How Independent Practices Should Handle Electronic Referral Management

Posted by Christian Kratsas on 1/11/17 6:23 AM


Over the past decade, as healthcare organizations began to implement electronic referral management applications, studies were conducted to measure their overall functionality and value in patient care and satisfaction. The results proved that when handled properly, electronic referral management cured several problems inherent in the old paper-based coordination of care procedures. What emerged from years of trial and error was a clear set of best practices for both primary and specialty care facilities that keeps the patient front and center.

When a healthcare organization decides to implement an ERM, what are those best practices to keep in mind?

Patient Care Properly Revolves Around the Primary Care Physician

Specialty care information should always be easily accessible to the primary care physician at the center of the referral hub. Because the patient will return to the PCP for post-specialty follow-up and possibly additional referrals to other specialists, having all data centralized with the PCP keeps it visible on all coordinated care fronts. For the specialty HCO, this means timely responses to referral consults and diligent upkeep of the patient's record if the referral is valid. For the PCP, this means timely review of the specialist's input and further coordination, if needed.

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Choose a Dedicated Reviewer

When a specialist receives dozens of referrals per week, a dedicated reviewer should be assigned to triage the referrals and weed out those that aren't appropriate. This staff member could be an advanced practicioner to save costs and free the specialist's time to see more patients. The reviewer can respond to consults and offer suggestions, call for certain tests before scheduling, follow-up when the results come in and either approve for appointment or recommend a more appropriate specialty.

Assess Specialists for Top Referral Priority

Since electronic referral management systems track success, failure and other performance metrics regarding access to a specialist and patient satisfaction with the specialist's care, it's easy to tier top-performing specialists so they're upfront in the decision support process and lable secondary referral partners accordingly. Metrics for consult report compliance, appointment lead time, reputation and cost can be applied to the electronic referral management process. The PCP can assess the strengths and weaknesses within the specialty network and develop strong ties to high performers for the sake of great patient experience.

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Follow-up, Accountability, and Automation

Once a consult results in an agreement to see the referred patient, the PCP should keep tabs on the process to verify that an appointment was, indeed, set and that the patient showed. While the principle of out-of-sight-out-of-mind plagues everyone, with the automation provided by electronic referral management, both the PCP’s and specialist's offices can utilize alerts and reminders for follow-up activity. By electronically maintaining the patient's presence in the workflow, both offices can relay the information as needed and according to a chosen window of time.

Review Patient Data for Referral Successes

The performance reports built into the electronic referral management system allow for an overview of the patient data from the specialized care facilities. By analyzing the volume and velocity of referrals, the diversity of specialty care involved, and how well the patient is responding to the care, the PCP has actionable information at hand by which to measure success. A big picture view will reveal any bottlenecks or deficiencies in the treatment program and any needed improvements or further referrals can then be implemented.

With patient health as the goal, utilizing an electronic referral application only helps the process of attainment. Paper records transfers will eventually become a thing of the past, as well they should. Integrative electronic referral systems truly expose wasteful and unwieldy processes involving paper files. Electronic creation, collection, storage and transfer of records streamlines workflows for seamless coordination of care. When things flow smoothly, patients win.

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Topics: Referral Management, Referral Workflow