Tag Archives: physician

Why is Documenting A Medical Referral Not Easy For A Community Clinic?

How does referral works in a Community Clinic?

Community Health Centers (CHCs) are private, non-profit organizations that directly or indirectly (through contracts and cooperative agreements) provide primary health services and related services to residents of a defined geographic area that is medically underserved. CHCs are high referral outbound centers, who send out a number of referrals in a day. A Community  Health System has many PCPs who attend to numerous patients with different health problems. The PCP initiates referrals when the patient needs an additional diagnosis from an imaging center or a specialist practice. The following are the steps through which a referral flows,

  1. Referral Initiation – The referring provider gives the details of the patient and diagnosis to the central referral coordinating team. A referral coordinator will study the demographics of the patient and the diagnosis required.
  2. Insurance Pre-authorization – If the patient has an insurance coverage, the referral coordinator will validate the same. This step is required to find out which imaging center or specialist practice will cover the medical expenses.
  3. Finding the right provider – Depending on the treatment required, insurance coverage, patient’s convenience, the referral coordinator will narrow down the search and find the right receiving provider for the referral.
  4. Sending out the referral – After finding the right provider, patient information and the diagnosis details are shared while referring. The physicians can share the information via phone, fax, email, etc depending on the source that suits the receiving provider.

Medical referral history documentation

Referral history gives details of what has happened with the referral till date. The referral history is equally important to both the referring and receiving providers. Unfortunately, the receiving provider maintains this history through paper-based forms or EHR and it is not easily accessible to the referring provider. Documenting a medical referral is quite a challenge for the provider who initiates the referral. So what factors make it so tedious and challenging?

  • Physicians get busy – After the referral is initiated, the referring provider gets busy with other appointments and forgets about the referral until the receiving provider gives updates. Not to forget the receiving provider is also a specialist or from an imaging center who will also be busy. The receiving provider or the patient fails to communicate with the referring provider regarding the progress of the referral which makes it difficult to document the referral.
  • Lack of effective modes of communication – There is no effective platform to share patient’s sensitive data or communicate with the referring or receiving provider. The physicians are not available over calls or messages which makes the situation worse. There is a need for a standard HIPAA compliant application that the referring and receiving providers can use to share information which helps in referral documentation.
  • Manual effort making the referral process tedious – The referral process has manual intervention at every stage. This frustrates the providers and the referral coordinating team. Giving timely updates to the referring provider regarding a referral is too much of effort for the receiving provider. Documenting the referral manually becomes a challenge.

Why document a medical referral?

  • Patient’s need – The patient may come to the clinic at any time looking for the medical history of the referral. At that point, the clinic should be able to give the patient the medical referral history. So documenting a referral becomes a necessary process.
  • Clinic’s records for future reference – It is important for a Community Neighbourhood Health Center to maintain a history of its patient’s demographics and referral records. If the patient comes back to the clinic with an illness, these records will help in understanding the patient better and giving the best treatment the patient needs.
  • Direct future referrals – A history of medical referral records will help the physician in figuring out who responds quickly and who does not. The next time the physician sends out a referral, he/she will choose the most responsive and the most suitable receiving provider for the referral.

Information Technology to aid Community Health Systems

Information Technology is transforming healthcare to a great extent. Documenting a medical referral is easy for a healthcare based software application like HealthViewX. HealthViewX Patient Referral Management solution simplifies the referral process by the following steps,

  1. Referral Initiation – The patient demographics and diagnosis required are already in the application. The referral coordinator can create the referral through a simple three step form which includes insurance pre-authorization, finding the appropriate receiving provider with the help of  “smart search”, etc. The receiving provider is notified of the referral.
  2. Referral status and timeline view – With the status, a referral is tagged to, the referring provider can get to know in what stage the referral is. A timeline view shows a history of stages through which the referral has progressed.
  3. Referral and timeline view reports – The timeline view and the referral analytics data can be generated as a report in any form chosen.
  4. Referral closure and feedback – If the referral is completed, the status can be changed to closed. A feedback form is generated for the patient and the receiving provider. This can help the referring provider in making the referral process better next time.

HealthViewX Patient Referral Management solution smoothes out the referral process and reduces the burden of the referring and the receiving ends. Do you want to know more about HealthViewX Patient Referral Management solution? Schedule a demo with us.

Referral Management Software Vs EHR Rollouts

Referral Management is quite a laborious process. For an enterprise hospital, managing referrals is even more tedious than a Community Clinic. These large multi-specialty set-ups are formed by joint ventures or mergers or acquisitions. The bigger the network, the more complex is the enterprise medical referral management. EHR/EMR implementation and maintenance is the biggest challenge of all.

Now, what is an EHR/EMR? And why is managing referrals through EHR/EMR system a huge problem?

Electronic Health Records

Electronic Health Records (EHR) represent the patient’s chart data in digitized forms. EHRs are real-time, patient-centered records that make information available instantly and securely to authorized users. An EHR has the patient’s clinical data including demographics, progress notes, problems, medications, vital signs, past medical history, immunizations, laboratory data and radiology reports over a period of time.

