Tag Archives: community clinic

5 Healthcare Industry Trends To Watch Out For

With every passing day, the healthcare industry is growing and becoming better. In order to keep up with the huge demand for medicine and treatments, researchers are inventing new systems and technologies. So what are the healthcare trends to watch out for in 2019 and beyond?

The number of baby boomers who retire and come under Medicare or Medicaid is increasing every year. At the same time, medical experts are making unbelievable achievements in treatments and medicine. So it is difficult to predict the number of inventions in the future. But one thing we know for sure is that the healthcare industry has a bright future.

Due to the rapid advancement in technology, the healthcare industry has grown quickly to serve a huge number of people across the world. Despite the uncertainty in the future, it is possible to predict by looking at the medical learning centers because that’s where most of the ideas originate.

So, let us go into the top 5 healthcare trends to watch out for!

  • Electronic Medical Records/Electronic Health Records

Electronic Medical Records (EMRs) are the top of the list. But these are not new so how can it be a trend? Most of the health institutions across the U.S. have adopted the use of electronic medical records and it has positive effects.

According to Assignment Masters, it is necessary to have patients’ records in digital form to not only access these easily but also convenient for medical experts to communicate and share information with other experts in a different area. With these records, any physician can access the patient’s medical history in seconds and this allows him or her to make informed decisions when treating the patient.

Although EMRs have been around for a while, it took some time for health systems across the U.S. to embrace and implement it. Today, most of the health systems use electronic medical records. 

In 2019, we can see how technology will continue improving patient care in the long-term. With digital records, the medical expert can devise effective treatment plans anytime.

  • Smartphones allowed in medical classes

The second trend is all about how technology will not only change systems in hospitals but also in the class. Today, technology has changed how medical experts interact, gather information and make decisions. It has also changed the way medical students are trained. Today, healthcare workers don’t get in trouble for having smartphones and Edugeeksclub in class. In fact, they are encouraged to use these devices to improve their learning methods.

Teachers have also changed their teaching methods. They have reported having an easier time teaching using new equipment and software. It allows them to share important information easily and fast as compared to the traditional lecture which was difficult for the teacher and boring for the student. Students can also collaborate easily through these systems and this gets them prepared for real-life experiences.

  • Artificial Intelligence

It is impossible to discuss the future of the healthcare industry without thinking about artificial intelligence. Artificial intelligence will change and improve healthcare in many different ways. In general, artificial intelligence will open the avenue for human beings and technology to connect. Through this connection, it is easy to monitor and analyze the activity of human beings all over the world easily.

With artificial intelligence, healthcare providers will have the best tools in their hands to treat patients. For instance, using this technology, healthcare providers can easily offer their services in places where there is a shortage of doctors without being there physically. Some experts are predicting that treatments such as radiology will be enhanced to a point that healthcare providers will not need to take tissue samples from patients.

According to Essay Shark, artificial intelligence in the health care industry will increase by $1.7 billion and this is expected to improve performance and productivity by ten to fifteen percent in the next few years. Artificial intelligence will improve efficiency, save time and money and improve the experience of the patient.

  • Medical devices

Technology has made it possible for patients to consult their doctors without having to visit them. Today, doctors and patients can video chat any time they want. After communicating with the patient and analyzing his or her records, the healthcare provider can easily make informed decisions. This is good news for patients who are very old or for people who cannot get out of their houses.

With improvements in technology, our healthcare system will also improve. Medical experts have spent a lot of time and energy innovating medical devices that will revolutionize the healthcare industry. With these devices, you don’t have to wait for days or hours to get your results. They are fast and efficient.

These machines are not only convenient for patients but also to health providers. Their quality of service determines health or sickness and frustration. 

  • Improved quality of service

All technological advancements are centered on improving the experience of the patient. In every profession, the experts are paid based on the quality and quantity of service they render. Technology allows healthcare providers to measure their outcomes based on the hours they log in and the health outcomes of their patients.

