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.
With coordination of care a major aspect of healthcare delivery, mistakes in the process lead to patient dissatisfaction or possibly worse. An excess of frustration in a patient's experience often leads them to pursue other primary care options. Fortunately, the emergence of electronic referral management technology can reduce errors significantly when referring to network specialists. The advantages of an electronic referral network can be seen and measured within those HCOs that adopted them early. As medical enterprises continue to implement the systems, better care coordination and happier patients will be the result.
Electronic health record (EHR) rollouts are huge undertakings. It cost Massachusetts General Hospital $1.2 billion to shift towards Epic Systems’ EHR over the last three years. And the rollout has been complicated. They had to keep their old, homegrown systems running at the same time while they switched to their new EHR system. On top of that, they had to conduct extensive data conversions, testing and staff training.
Outpatient physician practices don’t fare much better with EHR rollouts. Outpatient EHR system implementations are estimated to cost $46,569 per physician. And one study of 49 PCP practices determined that the average 5-year return-on-investment of an EHR system was a loss of $43,743 per physician. 73% of the surveyed primary care practices demonstrated a negative ROI from EHR systems over 5 years.