Pros of Electronic Health Records

  • Financial Incentives – Medical providers who convert patient records into electronic ones get financial incentives from CMS.
  • Speedy process – With an EHR system, doctors can immediately place orders for imaging or laboratory work. This reduces the chance of an error occurring because the handwriting of the doctor is difficult to decipher.
  • Unlimited access to medical records – With the help of a patient portal connected to the EHR system, both patient and provider can access medical records very easily.

Impacts of EHR on the existing referral workflow

  • Easy management of patient data – As mentioned earlier, Electronic Health Records (EHR) are digitized forms of patient’s chart data. It helps is managing all patient-related information like medications, vitals, diagnostic reports, medical history, etc.
  • e-messaging between providers – In order to attest referral information, telephone tag between providers is common. It is a time-consuming process. With EHR software, physicians can e-message across practices. One situation that benefits in particular from e-messaging is referrals. Rather than playing telephone tag to get an appointment scheduled, the physician electronically sends a message to schedule the appointment.

Patient Referral Management Software

Large Enterprise hospitals have implemented an EHR/EMR system because it helps them manage their patient data securely. Providers face difficulties in managing paper-based patient records. So EHR implementation is indeed a boon to them. Yes, indeed EHR/EMRs are doing a great job but are they doing enough for patient referral management?

The obvious question now will be  “Why HealthViewX?”.

  • Inbound and Outbound Referrals – HealthViewX Referral Management Solution can integrate with both the receiving and referring end. For inbound referrals, it helps in channelizing various sources into one single queue. In case of outbound referrals, it facilitates integration with the existing system to read the patient data and send out referrals.
  • Referral Timeline – Any referral has a timeline, to capture the progress of the referral. It is common to the referring and receiving provider. A referral will be mapped to a status which helps in tracking it better. For e.g. – If a patient does not show up for the appointment, the status of the referral can be changed to no-show and an appropriate reason can also be given. With the help of a referral timeline, the providers can always be aware of what is going on with the referral.
  • Workflow and Task Management – A workflow can be defined on how the referral flow must be(business rules). Tasks can be created to manage referrals by assigning it to the respective person.
  • Improved communication – HealthViewX Referral Management Solution supports messaging and calling features for the referring and the receiving providers to stay connected.
  • Data Management – The solution is HIPAA compliant and enables secure data exchange of all patient-related documents.
  • Seamless Integration – The solution can seamlessly integrate with any EMR/EHR/RIS or Third Party application thus providing minimal disruption in the existing referral flow.
  • Referral Data Consolidation – The consolidated data regarding the referrals and the referral history of any patient can be printed as a hard copy at any time in pdf/excel.
  • Smart Search – HealthViewX Referral Management solution has a smart search facility that helps in finding the right provider for the treatment required.
  • Referral Data Analytics – Referral data-centric dashboard gives clear figures regarding the number of referrals flowing in and out, a number of referrals in various status, patient follow-ups, etc.

HealthViewX Referral Management solution helps in building a secure referral network in no time. Our expert team will guide you in changing to a Patient Referral Management Software with minimal effort. Schedule a demo with us to know more about our solution. Schedule a demo with us to learn more.

Human-Centric Design In Healthcare

Human-Centric Design in Healthcare – A total game changer to strengthen your referral network, increase your revenue and boost patient engagement

Referrals are key for any Healthcare Specialities or Imaging Centres to generate a steady, strong and sustainable referral pipeline. Health systems need to understand that today’s referral is tomorrow’s repeat patient. Thus, adopting industry’s best practices or solutions will help them to improve patient experience and patient referral rates. Traditionally referrals come through multiple sources like fax, phone, direct messaging, virtual print, etc. and regardless of how they are referred, responding to patients’ health needs and keeping them within the network is vital for all businesses. A good referral relationship requires a systematic, streamlined and scheduled amount of time and attention.

Health Systems and Hospitals should know the financial impact of losing patient referrals and ascertain those lost revenue opportunities.

If, on average, 55 – 65% of revenue is lost from leakage, that means a hospital could lose between $821K to $971K per doctor per year. For a hospital that employs 100 affiliated providers, those numbers skyrocket to between $78M to $97M per year.

The technology in healthcare is exponentially advancing and rapidly changing the industry for the better. Both, small and large health systems, and imaging centers have more options to select a suitable solution than ever before. But, before choosing it is important to evaluate, analyze the options and adopt the right solutions to achieve their business goals or needs.

In the referral process, it is important for the referring physicians to know if their patients actually see the recommended specialist. Research has demonstrated that 25% – 50% of referring providers do not know if their patients completed the referral, both the referring and receiving provider may not communicate, and studies show that around 50% of providers do not have contact with one another. And, 61% of patients would switch providers if it were more convenient to schedule an appointment.