It also makes it easier for healthcare providers to determine which type of treatment works best and how to get the best outcome out of them. Tests can be performed quickly and accurately. Medicine and other forms of treatment are available. In the coming years, patients will receive the best care that man has been dreaming and working towards to for thousands of years.

The health care trends discussed above are just but a fraction of what we should expect in the near future. With technology advancing at a rapid rate, we look forward to quick and efficient medical tools and treatments. As technology advances, it will reduce the burden on healthcare practitioners and they will be able to deliver the best quality of service.

Talk to our experts to know more about Healthcare updates.

HIPAA Compliance Checklist

The HIPAA compliance checklist is divided into segments for each of the applicable rules. One important point is that there is no hierarchy in HIPAA regulations, and even though privacy and security measures are referred to as “addressable”. It does not imply that they are optional. Any organization must adhere to each of the criteria in the HIPAA compliance checklist to achieve full HIPAA compliance.

It is necessary for organizations having electronic Protected Health Information (ePHI) to read through this HIPAA compliance checklist. The primary motive of this HIPAA compliance checklist is to help organizations comply with HIPAA regulations. Failing to this breaches the security and privacy of confidential patient data and results in substantial fines and even criminal charges.

Ignorance of HIPAA regulations is not considered to be a justifiable defense by the Office for Civil Rights of the Department of Health and Human Services (OCR). The OCR will issue fines for non-compliance regardless of whether the violation was inadvertent or resulted from willful neglect.

What is HIPAA compliance?

The Health Insurance Portability and Accountability Act (HIPAA) sets the standard for sensitive patient data protection. Companies that deal with PHI must have physical, network, and process security measures in place and follow them to ensure HIPAA Compliance. Covered entities (anyone providing treatment, payment, and operations in healthcare) and business associates (anyone who has access to patient information and provides support in treatment, payment, or operations) must meet HIPAA Compliance. Other entities, such as subcontractors and any other related business associates must also be in compliance.

HIPAA Requirements

Every Covered Entity and Business Associate that has access to PHI must ensure that they should

  • Adhere to the technical, physical and administrative safeguards
  • Comply with the HIPAA Privacy Rule to protect the integrity of PHI
  • follow the procedure in the HIPAA Breach Notification Rule in the event of PHI breach

All risk assessments, HIPAA-related policies and reasons why addressable safeguards are not implemented must be chronicled in case of PHI breach. An investigation will take place to establish how the breach happened. Each of the other HIPAA requirements is explained in detail below.

HIPAA Security Rule

The HIPAA Security Rule sets the standards for safeguarding and protecting ePHI when it is at rest and in transit. The rules apply to anybody or any system that has access to confidential patient data. By “access” it means necessary to read, write, modify or communicate ePHI or personal identifiers which reveal the identity of an individual.

There are three parts to the HIPAA Security Rule

  • Technical safeguards
  • Physical safeguards
  • Administrative safeguards

Let us address these in order, in our HIPAA compliance checklist.

Technical Safeguards

The Technical Safeguards is about the technology used to protect the ePHI. The important requirement is that ePHI must be encrypted to NIST standards once it is beyond an organization’s internal firewalled servers. This is to ensure that any breach of confidential patient data renders it unreadable, indecipherable and unusable.

Physical Safeguards

The Physical Safeguards focus on physical access to ePHI irrespective of its location. ePHI can be stored in a remote data center, in the cloud, or on servers located within the premises of the HIPAA covered entity.

Administrative Safeguards

The Administrative Safeguards are the policies and procedures which bring the Privacy Rule and the Security Rule together. They are the pivotal elements of a HIPAA compliance checklist. These require a Security Officer and a Privacy Officer to put the measures in place to protect ePHI.

