The New England Journal of Medicine describes the traditional patient referral process as a perilous journey . Right off the bat, only half of patients show up to their referred specialty physician appointments .
In fact, the referral process is so fragmented that even when patients do show up to their specialist appointments, only 32% of specialists will receive clinical information from the PCP prior to seeing the referred patient. 
Many independent practices are managing referrals this way -- with limited measurement and communication between providers at every step of the referral journey. The whole process is manual, inefficient, and can be harmful to the health of the patient for many reasons, including missed or delayed diagnoses  and higher hospitalization and emergency room usage .
In this infographic, we illustrate the challenges and gaps in each step of the traditional referral management process. The Perilous Referral Management Journey highlights the disturbingly low number of patient referrals that result in an integrated closed-loop.
In a closed-loop referral, primary care physicians and specialists seamlessly receive the information they need to provide optimal care throughout the entire process.
Follow 30 referrals as they set off on a journey through the four perils in the typical patient referral process.
1. New England Journal of Medicine | http://www.ncbi.nlm.nih.gov/pubmed/18322289
2. The Journal of the American Board of Family Practice http://www.ncbi.nlm.nih.gov/pubmed/7942098
3. Archives of Internal Medicine http://www.ncbi.nlm.nih.gov/pubmed/22271124
4 Journal of General Internal Medicine http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1495590/
5. Milbank Quarterly http://www.ncbi.nlm.nih.gov/pubmed/21418312
6. Archives of Internal Medicine http://www.ncbi.nlm.nih.gov/pubmed/21220662
7. eHealth Initiative and Premier, Inc. https://www.premierinc.com/wpdm-package/the-evolving-nature-of-accountable-care/
8. Annals of Internal Medicine http://www.ncbi.nlm.nih.gov/pubmed/17015866
9. New England Journal of Medicine http://www.ncbi.nlm.nih.gov/pubmed/20427777
10. Milbank Quarterly http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2690145/
11. Health Services Research http://www.ncbi.nlm.nih.gov/pubmed/12132594