Today’s patient referral system is a paradigm shift from fee-for-service to value-based-care. This shift towards increased collaboration, improved overall access to care, lower cost, better outcomes, etc., demands a technology that is human-centric. Such design will improve communication and collaboration, transparency, efficiency for coordinated care to align with the business objective to improve efficiency and deliver better patient care. In order to achieve this, healthcare systems need to change their longstanding approach to keep the referrals within their network and learn to be agile. The new solution should enable workflow optimization and improve financial performance when combined with operational best practices to provide timely care, improved appointment conversion, and completion rates.

So how to get a steady, strong and sustainable growth for your business?
1. Invest in the right technology
2. Diversify – build a strong referral network, keep your referring physician informed, collaborate better for an improved outcome and have a steady patient inflow
3. Grow and sustain your revenue stream

Then, sustain and grow to the next level
1. Learn to be agile – agile provides compelling competitive advantages
2. Follow industry best practices – Engage| Interact| Build Trust
3. One of the most important responsibility is to make your patients feel safe and truly valued
4. Keep your referring physicians informed about the referral, build trust and get more patients referred to you

Most PCP’s and other healthcare providers remain the most important source of new patient acquisition. Driving new patient acquisitions and retaining them within the network is an ongoing requirement for successful practices. To succeed in business, providers need to

– Effectively manage referrals from multiple sources, utilize a standard deep-rooted process
– Communicate instantly with referral sources to fill in the missing information
– Respond to referrals quickly to reduce referral leakage
– Customizable dashboards to give instant information for informed decisions
– Ensure to have a key metrics to track, study and measure real-time metrics for referral volume and patient leakage
– Improve overall quality of care across the care continuum
– Have a well-orchestrated customizable workflow

Once a referral comes in it is important to analyze – who needs to be involved, what has to happen, and when – the timelines. This has to be documented and technology can be of great help to have all the parties involved. With the help of industry experts, human-centric designs often involve out-of-box thinking and lead to creative and highly innovative solutions when compared to that of traditional designs. To create a successful human-centric design it is important to share and discuss what you’ve made with the people you’re designing for and further refine it according to their requirement and current business challenges. By understanding the customer needs, technology providers will be primed to innovate successfully.

Our powerful solutions are tightly focused to give your business the winning edge, improve your patient experience and achieve operational excellence. Understanding the customer needs and developing solutions is our hallmark. Sustainable development means adopting solutions that best suit your business needs. The sustainable growth of any business is the result of forces working together. Let’s get started!

Referral – What a PCP and Patient need to know!

Communication is a critical aspect of healthcare. Most healthcare providers across the country have systems, processes, and procedures implemented to ensure smooth flow of communication. However, such innovations are largely focused on improving in-facility communication, resulting in poor communication between facilities.

The ability to send and receive information between facilities can not only improve the patient healthcare outcome but also enhance healthcare efficiency. A referral management software would simplify procedures between primary care physicians and patients. It would also help PCPs to closely monitor the progress or the outcome of the patients who are referred to a specialist.

Problems With Conventional Referrals:

  1. Physician refer patients but cannot follow up
  2. Lack of communication between primary physicians and patients
  3. Patients not meeting the referred specialist
  4. It is impossible to send follow-up information

The existing problems listed above highlight the Complexity in current referral procedures. The root of these issues can be traced to the physician’s practice because they are the ones who initiate a referral.

Here are some key points that PCPs are expected to validate before sending out a referral to a specialist.

Get to Know Your Patients More

Knowing a patient is as important as knowing about the problems they have. The patient outcome should be foreseen before a referral is made. Most patients visit one PCP whom they trust to a great extent. If the referral process does not meet their expectations, the patients may seek alternative options.

In some cases, patients get the second opinion from another physician after getting suggestions from a specialist. This scenario happens quite often despite being a reverse process. This shows the importance of PCP in the referral cycle as it is their responsibility to ensure patients’ smooth transition and get the required care.

Do Patients Really Need Specialists?

Once a patient selects their PCP, they generally don’t see any other physician or specialist unless a need arises. Here PCPs are the generalists who take full responsibility for their patient. Before getting a patient to step into the specialist’s office they must identify a clear need for the specialist’s visit.

Also, general practitioners could solve many of the patient’s problems without the need for a specialist’s help. Only in some cases do physicians require additional visits to identify the problem. If after multiple visits they cannot diagnose the problem they will send patients to a specialist at the time of need as they are primarily liable for their patient’s care.

Managing the Referral

To avoid any delay in patient diagnosis, some physicians make referrals frequently. But referring more does not mean it is the optimal approach.

Most referrals happen within the network. Physicians send patients to specialists who are known to them and these specialists can easily follow up to them, which helps in closing the referral loop. When this process does not go as planned then the PCP will stop referring to that particular specialist as referral closure is important to identify the patient’s health status.

Key points a patient must be aware of:

  1. Referral is an important process in healthcare
  2. Referral success partially depends on patient cooperation
  3. The referral will require some patient-related data transfer and some methods of data transfer are safer than others.

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.