A lot of physicians think they have electronic referral capability because it comes with their electronic medical records system. But while most EMRs capture referral information, there is no way to transmit it out to the specialist, or for the specialist to transmit diagnosis, treatment or results back to the referring physician. That's a crucial detail that hinders practice productivity.
Approximately 22 million people are referred to another doctor by a physician each year, according to data compiled by San Francisco-based electronic health records (EHR) provider Practice Fusion. But only 16% of primary care providers surveyed said they use an electronic process to send patient records for referrals, according to poll by Growth Survey Research Practice Fusion.
Amanda Patanow, vice president of Doctors Administrative Solutions LLC of Tampa, Fla., believes the 16% figure is probably a bit high.
“A lot of people say they have electronic referral capability,” Patanow says. “It’s on the computer, so it’s electronic in their office. But it’s not electronic in that it’s not communicating electronically.”
Connectivity Is the Issue
Patanow says that the biggest obstacle to electronic patient referral is connectivity, a fact even among those practices that have deployed complete EMR systems. While most EMRs will capture referral information within the patient’s record, there is no way to transmit it out to the specialist, or for the specialist to transmit diagnosis, treatment or results back to the referring physician.
Patanow uses the telephone as an analogy. “Early on, the telephone was invented and it was this really great tool, but if I don’t know anyone else on the telephone, it doesn’t do me any good to have one,” she explains. “So, our saying is you have to be operable in order to be interoperable.” We have just begun to hit a large-enough number of healthcare providers who are operable, so they can become interoperable, she says. Only then will electronic referrals become a useful tool.
Currently, unless the referral information and results are manually entered, a patient’s record will be incomplete. It also means it is up to the patient to follow through on the referral appointment -- which is never guaranteed. A breakdown in the coordination of care can have a significant negative impact on a patient’s health.
A Benefit to Physicians and Patients
Patanow says that making patient referrals electronically can result in considerable benefits for a physician practice. The first is patient care, which improves when each physician involved has the full information to make medical decisions. It helps patient care when duplicate tests aren’t being ordered, because the information is being shared from one provider to another. And it helps patients when the providers know all the medications that each patient is taking, so that there aren’t potential drug interactions.
Beyond patient care, productivity within the practice is greatly improved with electronic referrals. “Because it’s such a manual process now, it takes up a lot of staff time to first check authorizations with the insurance company, and then contact the provider to whom they’re referring the patient, and share that information,” Patanow explains. “Once the patient is seen, the provider who took that consultation then has to send the information back to the referring provider.” In addition to being time consuming, this manual process is vulnerable to errors, information falling through the cracks, charts getting lost or delayed, etc., she says.
Staff efficiency and productivity is a huge motivator for many physician practices, says Patanow. “Today’s providers are being pressured to give up their independence. Reimbursements are being cut, regulations are increasing, and they are really struggling to hold onto that independence,” she says. Modernizing their business tools to boost productivity and efficiency helps physicians hold onto their independence, Patanow says.
Ask the Right Questions
Before choosing an EHR system, physicians should determine whether electronic patient referral is available, Patanow says. If it’s not available, ask why -- and whether it will be in the future.
“It’s a matter of education -- understanding that [electronic patient referral] exists, and how it will impact their workflow,” she says. “I talk to a lot of small practices that have at least one full-time employee spending time on nothing but referrals. [Referring patients electronically] will free up so much of that time.”