HIPAA Privacy Rule

The HIPAA Privacy Rule governs how ePHI can be used and disclosed. In effect since 2003, the rule applies to all healthcare organizations. It demands that the implementation of appropriate safeguards to protect PHI. It also limits the use and disclosure of PHI without patient authorization. The Rule also gives patients or their nominated representatives,  rights over their PHI; including the right to

  • obtain a copy of their health records or examine them
  • to request corrections if necessary

HIPAA Breach Notification Rule

The HIPAA Breach Notification Rule authorizes the covered entities to notify patients when there is an ePHI breach. It also requires them to promptly notify the Department of Health and Human Services of such the breach of along with issue a notice to the media if it affects more than 500 patients.

There is also a necessity to report smaller breaches those affecting fewer than 500 individuals via the OCR web portal. These smaller breach reports should ideally be made once the initial investigation has been conducted. The OCR only requires these reports annually.

HIPAA Omnibus Rule

The HIPAA Omnibus Rule was introduced to address the areas that had been omitted by previous updates to HIPAA. It amended definitions, clarified procedures and policies, and expanded the HIPAA compliance checklist to cover Business Associates and their subcontractors.

HIPAA Enforcement Rule

The HIPAA Enforcement Rule governs the investigations that follow a breach of ePHI. It enforces penalties for covered entities responsible for an avoidable breach of ePHI and conducts the procedures for hearings.

What Should a HIPAA Risk Assessment Consist Of?

OCR provides guidance on the objectives of a HIPAA risk assessment:

  • Identify the PHI that your organization creates, receives, stores and transmits – including PHI shared with consultants, vendors, and Business Associates.
  • Identify the human, natural and environmental threats to the integrity of PHI – human threats including those which are both intentional and unintentional.
  • Assess what measures are in place to protect against threats to the integrity of PHI, and the likelihood of a “reasonably anticipated” breach occurring.
  • Determine the potential impact of a PHI breach and assign each potential occurrence a risk level based on the average of the assigned likelihood and impact levels.
  • Document the findings and implement measures, procedures and policies were necessary to tick the boxes on the HIPAA compliance checklist and ensure HIPAA compliance.

HealthViewX, a HIPAA compliant platform for Chronic Care Management and Patient Referral Management

How nice would it be if a solution like HealthViewX can protect all patient-related data securely? The practice need not worry as HealthViewX is a HIPAA compliant solution. We are passionate about making things easy for the healthcare industry. We offer three important solutions.

In this period, when the healthcare industry is experiencing its most drastic change, HealthViewX focuses on helping healthcare providers adapt and evolve to meet the changing needs of the industry and provide the best quality care for its patients.

Know more about our Care Orchestration Solutions to Improve Care, Performance, and Compliance! Partner with us for sustained healthcare outcomes, data insights and informed decision making!

Does A Referral Management Software Really Enhance The Patient Experience?

          When patients need advanced treatment or additional diagnosis that cannot be given within the practice, they are referred to a specialist/imaging center. The process of managing all the patient referrals that are received or sent is called patient referral management. There are many challenges faced by the patients in the referral process.

Challenges faced by patients

Let us review a typical referral process including the challenges faced by the patients.

  1. Patient visits the PCP – Andrews met with an accident recently. He met his PCP, Dr. John the next day as he was experiencing pain in his knee joints. After examining him, Dr.John wanted him to consult an orthopedic. The doctor then initiated the referral.
  2. PCP initiates the referral – John created a referral in his EMR. He did not have time to do the insurance pre-authorization so he left it to Andrews. He then found an orthopedic and gave him referral information verbally. Now when he met the specialist, Andrews had to again elaborate his condition and problems to him. This increased the efforts he took to meet a specialist. It did no go well with Andrews as he was already in pain.
  3. Patient Disorientation – John had instructed Andrews about the specialist he should visit, tests he should take and how to explain his condition. Andrews found these instructions too complicated to comprehend. He left the clinic with lots of confusions and doubts.
  4. Patient visits the specialist – Andrews then called the specialist a number of times. The first two times, the line was engaged. Finally, when he got through, all appointments were booked for the day.  to confirm his appointment. He had to wait for 24 hours in pain to meet the specialist. He spent another two hours in coordinating with the insurance company. At last, He met the orthopedic after long hours of waiting in pain. He got treated but was not happy with the waiting time and negative experience. He did not get back to the PCP to share referral updates and plans to visit some other PCP next time.

