Digital Referrals Improve Accessibility in Specialty Care Delivery

March 19, 2024
There is potential in digital referrals processes to streamline and improve the patient experience and relieve clinicians' administrative burdens

We have entered a digital age where paper-based systems are quickly becoming obsolete. Electronic records and communications not only cut down on the physical and ecological footprint of healthcare, but also help to ensure more efficient and accurate information transfer. As technologies continue to advance, they facilitate the streamlining of healthcare services and increase opportunities to provide faster, better care to patients.

Relieving administrative burden

Since the COVID-19 pandemic, burnout has become an increasingly serious issue, resulting in staffing shortages, which in turn, delay patient care. A substantial portion of this burnout can be attributed to administrative burden — the time and energy poured into documentation practices associated with patient care, including prescriptions, billing, insurance authorizations and more. Any opportunity to reduce this burden by streamlining processes could thus benefit healthcare providers and patients alike.

Streamlining referral process

Medical referrals are often required by health insurance companies for coverage of specialty care. However, by definition this creates a barrier in access to medical specialists, and the referral process itself can be very cumbersome and time-consuming. In some cases, the turnaround time from a primary care physician’s (PCP’s) referral to scheduling a specialist visit is as much as three days to one week, and that is just the first step in the process.

Referrals are often delayed due to factors like miscommunications about what services the specialists provide (improper referrals), or insufficient information provided by the PCP to the specialist’s office. For example, 68 percent of the time, specialists report receiving no information from the referring PCP. These factors ultimately result in severe delays in service, such that patients are unable to access the care they need in a reasonable timeframe. In fact, only 50 percent of patient referrals ever result in a completed appointment. 

Digital referral management can help mitigate these accessibility issues by improving wait times. Through standardization of the information and automation of records transfer, electronic referrals can ensure that all of the necessary information is delivered to the specialist to facilitate faster approvals and scheduling. In turn, this reduces the administrative burden on both the PCP and the specialist by reducing the back-and-forth communications, freeing up more time to see more patients and further reduce wait times.

Improving patient outcomes

Medical outcomes are typically better with prompt diagnosis and treatment; this is particularly true in therapeutic areas like oncology, where any delay in treatment can allow tumor progression to later stages, which reduces the likelihood of overall survival. Even the survival outcomes of patients with stage 1 cancer are affected by a 2-4 month delay in care, indicating that time is of the essence.

Knowing this, delays in the referral process can also create substantial stress for patients frantically seeking care. Automated processes can help reassure the patient that their case is being handled as efficiently as possible. 

Closing the referral loop

Of course, patient care does not cease for the patient once they are able to schedule an appointment with the specialist; the PCP continues to be involved. Indeed, one report indicates that only 40 percent of specialists follow up with full reports to the PCP, and those reports can take over a week to generate. Such gaps in communication may not only affect patient care and follow-up, but also increase the burden on physicians and their staff to connect with one another to gain insights on the outcome of a consultation. 

With electronic referral systems, updates are automatic, which means a PCP can check patient records directly and see if the referral has been processed or the patient has been scheduled for a visit with the specialist. Similarly, specialists can use the information from the electronic system to fill in any gaps in information they need to treat the patient appropriately, as full health records can be attached to the referral.

Benefits to the physicians, administrators, and patients

In short, digital referral systems ease the burden on PCPs and specialists by providing templates for communication, which ensure all of the necessary patient information is transferred from one to the other, and automated processes that ensure the availability of up-to-date information. This reduces the miscommunications about services provided and eliminates the time-consuming calls back and forth to obtain information about the patient’s background or progress.

Standardization of referral forms and automated processes also substantially reduce the burden on healthcare administrative staff for the same reasons as they do for physicians: the electronic referrals ensure completeness of information upon submission, which leads to fewer communications between offices to fill in the gaps, and systems are updated automatically, so there is also a reduced need for follow-up calls to update patient records. Additionally, from an administrative perspective, these systems are self-organized, which reduces time devoted to tedious paper filings.

The automated completion, processing, communications between offices, transfer of patient records, and system updates leads to faster, more efficient review of referrals, reducing wait times to see a specialist. Moreover, this ensures better quality of care by ensuring access to the full patient records and simpler, more straightforward follow-up communications by the physicians. 

Digital referral systems are an economic investment

Electronic referral setups can require some initial investment to implement, including time and training for employees.10 However, it has been reported that these systems are often very intuitive and easy to use, which makes for a smooth transition. Additionally, the time-saving nature of digital referrals leads to impressive cost-savings overall by reducing the administrative burden and increasing patient throughput, which makes them a cost-effective solution. 

Best practices

The referral process is meticulous, and amounts to almost a dozen steps from the PCP ordering the referral and the specialist scheduling an appointment to generating consultation reports and following up with the PCP. Optimizing patient care requires timeliness on the part of the patient and the providers at each of these steps, and that is best facilitated through prompt action and communication.

On the ends of both the PCP and the specialist, rapid turnaround can be achieved with some simple and agreed-upon processes:

  • Verify what information, tests and documentation are needed for a patient referral and ensure all is provided to the specialist
  • Communicate promptly with patients for scheduling and follow-ups
  • Keep information in the referral system up to date 

Digital referral systems increase the possibility of providing faster and better patient care through accurate and efficient transfer of information between physicians and the patient. The reduction in administrative burden improves the experience for the healthcare providers as well, reducing costs and time spent on unnecessary tasks. Ultimately, these digital solutions will help ensure more equitable access and assist healthcare providers in meeting the ever-growing needs for specialist services. 

Mai Al Eryani is senior manager of Strategic Initiatives at The US Oncology Network.


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