avoid a patient shift to other networks.

Building a better care system
Equipping health systems with software tools will help to optimize referral networks. By focusing on network optimization, we not only reduce referral leakage it also directs healthcare system on the right path. So healthcare organizations need to build clinical integration networks.

Referrals impact adversely in the revenue cycle of providers, and they most often fail to realize the importance of losing a patient and revenue while directing patients to a specialist outside of their network which could be prevented by building clinically integrated networks that will help to analyze problems within the network and prevents referral leakage.

Accidental Violation of HIPAA Compliance

Patient information secrecy is of utmost importance for any healthcare organization and medical professionals due to the risk of being compromised, exposed or accessed. With initiatives and innovation in healthcare IT space by various federal agencies (particularly CMS) and health care providers throughout the country over the years, have embraced healthcare IT innovations to secure healthcare data.

Most providers even today use conventional processes to send and receive medical referrals which could lead to an accidental violation of HIPAA (Health Insurance Portability and Accountability Act of 1996) rules which sets the standards to the use and share of patient-related information to ensure security.

In best practices, referrals are managed by referral coordinators who are in charge of sharing patient information, setting appointments and ensuring closure of the referral loop. The referral coordinator and other staff may be committing HIPAA violations in the following manner:

1. Triplicate Forms– Commonly, medical referrals are conducted using triplicate forms and it contains patient identification information. Such forms are circulated to the Specialists’ office and a copy is kept at the PCP’s office.

2. Patient Information Faxing– Hospitals and clinics relay a lot on faxing. Patient information for referrals are sent via faxes and it is not uncommon for providers to misplace such documents.

3. Use of Personal Portals and Storing Devices– For the ease of communication healthcare providers and referral coordinators repeatedly make use of their personal communication devices or portals like emails, cell phones etc.

According to HIPAA, all those above scenarios fall under the category of accidental violation of HIPAA regulations and such violators are subject to a penalty ranging from $100 dollars to $50,000 per violation depending on how the violation is categorized as.

It is not rare for providers to find themselves in these circumstances like many have in the recent past. Some due to negligence don’t comply with HIPAA regulations and on the other side of the spectrum for criminal activities involving staff misuse. Providers could take immediate actions against this issue and cut their risk in half.

a. Educating your staff on the threat to patient information, HIPAA violation and penalties involved.
b. Establishing standard procedures for staff to follow while dealing with medical referrals.
c. Likewise establishing security infrastructure to secure health data in hospital servers and cloud.

In the long run, these measures will not be enough. These methods do not have the capacity to manage large numbers of medical referrals and providers cannot divert much of their resources to maintain an IT team when there is always a shortage of helping hands.

Healthcare providers need to move away from paper triplicate forms and fax machines and embrace Referral Management Solution.

HealthViewX Referral Management Solution is a comprehensive, multi-channel solution that is secure as it is functional.