Challenges faced by the physicians

What factors stop Dr.John from giving the best patient experience to Andrews?

  1. Insurance Pre-authorization – John runs a practice where he treats many patients in a day. He has not adopted a referral management software. So he has to do the insurance pre-authorization for his patients. It is time-consuming and tedious.
  2. Finding the right specialist/imaging center – The clinic has no effective approach for finding the right specialist/imaging center. The chances of missing out on a good specialist/imaging center are high as it is done manually as they are not updated regularly.
  3. No referral updates – John is not up-to-date with the progress of the referrals which makes referral loop closure impossible.

The lack of a systematic referral workflow increased the manual effort and makes it tedious to follow-up with patients and receive referral updates.

HealthViewX Patient Referral Management System

Considering the challenges faced by the patients, an automated Healthcare Patient Referral Management System is the need of the hour. Electronic healthcare referral management system helps healthcare organizations in the seamless processing of the referral process.

Let us review the same instance with HealthViewX Referral Management solution in place,

  1. Patient visits the PCP – Andrews met with an accident recently. He met his PCP, Dr. John the next day as he was having pain in his leg. After examining him, Dr.John wanted him to consult an orthopedic. The doctor then initiated the referral.
  2. PCP initiates the referral – John created a referral in HealthViewX system. HealthViewX does the insurance pre-authorization automatically in the background. With the help of the “Intelligent Smart Search” feature, he found an orthopedic. After giving the necessary information, John created the referral. The specialist got notified of the referral and all referral information were easily accessible by him.
  3. Patient Disorientation – Andrews left the clinic with clear information about the specialist and appointment details. There was no need for him to call up the specialist for appointment as everything is automated. The patient will be notified about the appointment and tests to be taken.
  4. Patient visits the specialist – Andrews met the orthopedic soon after the appointment was fixed. He got the best treatment and was satisfied with the referral process.

If you were Dr.John, would you not want Andrews to have a better experience? By using referral management software, you can ensure that Andrews’ knee pain heals while he also develops a positive opinion about your practice. Using a referral management software, you as a PCP can retain patients like Andrews in your network.

HealthViewX Patient Referral Management Solution features

  • Insurance Pre-authorization – HealthViewX solution supports automated insurance pre-authorization that reduces the manual work of the referral coordinators.
  • Intelligent Provider Match – The solution supports an “Intelligent Provider Match” Feature that helps in finding the right specialist/imaging center easily.
  • Seamless communication – HealthViewX solution has an inbuilt audio calling and messaging application which is secure and enables faster communication
  • HIPAA compliant data security – The solution is HIPAA-compliant and offers secure data exchange. It supports almost all formats of files and keeps the patient documents safe.
  • Referral history – The timeline view provides the history and current status of the referral. A status helps in knowing the referral progress.
  • Referral loop closure – Referral updates are hard to miss that makes it easier to close the referral loops on time.

HealthViewX Patient Referral Management application solves most of the challenges faced by the patients and PCPs. This increases patient satisfaction and revenue. To know more about HealthViewX solution, schedule a demo with us. Our patient referral management experts will guide you through our HIPAA-compliant solution.

Improving Patient Referral Management Workflow Between Federally Qualified Health Centers & Specialists Clinics/Imaging Centers

Federally Qualified Health Centers and what do they do

A Federally Qualified Health Center (FQHC) is a community-based organization that provides comprehensive primary care and preventive care, including health, oral, and mental health/substance abuse services to persons of all ages, regardless of their ability to pay or health insurance status. Thus, they are a critical component of the health care safety net. FQHCs are called Community/Migrant Health Centers (C/MHC), Community Health Centers (CHC), and 330 Funded Clinics. FQHCs are automatically designated as health professional shortage facilities. a non-profitable, consumer-directed healthcare organization. FQHC serves the underserved, underinsured and uninsured people, and provides them with access to high quality and preventive medical health care. FQHCs were originally meant to provide comprehensive health services to the medically underserved to reduce the patient load on hospital emergency rooms.

