Once considered a critical component of meaningful use, DSM (Direct secure messaging) within an EHR poses significant limitations to referral management. While it conveys information electronically within a practice, DSM alone does not provide for comprehensive data exchanges between PCPs and consulting physicians. The Journal of General Internal Medicine notes that communication breakdowns affect care delivery between two practices on different systems. Specialists report that, 86% of the time, they do not receive information from the PCP prior to the referral visit. Additionally, poor referral tracking leads to inappropriate or unnecessary referrals and inefficiencies in care delivery. DSM in EHRs presents inevitable challenges for both primary and specialty care practices.
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The shortcomings of DSM
1) Setting up the system is cumbersome, requiring considerable amounts of time to implement it and train staff to use it. DSM typically does not utilize the most user-friendly interfaces. Directories are frequently difficult to navigate. Many practices do not have DSM capabilities, so they cannot adequately connect with providers who do.
2) EHRs lack practice-to-practice interoperability. While well-suited for streamlining workflows within one practice, they do not provide for seamless sharing of information between PCPs and specialists. Data conveyed via EHRs is often fragmented.
3) Direct messaging in EHRs is inadequate to meet the ever-evolving requirements of meaningful use. The current emphasis on value-based care necessitates that clinical information is shared between care transitions so that providers have a more thorough understanding of a patient's health status to provide optimal care.
4) DSM leaves providers without a reliable way to track referrals. PCPs are not automatically notified when patients do not make an appointment with the consulting physician. Consequently, they have to manually follow up, which is not practical when tracking large numbers of patients.
5) Patients are less likely to follow through when they are responsible for scheduling appointments with specialists. Typically, an appointment can't be made until the PCP sends the patient's information to the consulting physician. If the report is delayed, or not sent at all, which is often the case, the patient may be discouraged from completing the appointment.
6) DSM hinders communication between physicians. Specialists will likely have difficulty receiving reports through DSM. Likewise, reports from consulting physicians often do not reach PCPs in time for prompt follow-up care.
7) EHRs alone cannot measure performance indicators, such as the quality and timeliness of consult reports or time-to-treatment intervals.
High-Performance Referral Management
Since traditional EHR care coordination does not effectively close the loop on referrals, increasing numbers of practices are implementing electronic referral management systems. These cloud-based referral systems provide timely clinical information and use workflow automation to facilitate best practices in referral management.
- Providers can easily track referrals, even when collaborating with specialists who do not use an EHR system. Consequently, referrals do not fall through the cracks.
- Improved communication allows PCPs and specialists to agree on treatment approaches and better coordinate care.
- Reports sent between physicians are logged automatically, so providers do not have to manually follow up on each patient. Information can be sent and received consistently.
- Automation allows practices to generate and analyze reports on every aspect of the referral process. Metrics are used to measure key performance indicators, providing insights that allow providers to quickly determine areas that need improvement.
Electronic referral systems promote accountability and transparency for PCPs and specialists alike, while patient satisfaction is optimized when lead times are reduced and care delivery improves. Also, increased referral completion rates maximize reimbursement for providers.
Electronic referral management goes beyond traditional EHR care coordination to enhance outcomes for all stakeholders in the referral process.