Referral management systems are responsible for streamlining end-to-end referral processes and improving transparency within these processes. However, health systems relying on manual referral management solutions continuously suffer from communication gaps between specialists and care providers.
The lack of coordination between providers leads to various problems such as clinical operational inefficiency, broken referral loops, missing medical information, and late treatment. These problems directly affect the quality of care patients receive and decrease health outcomes for patients.
Despite that, many health providers are slow to adopt available technologies and end up creating further obstacles in the patient care continuum. In this article, we will discuss common challenges for referral management systems in 2021.
The problem with traditional referral management systems is that they hand patients with a slip of paper and expect them to pursue an appointment themselves. However, in truth, most of these patients don’t schedule an appointment for themselves. A study from the NCBI discovered that one-third of patients don’t follow through with referrals from their PCP.
One of the reasons behind this is that self-scheduling processes require multiple calls and long lead times. All these things sometimes frustrate patients to the point that they give up on the appointment altogether.
Because of these incidents, patients lose much-needed care, whereas specialists lose revenue resulting from no-shows. Similarly, PCPs lose valuable resources they spent on coordinating referral visits.
It’s necessary for Primary Care Providers to explain every step of the referral process clearly to patients. Besides that, PCPs should make sure patients receive all the support they need while scheduling appointments. However, an effective E-Referral Management System can also schedule appointments seamlessly.
Many times, physicians miss valuable patient information due to a lack of coordination between providers. It’s also common for referral systems to miss findings and vital symptoms from initial tests while sending the referral order; something that leads to health complications that should have been avoided.
Care Coordination Challenges
Another critical problem in traditional referral management solutions is that primary and secondary care providers are unable to exchange information timely and accurately.
Referral orders include information such as the reason for the patient’s visit, the required service, the urgency of the appointment, as well as insurance verification.
These referral orders have to be transferred efficiently to avoid errors in treatment and verify the payment. Without this information, specialty providers have no way of knowing how to treat patients and who is the primary care provider of the patient.
A research study conducted by the Journal of Internal Medicine found that 50% of specialists were dissatisfied with the integrity and timeliness of the clinical information they receive. Other times, providers send referral faxes to specialists without stating the reason behind the patient’s visit.
Referral errors are one of the greatest issues caused by inefficient referral management systems. These errors can have grave consequences for the patients involved. According to one research published in 2018, medical errors have become the third leading cause of death in the U.S with estimated fatalities being as high as 440,000.
Poor Referral Tracking Systems
After a referral is issued, primary care providers must be able to track patients throughout their patient journey. Otherwise, referral coordinators cannot monitor patient care effectively and find out what type of tests the specialist ordered, when the appointment took place, and even whether the patient went for the appointment or not.
A research conducted by the US National Library of Medicine National Institutes of Health suggests that as much as 25 to 50% of referring physicians are unsure of whether their patients are able to see a specialist or not.
Doctors are responsible for referring patients to specialists once their condition demands it. However, after a referral, it is up to the efficiency of the referral management system to ensure the timely appointment and treatment of patients. Because of poor referral tracking from care providers, their staff has to call specialists to verify a patient’s arrival.
An e-referral management system allows both PCPs and specialty groups to have greater visibility of the entire referral process. This also allows them to analyze critical trends and address operational inefficiencies more successfully.
Lack of Follow-Ups
Even after a referral appointment has been completed, many specialists don’t close the loop with the PCP. An article published in the US National Library of Medicine National Institutes of Health mentions 40% of PCPs said they did not receive a report from referred specialists for the patient’s follow-up.
The inability of specialists to provide follow-up reports further burdens the referral cycle. At the same time, the information regarding the patient’s condition is delayed from being a part of his/her electronic medical record. Lastly, performing these tasks manually increases the probability of data being misinterpreted or lost, which seriously affects patient care in extreme cases.
Referral leakages are a significant problem for healthcare providers across the country. These leakages result in billions in loss of revenue with some estimates ranging the loss of revenue from 55% to 65%.
Traditional referral management solutions cause unnecessary delays in treatment. Patients in critical condition cannot afford delays in treatment so they leave their existing hospital network in favor of other healthcare providers.
Managing Multiple EHRs/EMRs
Many primary and secondary healthcare providers use different types of electronic health/medical records. Because of various acquisitions and mergers of healthcare systems, many of these providers function on hybrid systems. Interoperability between multiple EHR/EMR systems is a significant challenge for referral management solutions.
Finding the Right Specialists
It’s common for large hospital systems to host a huge number of specialists. Primary care providers have no way of knowing whether a specialist is new or lacking experience after acquisitions or mergers. This forces many PCPs to refer patients out of their networks despite having a specialist within the network.
Lack of Referral Analytic Features
Health systems have to manage countless incoming and outgoing referrals within their networks. However, due to the sheer number of these referrals, is difficult to track and monitor different categories of referrals. If a referral management solution lacks analytic features, then the provider cannot identify patterns of specific referrals, making it difficult for them to optimize their workflow further.
Referral management solutions in health systems have to cope with various challenges that cause unavoidable problems for both patients and providers. However, using cloud-based digital automation technology can help address these challenges and minimize the inefficiencies within their referral management processes.
eReferral Management Automation is a specialized referral management solution that enables providers to minimize manual referral tracking, enhance patient outcomes, and deliver more integrated, effective healthcare.