FQHCs include community health centers, migrant health centers, health care for the homeless health centers, public housing primary care centers, and health center program “look-alikes.” They also include outpatient health programs or facilities operated by a tribe or tribal organization or by an urban Indian organization. FQHCs are paid based on the FQHC Prospective Payment System (PPS) for medically-necessary primary health services and qualified preventive health services furnished by an FQHC practitioner.

Their mission has changed since their founding. Their mission now is to enhance primary care services in underserved urban and rural communities

Patient Referral Management in Federally Qualified Health Centers

Federally Qualified Health Centers comprises of PCPs who offer primary health care services and related services to residents of a defined geographic area that is medically underserved. Many patients visit a PCP in a day. Federally Qualified Health Centers do not have the facilities for giving specialized treatments or for taking advanced tests. So, when a patient requires any specialist medical attention, the PCP refers him/her to the most suitable imaging center or specialty practice.

Federally Qualified Health Centers mostly refer their patients out of the network. The referral workflow from the perspective of a referring provider is as follows.

  • The PCP sends the referral through the EHR/EMR to the referral coordination team.
  • The referral coördinator will study the patient demographics and understand the required diagnosis.
  • The team coordinates for insurance preauthorization to cover the medical expenses for the required treatment/services.
  • Based on these, the referral coordinator will find the right specialist or imaging center for further diagnosis.
  • After finding the right specialist or imaging center, the patient details are sent out as a referral.
  • Community Health Systems sends referrals through various sources like phone, fax, email, etc.
  • The referral coordinator chooses the source depending on the receiving provider’s convenience.

The gap between the Federally Qualified Health Center and specialty care

A referral process may become inefficient and ineffective if the Federally Qualified Health Centers and the specialty clinics/imaging centers fail to communicate. When there is no proper communication from the specialty centers/imaging centers the community healthcare network finds it difficult to understand the progress of the referral. Let us see it from different perspectives to understand why there is a communication gap.      

  • From a referring provider’s perspective, the referral coordinator receives and processes many referrals every day. After sending out a referral, it is very difficult to follow-up with it manually. There are no effective and secure means of communication between the referring and the receiving providers. If the receiving provider or the patient fails to update the progress of a referral to the referring provider, he/she will never get to know what happened with the referral. Closing the referral loop becomes nearly impossible in this case.
  • From a receiving provider’s perspective, the referral he/she receives may contain incomplete information. Without vital details, processing the referral will be difficult. The source of referral are many but there is no single interface to manage it all. Missing out on referrals is common. There is no way of getting a consolidated data on the number of referrals missed and the number processed. Patient referral leakage becomes imminent if the referrals remain unprocessed for a long time.
  • From a patient’s perspective, the physician refers him/her to take tests in an imaging center and then meet a specialist to continue with the treatment. If the patient has to communicate back and forth between the referring and the receiving providers for incomplete information, history of illness, etc, it annoys the patient. It is frustrating for the patient to communicate between the two ends.

Referrals become incomplete, inefficient and ineffective when the participants fail to communicate and share timely information.

Guidelines to bridge the gap between Federally Qualified Health Centers and Specialist Clinics/ Imaging Centers

  1. The referring provider must understand the reason for the referral. The referring provider should also make the patient understand why a referral is necessary and what the patient can expect from the referral visit. Give time for questions and encourage the patient to clarify their doubts during the referral appointment.
  2. When the referral coordinator does the insurance pre-authorization, he/she must make sure that the receiving provider covers the insurance policy of the patient. This will keep the patient better informed of how much the service will cost.
  3. It is better for the referral coordinator to contact the specialist directly. He/She can give information about the patient’s current situation, as well as other medical records, test results, and documents to avoid duplication of effort.
  4. Both the sides have to agree on the urgency of the referral and discuss the duration of the process, frequency of referral updates and the mode of communication.
  5. Any tool that can give prompt reminders on the appointments, follow-ups to both the patient and the receiving providers can help.
  6. After the referral reports arrive, the provider must check the results and recommendations. If the referring provider cannot understand the specialist’s evaluation, he should contact the specialist to understand the diagnosis better.
  7. Referral is an important part of patient care but the patients are not obligated to follow-up with the specialist. If the referral isn’t completed, the referring provider must talk to the patient during the next visit to find out why. Documenting this can help in directing future referrals to the right specialist or imaging center.

