High Performance Referral Management vs EHRs

It would be easier to coordinate team-based medical care on facebook rather than with EHR systems.

- John Halamka, CIO | Beth Israel Deaconess Medical Center and co-chair of the federal HIT Standards Committee, at the HIMSS conference in March 2016¹

EHRs aren’t enough

A common misconception is that an electronic health record (EHR) can close referral loops and provide high-performance referral management for primary care practices. However, not long after EHRs were implemented, users quickly realized that EHRs alone are not able to establish a pipeline that allows data to flow between PCPs and specialists from different organizations.²

Some EHRs have direct secure messaging (DSM) capabilities, which can send transactional raw information back and forth between systems. However, DSM is merely a conduit for a minimum exchange of information. Despite what some EHRs might claim, DSM cannot fully address a practice’s goals for interoperability nor is it enough to run high-performance closed-loop referral management. Given that DSM alone does not automatically close referral loops, it is insufficient, cumbersome and unrealistic to rely on it for referral management.

As a result, primary care practices that try to rely on DSM for referrals are not able to analyze referral performance metrics such as the amount of time it takes for patients to get scheduled with specialists (time-to-treatment) or how fast specialists send back consult reports (consult report compliance). Using DSM alone also does not facilitate the communication between PCP and specialist offices that’s needed for optimal coordinated care.

Harvard Medical School professor Dr. John Halamka, the CIO of Beth Israel Deaconess Medical Center and co-chair of the federal HIT Standards Committee, has often discussed the limitations of EHRs for care coordination, which includes referral management. Dr. Halamka states that “an EHR is...not enough for population health or care management.”³ At the HIMSS conference in March 2016 Dr Halamka even argued that it would be easier to coordinate team-based medical care on facebook rather than with EHR systems.⁴

[DOWNLOAD] Better referral management processes, automated.

High performance referral management is actionable and goes beyond EHR limitations

Studies demonstrate that most referral workflows are broken in one or more of the steps involved in closing referral loops. Broken referral processes distress patients and are unhelpful for providers.⁵

Therefore when referral loops are successfully closed and analyzed, PCPs get actionable answers to the important questions needed to build a successful foundation for value-based care:

• What specialist appointments happened?
• Where did they happen?
• When did they happen?
• What was the outcome?

Even though closed referral loops have benefits for patient care, few physicians have high performance referral management systems that can close referral loops every time.

So what kind of referral process qualifies as high performance referral management?

High performance referral management involves:

• Tracking and analyzing the entire referral process electronically.
• Ensuring that specialist consult reports get sent back to PCPs quickly and efficiently.
• PCPs and specialists are on the same page about the status of every referral and patient referrals never fall through the cracks.
• Knowing which patients have declined to make an appointment.
• When consult reports are sent back from specialists to PCPs, it is tracked and logged automatically.
• Important referral information and practice-to-practice communication flows back and forth seamlessly.

When referral loops are closed and tracked, everyone wins. Patients get better care. Specialists get important referral information, every time. And primary care practices get:

• Patient-Centered Medical Home (PCMH) credit
• Meaningful Use Stage 2 credit
• Comprehensive Primary Care Plus (CPC+) credit under at least one of the 14 electronic clinical quality measurement category requirements⁶
• One of 10 “cross-cutting measures” under Medicare’s proposed Merit-Based Incentive Payments (MIPS) reimbursement framework, which will apply to 2017 performance for the majority of primary care practices in the country⁷
• At least one of 14 measurements within the care coordination category under the newly proposed MIPS Clinical Practice Improvement Activity (CPIA) framework⁷

“In a world...dependent on outcomes and wellness, you need something beyond an EHR.”⁸

Go beyond your EHR system and start achieving high performance referral management. Share your practice's strategy for referral management in the comments.