What Happens When Specialists Don't Get Patient Records from PCPs

Posted by Christian Kratsas on 2/22/17 7:44 AM


Communication between primary care physicians (PCPs) and the specialists they refer patients to is paramount to the overall best outcome for the patient. Much of the communication breakdown lies in outdated protocols and manual workflows that some organizations continue to employ. In the past, many physicians referred patients to various specialists, but never followed up on the recommendation. The patient was left to make their appointment with the specialist. In those cases, as high as 50% of the patients never made the appointments or followed up on the physician's recommendation. As illustrated, improving referral adherence shouldn't solely be the responsibility of the patient.

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Furthermore, the sharing of patient files in a timely manner is another contributing factor in the relationship between PCPs and specialists. Patients are better served when the specialist has already received their charts and information prior to the initial consultation. This saves time in the introductory visit and ensures that pertinent information isn't missed in charting.

However, as most processes stand, the exchange of clinical documentation between primary and specialty care is lackluster and inefficient at best. Former CMS administrator Andy Slavitt continues to boast the lack of interoperability between both parties even after his two year term, blaming the faulty system on siloed data by many health IT solutions. In an article on Physicians Practice, Slavitt states that "getting the information from doctor #1 to doctor #2 shouldn’t be as “technically hard” as it currently is." We can't agree more, Andy!

"[G]etting the information from doctor #1 to doctor #2 shouldn’t be as “technically hard” as it currently is."

- Andy Slavitt | Former CMS administrator

The Negative Impact of Incomplete Patient Records

Fortunately, HIT solutions that streamline the sharing of patient records do exist! Access to complete patient records offers benefits to the patient, the specialist, and the referring physician by way of efficiency and better overall treatment.

A lack of cohesive communication can lead to a number of negative scenarios:

  • Medical Malpractice. There's a distinct liability in the lack of cohesive records. It's imperative that patient records are complete and that there is adequate reason to refer patients to a specialist. Complete records, which have not been altered, are important in cases where there may be an issue of liability.
  • Incomplete Information. When PCPs don't supply records to the specialist prior to their initial consultation with a shared patient, there's a chance that the specialist will not be given all of the information important to proper diagnosis. Patients may not recognize certain health information as important and may fail to note everything for the specialist.
  • Unnecessary Treatment. Lack of patient records means that the specialist will often run preliminary exams or tests that may not be necessary or may have already been completed by the PCP. While specialists may opt to run their own tests regardless, the full information in advance may save them from some costly tests that they might otherwise rule out initially.

Cohesive Communication Between Physicians

Primary care leadership knows that it is mission critical to build ongoing communication networks with the specialists their patients are seeing for extended treatment. It is both essential and foundational to many of the Clinical Quality Measures (CQMs) tied to reimbursement agreements. A formal network of communication and care collaboration provides PCPs with better oversight of their patient's total health, while furthering their ability to recognize and diagnose other issues. It also allows the primary care physician to help patients make treatment choices, as they often work as a primary resource for overall health. This communication offers the specialist further insight into the patient's overall health and leads to more optimal treatment plans and better outcomes.

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Topics: Coordinated Care, Referral Adherence, Care Transitions