HealthViewX Patient Referral Management solution communicates effectively between the referring and the receiving ends. The timeline view and referral status help in tracking the referral. Prompt reminders will never let you miss an appointment or follow-up. To know our solution better, schedule a demo with us.

Why Is Documenting A Medical Referral Not Easy For A Federally Qualified Health Center?

How does referral works in a Federally Qualified Health Center?

Federally Qualified Health Centers (FQHCs)  are private, non-profit organizations that directly or indirectly (through contracts and cooperative agreements) provide primary health services and related services to residents of a defined geographic area that is medically underserved. Federally Qualified Health Centers are high referral outbound centers, who send out a number of referrals in a day. A Federally Qualified Health Center has many PCPs who attend to numerous patients with different health problems. The PCP initiates referrals when the patient needs an additional diagnosis from an imaging center or a specialist practice. The following are the steps through which a referral flows,

  1. Referral Initiation – The referring provider gives the details of the patient and diagnosis to the central referral coordinating team. A referral coordinator will study the demographics of the patient and the diagnosis required.
  2. Insurance Pre-authorization – If the patient has an insurance coverage, the referral coordinator will validate the same. This step helps in finding out which imaging center or specialist practice will cover the medical expenses.
  3. Finding the right provider – Depending on the treatment required, insurance coverage, patient’s convenience, the referral coordinator will narrow down the search and find the right receiving provider for the referral.
  4. Sending out the referral – After finding the right provider, patient information and the diagnosis details are shared while referring. The physicians can share the information via phone, fax, email, etc depending on the source that suits the receiving provider.

Medical referral history documentation in Federally Qualified Health Centers

Referral history gives details of what has happened with the referral till date. The referral history is equally important to both the referring and receiving providers. Unfortunately, the receiving provider maintains this history through paper-based forms or EHR and it is not easily accessible to the referring provider. Documenting a medical referral is quite a challenge for the provider who initiates the referral. So what factors make it so tedious and challenging?

  • Physicians get busy – After the referral is initiated, the referring provider gets busy with other appointments and forgets about the referral until the receiving provider gives updates. Not to forget the receiving provider is also a specialist or from an imaging center who will also be busy. The receiving provider or the patient fails to communicate with the referring provider regarding the progress of the referral which makes it difficult to document the referral.
  • Lack of effective modes of communication – There is no effective platform to share patient’s sensitive data or communicate with the referring or receiving provider. The physicians are not available over calls or messages which makes the situation worse. There is a need for a standard HIPAA compliant application that the referring and receiving providers can use to share information which helps in referral documentation.
  • Manual effort making the referral process tedious – The referral process has manual intervention at every stage. This frustrates the providers and the referral coordinating team. Giving timely updates to the referring provider regarding a referral is too much of effort for the receiving provider. Documenting the referral manually becomes a challenge.

Why document a medical referral?

  • Patient’s need – The patient may come to the clinic at any time looking for the medical history of the referral. At that point, the clinic should be able to give the patient the medical referral history. So documenting a referral becomes a necessary process.
  • Clinic’s records for future reference – It is important for a Federally Qualified Health Center to maintain a history of its patient’s demographics and referral records. If the patient comes back to the clinic with an illness, these records will help in understanding the patient better and giving the best treatment the patient needs.
  • Direct future referrals – A history of medical referral records will help the physician in figuring out who responds quickly and who does not. The next time the physician sends out a referral, he/she will choose the most responsive and the most suitable receiving provider for the referral.

