Today’s healthcare model demands that services be centered around patients. This model faces additional challenges when care needs to be coordinated among multiple providers. Between 1999 and 2009, the number of primary care visits resulting in referral has increased by 159%.
Problems with the existing referral workflow
Research strongly indicates that referring physicians need to improve the quality of information they provide to consulting physicians. When surveyed, 63% of PCPs and 35% of specialists report dissatisfaction with the current referral process because,
- Paper referrals often do not provide adequate information
- Consult reports are not delivered in a timely manner
- Many referrals do not even include transmission of information, either to or from specialists
Consequently, PCPs are always not aware if a patient has seen a specialist. To add to this, up to 80% of ACO clinicians report the lack of interoperability among data systems is the greatest challenge. It happens particularly when they are attempting to locate information from out-of-network providers. Physicians consistently indicate that improvements are needed in the referral system to optimize patient care.
Why are automated workflows important?
Did you know? Among all patient referrals from PCP to the specialist, it is estimated that only half as many patients show up for their specialty care appointment. Furthermore, “self-referral” patients who see specialists without a recommendation from a PCP are associated with higher patient dissatisfaction and poorer continuity of care with the primary care doctor. A study states that 70% of specialists rate the referral information they receive from Primary Care Providers as fair or poor.
In a patient-centric healthcare environment, patient satisfaction is the major concern of many practices. An automated referral workflow provides a way for physicians to ensure that patients are getting the care they need when they need it. As PCPs refer more patients to specialists each year, coordinated care and automated referral workflow become an urgent issue for both independent and hospital-based practices.
How can an Electronic Referral System help?
Information Technology enables patient referral workflow automation. HealthViewX Patient Referral Management System simplifies the process and closes the referral loop on time.
- The Primary Care Provider (PCP) identifies the need for a referral and initiates the same through the EHR system.
- The referral coordination team then validates the referral and does the insurance pre-authorization with the help of HealthViewX solution.
- The Intelligent Provider Smart Search feature of HealthViewX Patient Referral Management System helps in finding the right specialist or imaging center easily.
- The referral coordination team then sends the referral with the necessary documents to the relevant specialist or imaging center through the HealthViewX platform.
- The receiving provider gets notified about the referral and can schedule appointments with the patient.
- The patient and the receiving provider get reminders of the appointments thus reducing no-show rates.
- The referring provider is also notified about the status of the referral and how it is progressing. HealthViewX timeline view makes tracking and managing the referral lifecycle easier.
- HealthViewX tracks and sends reminders to the receiving provider to update the diagnosis, treatment recommendations, care plans in the referral.
- HealthViewX makes it easy for the referring provider by automatically updating this information back to the EHR system.
- Thus the HealthViewX solution closes the referral loop on time and helps in easy monitoring of the same.
Impacts of implementing an electronic referral management system
After the implementation of an electronic referral system, providers have observed,
- Enhanced direct communication between PCPs and specialists regarding their mutual patients
- Better appointment tracking
- Improved access to specialty care
- Increased consult report compliance and follow-up
In addition, referral systems appeal to front-office staff because of its intuitive user interface and human-centered design. When providers can easily access needed information, they’re empowered to deliver better care.
Benefits of automating the referral workflow
- Increased Medicare reimbursements – Medicare considers closing medical referral loop as a benchmark for giving reimbursements. Closed medical referral loops increase the opportunities for Medicare reimbursements for referral marketing.
- Streamline referral management – With HealthViewX Patient Referral System in place, the referral workflow is automated and streamlined.
- Improved patient care – Reduced waiting time gives patient satisfaction thereby improving the care quality.
- Increased productivity – Reduced operational time improves the efficiency of the patient referral system.
- Milbank Quarterly | http://www.ncbi.nlm.nih.gov/pubmed/21418312
- Journal of Family Practice | https://www.ncbi.nlm.nih.gov/pubmed/11350708