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How Technology Helps Clinics Coordinate Better Care Via Referrals

Specialty referrals are a common practice in US healthcare. A study by Ateev Mehrotra and colleagues published in “The Milbank Quarterly” found that more than 33 percent of patients are referred to a specialist each year in the US. Visits to specialists constitute more than 50 percent of all outpatient medical visits each year nationwide.

Yet not all patients who receive a referral actually get the specialty care they need. A study published in the “Annals of Family Medicine” by Christopher B. Forrest, MD, Ph.D. and a team of researchers discovered that up to 20 percent of referrals weren’t completed within three months.

As healthcare practices find themselves held increasingly accountable for patient results, the need for improvements in coordinated care and referral completion increases accordingly. New technological tools can improve coordinated care and referral results.

The (Slow) Rise of Tech Tools and the Pressure of Patient Referrals

While web-based referral systems have existed for at least a decade, as Jane Metzger and Walt Zywiak of the Center for Studying Health System Change discussed in 2008, their adoption has been slow.

Incentives provided by the Centers for Medicare and Medicaid Services (CMS) to encourage the use of electronic health record systems and patient portals, popularly known as Meaningful Use, have focused primarily on patient health records and communication, leaving referrals as an afterthought. But as electronic health records become the new normal, the demand for improvements in referrals and coordinated care is taking center stage again.

In the past, referrals have typically been limited to the specialists a particular provider knows and trusts, says Martha Thorne at the Healthcare Financial Management Association (HFMA). In the present and near future, however, a provider’s ability to refer more broadly will need to expand. Technology provides the ability to offer more personalized referrals by collecting and analyzing data more efficiently than humans can do alone, Thorne says.

Physicians simply don’t have the time to make personalized referrals without employing technological aids, says Bridget McKenzie, chief nursing officer and vice president of medical management at Conifer Health Solutions. Fortunately, a number of platforms have risen to meet the demands of improved referrals, offering better communication options, data analysis, options for integrated healthcare, tools for improved individualized care and streamlined billing management.

Improving care coordination is central to improving value-based care, say Krista Fakoory and Jennifer Gingrass at ECG Management Consultants. Centralizing referral management and integrating it with a practice’s electronic health records can improve referrals and care coordination without imposing onerous time or financial costs on a healthcare practice.

Tools for improving referral management have even entered the mobile space. For instance, Henry Ford Health System recently launched a mobile app that makes it easier for physicians to refer patients to the Henry Ford Transplant Institute. The app has helped the Transplant Institute better control its messaging and communication with physicians, says Dan Cobb, CEO and chief strategy officer for Daniel Brian Advertising.

4 Benefits of Improved EHR Technologies for Referrals

Many electronic health record platforms integrate tools that enhance communication with patients and improve coordination between providers. When leveraged effectively, these tools can help healthcare practices improve referrals and enhance value-based care.  

Managing the Referral Process

Primary care physicians play an important role in coordinating and supervising care, and they need access to adequate information to make the necessary informed decisions. To date, that information has not always been easy to gather or manage. Mehrotra’s research team found that one-quarter to one-half of referring providers didn’t know whether their patients had completed a referral given to them.

For many years, the siloing of medical information complicated the problem, says Jason Kressel, senior vice president of product and account management for MyHealthDirect. “Providers and patients do not have the visibility or solutions to change behaviors as the process is unfolding,” Kressel says. An integrated technological platform can help improve matters by making information easier to share, both among providers and between providers and patients.

Improving Patient Follow-Through

Patients may fail to follow up on referrals for several reasons, Cindy Jordan at the Advisory Board Company says. For instance, anxiety, job or home conflicts, or a desire to see a doctor of a particular gender or background can all pose hurdles that result in patients failing to get the specialist care they need. Systems that integrate patient messaging can improve patients’ follow-through when it comes to scheduling and attending appointments with specialists, says Paul D. Taylor, MD, chief medical information officer at Philips Wellcentive.

When these systems are automated, patients stay informed as office staff enter or process referrals. And when the system improves communication, it’s easier for physicians to stay engaged, Jordan says. This engagement is necessary to meet increasing demands for accountability when it comes to patient care.

Sharing Information Effectively

Even when patients attend the specialists appointments to which they’re referred, the specialist may encounter an additional hurdle: Lacking the information they need to provide optimal care, says April Savoy, Ph.D., a research scientist with the VA Center for Health Information and Communication at the Richard L. Roudebush Veterans Affairs Medical Center.

“Too often, patients are asked to provide information to the specialist – to provide their medical history and other pertinent details completely and accurately – to bring the specialist up to speed,” says Dr. Savoy.

This is an inefficient use of the patient’s and provider’s time, and it puts the patient in the position of having to communicate detailed medical information at a time when they may be least capable of recalling or organizing complex details. Instead, Dr. Savoy says, improvements in referral templates included in electronic health record systems can take the burden off the patient, allowing specialists to see relevant parts of the patient’s health record directly from the primary care physician.

This improved communication can be achieved without placing additional burdens on either the referring provider or the specialist, and it can lead to better care.

Improving Business

Systems that offer robust tools for referral management can also help primary care physicians and specialists improve business, Miranda Booher, RN, writes at Luma Health. For example, the same system that communicates automatically with patients about their referral appointments and with specialists to share patient information can also be used to send thank-you notes and follow-up information as needed.

The Path to Better Healthcare

While technological tools can improve the referral process, they aren’t a complete solution, notes Tejal K. Gandhi, MD, chief clinical and safety officer at Institute for Healthcare Improvement (IHI). “We absolutely need to improve the current technology for managing referrals, but equally important is having standard processes by which all clinicians in a practice make and track referrals and optimize communications with other clinicians and with the patient,” Dr. Gandhi writes.

Today’s technological tools have embraced this approach, standardizing the process for making, tracking, and completing referrals and for improving how information is shared between providers.

Yet providers still need the training and resources to ensure they’re using the system and its processes as intended, as Susan G. Straus, Ph.D., and fellow researchers explained at the 2011 AMIA Annual Symposium. A research team led by Adol Esquivel published 10 recommendations for improving provider interactions with electronic health record systems’ referral tools in “Medical Informatics and Decision Making.” These included careful attention to design, development, implementation and analysis of the system’s role in the healthcare practice.

By attending to these factors, providers can ensure they use technology as a tool to achieve better care.

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