Information Technology to aid Federally Qualified Health Centers

Information Technology is transforming healthcare to a great extent. Documenting a medical referral is easy for a healthcare based software application like HealthViewX. HealthViewX Patient Referral Management solution simplifies the referral process by the following steps,

  1. Referral Initiation – The patient demographics and diagnosis required are already in the application. The referral coordinator can create the referral through a simple three step form which includes insurance pre-authorization, finding the appropriate receiving provider with the help of  “smart search”, etc. The receiving provider is notified of the referral.
  2. Referral status and timeline view – With the status, a referral is tagged to, the referring provider can get to know in what stage the referral is. A timeline view shows a history of stages through which the referral has progressed.
  3. Referral and timeline view reports – The timeline view and the referral analytics data can be generated as a report in any form chosen.
  4. Referral closure and feedback – If the referral is completed, the status can be changed to closed. A feedback form is generated for the patient and the receiving provider. This can help the referring provider in making the referral process better next time.

HealthViewX Patient Referral Management solution smoothes out the referral process and reduces the burden of the referring and the receiving ends of Federally Qualified Health Centers. Do you want to know more about HealthViewX Patient Referral Management solution? Schedule a demo with us.

 

Ten Advantages A Referral Management Software Should Provide

Referral Management Process in healthcare

Patient Referral Management in healthcare plays a vital role in treating patients. The physician identifies the need for a referral and sends it to the most relevant imaging center or specialty practice. A patient referral goes through the following steps,

  1. Referral Initiation – The referring physician identifies the need for a referral and initiates medical referrals.
  2. Insurance Pre-authorization – If the patient has an insurance coverage, the referring physician has to validate the same. The physician must do this to find the imaging center/specialist care practice comes under the patient’s insurance coverage.
  3. Finding the right provider – Depending on the treatment required, insurance coverage and patient’s convenience, the physician will narrow down the search and find the right receiving provider for the referral. Dr.Miller is a primary care physician. A patient visits his clinic complaining of chest pain. After the initial diagnosis, the physician refers him to a specialist for better treatment. The referring physician looks for the best cardiologist in the city. Considering the patient’s and specialist’s comfort, the referring physician initiates the referral.
  4. Sending out the referral – After finding the right provider, the referring physician shares the patient information and the diagnosis details with the receiving provider. The referral is sent via phone, fax, email, etc depending on the source, the receiving provider is comfortable in getting the referrals from.
  5. Following up with the referral – After the receiving provider receives the referral, the specialist may communicate with the referring physician for missing information. The physician should get things sorted and continue with the referral. The provider should schedule appointments with the patient and follow-up with the same. The specialist should give the referring physician timely updates on its progress.

The referral process is quite demanding for the physicians. Communicating and giving timely updates is not easy with the current workflow. Considering the complexity of referral networks, an effective Referral Management Software is the need of the hour.

Ten Advantages a Referral Management Software should Offer

The current process of referral is very time-consuming and tedious. It has no tracking system or cannot give periodic updates to the referring physician, patient, and the receiving provider. An updated electronic referral management system is required to streamline the referrals. It would enhance the overall experience of the PCP and patients, curb referral leakage and patient no-show rate. A Referral Management Software reduces manual intervention and makes the process simpler. It should offer benefits that will improve the physician-specialist equation, improve hospitals’ operational efficiency and increased revenue. The hospital must consider the following benefits before choosing a Referral Tracking Software,

