In this article, you will understand what factors are contributing to a broken referral process and what remedial measures can help.
Effective coordination between primary care physicians and specialists is key to enhanced patient satisfaction and high-quality health care. Unfortunately, US healthcare is currently struggling with the problem of abroken referral process.
It is not a new thing that the US healthcare system is one of the most complicated in the world. Everyday, hundreds of thousands of physicians, dentists, hospitals, and laboratories exchange a huge amount of data. In most cases, health information travels from one professional to another in the form of paper records. Yes, this is exactly when the risk of data loss and corruption peaks.
Let’s look at the factors that are fueling the broken referral process.
- Communication gap. The absence of effective communication between primary care physicians and specialists is by far the most influential driver of broken healthcare referral in the US. This broken link in the chain causes significant problems to the patients as well the physicians. According to statistics in a 2012 report by hitconsultant.net, 25% of primary care physicians do not receive timely information from specialists post-referral. Even worse, 68% of specialists have no idea about patients being referred to them.
- Paper vs patient. Because referrals are yet to transform fully into electronic forms, paper records are still the most preferred medium for referral communication. As a result, EHR is also not entirely free from paper. What happens next? Thousands of patients who cannot make sense of a doctor’s handwriting make wrong choices. Unfortunately, many of them die due to preventable medical errors.
- HIPAA violations. The HIPAA law (Health Insurance Portability and Accountability Act of 1996) requires every covered entity and its business associate to take appropriate measures to ensure privacy and security of sensitive health information. That being said, organizations using electronic referral system must comply with HIPAA. Regrettably, many organizations lack proper infrastructure and manpower to handle and back up referral data. This makes them vulnerable to data theft and loss leading to HIPAA violations and possible penalties.
What Organizations Can Do to Repair a Broken Healthcare Referral Process
In order to bridge the gap between primary care physicians and specialists, and ensure data safety, organizations can implement the following measures.
- Assess the loopholes and take preventive action. The first step in addressing the problem of broken healthcare referral is to identify the underlying causes. For example, if broken communication is the reason, the organization should work to enhance communication by utilizing patient referral forms. The form contains all essential information such as date, referring physician’s name, name of the specialist, and urgency of referral. Then, the referral coordinator should talk with the patient to schedule an appointment based on patient preference and specialist availability.
- Keeping a track of the referral process. There is an ongoing wrong concept that the role of primary care physician finishes once the appointment has been scheduled. However, this is not what actually happens or should happen. The primary care physician should know if the patienthas visited the specialist. In fact, they should also receive a notification about the visit. If the practice uses an EHR system with tracking features, the tracking process becomes easier. If that’s not the case, the referral coordinator can use a simple spreadsheet to track the process. The spreadsheet should contain at least the following essential information: patient name, physician or clinic referred to, diagnosis, and date of referral request
- Routine assessment of key information regarding the referral process. The key information that defines the quality of a referral process are:
- The time required for scheduling or confirming an appointment with a given specialist;
- The period for which a patient has to wait for actually meeting a specialist after an appointment is set up.
- The number of times a patient misses an appointment;
- The time it takes for a primary care physician to receive a post-appointment letter from the specialist regarding a given patient.
- Using HIPAA-compliant electronic referral systems. In order to protect sensitive health data and prevent their loss, it is critically important that the organizations use HIPAA-compliant referral systems. In case any data loss or theft occurs, the organizations should employ a proper reporting system. Note that those organizations that fail to report a health data breach to regulatory authorities and affected patients are liable for punishment under the HIPAA law.
- Take feedback from patients. Patient satisfaction is central to defining the quality of any healthcare service. For this reason, it is always a wise decision to ask the patients about their experience with the referral process. In fact, organizations should conduct routine surveys that measure the patient satisfaction. The patient feedback is a useful tool to take further actions to improve the quality of the service.
Broken healthcare referral in the US is rising despite growing implementation of EHR. Thousands of deaths occur annually due to problems with the healthcare referral process. One of the first things to address this issue is to ensure a proper communication among all the members in the chain, the primary care physicians, the patients, and the specialists.
Want To Know More?
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