  1. Multichannel Referral Consolidation – The receiving provider gets multi-channel referrals through sources like FAX, online forms, direct messaging, email, virtual print, direct walk-ins, etc. An Inbound Referral setup must have a Referral Management software that consolidates all referrals into a single queue. After the first step of multi-channel referral consolidation, it is easier to process the referrals.
  2. Reduced Referral Leakage – Referral Leakage is the single huge problem faced by high referral inbound setups. Referral leakage for any health system is between an average 55% to 65%. This, in turn, leads to high revenue loss. A Referral Management Software should ease the processing of several referrals on time. The Referral Tracking Software must help in finding the right specialist and also make sure that no tests are repeated. The Referral Management Software must make the patient documents available to both the referring and receiving physicians. Scheduling patient appointments and following up to see if the patient completed a referral visit will reduce the referral leakage.  
  3. Increased Operational Efficiency – It is the efficiency of hospital staff to manage referrals and check the progress of the treatment. A Referral Tracking Software must make the process simple by reducing the time spent on referral initiation. The software must make referral information available to both the referring and receiving physicians. Multi-channel referral consolidation, specialist smart search and increased referral tracking will improve operational efficiency.
  4. Automated Scheduling – The Referral Management Software must support an inbuilt scheduler. It schedules automated appointments with the patients and gives prompt reminders to the patient and the physician. This will never let a patient or physician miss their appointments thus reducing patient no-show rates. It helps the physician manage all their appointments on time. It thus leads to reduced patient referral leakage.
  5. Improved Referral Tracking – Manual referral tracking is a tedious job for hospitals. The referring physicians are least informed about the progress of the referral. This affects referral completion and referral loop closure. The Referral Management Software must always keep the referring physicians informed about the referral’s progress.
  6. Referral Completion – 25 to 50% of referring physicians do not know if their patients actually visit the specialist. Referral loop closure is very important for the referring physicians. Referral completion cannot happen when the referring physician is not informed about the progress of the referral.  The Referral Management Software must aid in referral completion by providing a secure platform for the receiving and referring physicians to communicate. Referral tracking and feedback for the referral from the receiving physician aid referral loop closure.
  7. Streamline the Flow of Referral – A Referral Management Software must streamline the flow of referral. It should consume less time for each step with minimal efforts of the patient, receiving and referring physicians.
  8. Enhanced communication between PCPs and specialists – The primary care physicians and the specialist find it difficult to communicate about referrals. The physicians may need to communicate for missing referral information, referral tracking or referral completion. The referral tracking software must have inbuilt messaging, audio and video calling features to enhance the communication between the primary care physicians and specialists.
  9. Improved Patient Satisfaction –  The patient faces difficulties in acting as a bridge between the referring and the receiving medical care physicians. This leads to patient dissatisfaction and patient referral leakage. Timely response to referrals, minimal diagnosis, and full insurance coverage improve patient’s experience with the referral. A Referral Tracking Software must cut down patient waiting time, improve the relationship between PCPs and specialists and the overall patient satisfaction. Improved patient experience directly results in increased revenue.
  10. Complete Referral Analytics – The Referral Management software should give complete data of the referrals flowing in and out of the network. Visualized data in the form of graphs, tables, charts, etc help in tracking the referrals in the pipeline. It helps in scheduling patient appointments with available documents. It gives a comprehensive data of the number of patients with various referral status and follow-up reminders for a day. The physician can customize the dashboard to show the preferred receiving physicians, the average revenue generated per patient referral, etc.

HealthViewX Patient Referral Management solution features

HealthViewX Patient Referral Management solution has features that best suit a hospitals’ Referral Management System.

  1. Seamless communication – HealthViewX solution has an inbuilt audio calling and messaging application which is secure and enables faster communication
  2. HIPAA compliant data security – The solution is HIPAA-compliant and offers secure data exchange. It supports almost all formats of files and keeps the patient documents safe.
  3. Referral history – The timeline view provides the history and current status of the referral. A status helps in knowing the referral progress.
  4. Data Analytics – A comprehensive dashboard helps to track the number of referrals in the queue and shows the number of referrals in different statuses. This helps in knowing how fast the referrals are getting closed.
  5. Report Consolidation – The data regarding the referrals and timeline view can be printed as a report anytime in pdf/excel form.

With HealthViewX Patient Referral Management solution in hand managing a referral life cycle is very easy. A 30-minute demo with our team will help you know how effective our solution can track and manage the referral life cycle. To know more schedule a demo with us.

 

Reference

https://www.mass.gov/files/documents/2016/08/uy/2011-hcctd-full.pdf

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3160594