Tag Archives: medical referrals

How Can An Open Patient Referral Loop Hamper Your Network?

The increasing complexity of patient referrals in healthcare

Patient referrals are increasing in number every day. Health Systems and Hospitals which send out numerous medical referrals find it difficult to track and close a patient referral loop on time. What factors prevent the referral coordinators, operations managers, physicians or care providers from closing the patients’ referral loops?

  1. Prior Authorization – The referral coordinator does the insurance pre-authorization for the patient referrals in healthcare. Considering that one out of every three patients is referred to a specialist, it is difficult to do prior authorization. This makes patient referral system time-consuming and affects referral loop closure.
  2. Finding the right specialist/imaging center – The referring provider must choose the right specialist or imaging center that will suit the patient best. He/She should send the referral to a reliable provider who will give the best care and give regular updates. The referring provider must also consider a provider who covers the patient’s insurance before initiating the referral. If the referring provider fails to do this, open patient referral loop becomes imminent.
  3. No updates on the referral progress – The receiving provider fails to update the progress of the referral. 25% to 50% of referring physicians do not know if their patients actually visit the specialist or imaging center. As many patient referrals are initiated on a daily basis, tracking it manually is difficult for the referring provider. This ultimately results in open patient referral loop.
  4. Inadequate referral information – The receiving providers usually have a tough time processing referrals with incomplete information. 70% of the specialists rate the patient referral information from the referring providers as poor. This affects the patient referral lifecycle.
  5. Outdated referral workflow – The current referral workflow is outdated. The providers find it difficult to cope up with the increasing patient referrals in healthcare. On an average, a referring provider spends half an hour to one hour per referral and even more time in following up. Outdated referral technology affects the referral loop closure.

Close a referral loop in healthcare with the HealthViewX Patient Referral System

Information Technology enables patient referral workflow automation. HealthViewX Patient Referral Management System simplifies the process and closes the referral loop on time.

  1. The Primary Care Provider (PCP) identifies the need for a referral and initiates the same through the EHR system.
  2. The referral coordination team then validates the referral and does the insurance pre-authorization with the help of HealthViewX solution.
  3. The Intelligent Provider Smart Search feature of HealthViewX Patient Referral Management System helps in finding the right specialist or imaging center easily.
  4. The referral coordination team then sends the referral with the necessary documents to the relevant specialist or imaging center through the HealthViewX platform.
  5. The receiving provider gets notified about the referral and can schedule appointments with the patient.
  6. The patient and the receiving provider get reminders of the appointments thus reducing no-show rates.
  7. The referring provider is also notified about the status of the referral and how it is progressing. HealthViewX timeline view makes tracking and managing the referral lifecycle easier.
  8. HealthViewX tracks and sends reminders to the receiving provider to update the diagnosis, treatment recommendations, care plans in the referral.
  9. HealthViewX makes it easy for the referring provider by automatically updating this information back to the EHR system.
  10. Thus the HealthViewX solution closes the referral loop on time and helps in easy monitoring of the same.

Features and Functionalities

  • Referral workflow automation reduces the time and manual effort spent on a referral. Thus HealthViewX solution improves the efficiency of the process.
  • Patient coordination framework achieved through the patient application that helps in managing appointments and log data for the care plans prescribed by the provider.
  • Automated insurance pre-authorization reduces the work of the referral coordination team and makes the process simple.
  • Intelligent Provider Search feature helps in finding the right specialist or imaging center in no time.
  • Referral timeline view and communication enables easy flow of information between the referring and the receiving ends.
  • Scheduler integration gives timely reminders and notifications to the patients and the providers about appointments, lab tests, etc.
  • Referral insights and analytics gives the PCPs concrete data of how many referrals were converted to an appointment by a specialty care or an imaging center. It will help in analyzing who responds quickly and to whom the PCP can direct future referrals.

Benefits of closing the patient referral loop in the healthcare industry

  1. Increased Medicare reimbursements –  Medicare considers closing medical referral loop as a benchmark for giving reimbursements. Closed medical referral loops increase the opportunities for Medicare reimbursements for referral marketing.
  2. Streamline referral management – With HealthViewX Patient Referral System in place, the referral workflow is automated and streamlined.
  3. Improved patient care – Reduced waiting time gives patient satisfaction thereby improving the care quality.
  4. Increased productivity – Reduced operational time improves the efficiency of the patient referral system.

HealthViewX Patient Referral Management application helps in closing the referral loop and increases the revenue for the practice. To know more about HealthViewX solution, schedule a demo with us. Our patient referral management experts will guide you through our HIPAA-compliant solution.

 

Referral Management Software Vs EHR Rollouts

Referral Management is quite a laborious process. For an enterprise hospital, managing referrals is even more tedious than a Community Clinic. These large multi-specialty set-ups are formed by joint ventures or mergers or acquisitions. The bigger the network, the more complex is the enterprise medical referral management. EHR/EMR implementation and maintenance is the biggest challenge of all.

Now, what is an EHR/EMR? And why is managing referrals through EHR/EMR system a huge problem?

Electronic Health Records

Electronic Health Records (EHR) represent the patient’s chart data in digitized forms. EHRs are real-time, patient-centered records that make information available instantly and securely to authorized users. An EHR has the patient’s clinical data including demographics, progress notes, problems, medications, vital signs, past medical history, immunizations, laboratory data and radiology reports over a period of time.

Pros of Electronic Health Records

  • Financial Incentives – Medical providers who convert patient records into electronic ones get financial incentives from CMS.
  • Speedy process – With an EHR system, doctors can immediately place orders for imaging or laboratory work. This reduces the chance of an error occurring because the handwriting of the doctor is difficult to decipher.
  • Unlimited access to medical records – With the help of a patient portal connected to the EHR system, both patient and provider can access medical records very easily.

Impacts of EHR on the existing referral workflow

  • Easy management of patient data – As mentioned earlier, Electronic Health Records (EHR) are digitized forms of patient’s chart data. It helps is managing all patient-related information like medications, vitals, diagnostic reports, medical history, etc.
  • e-messaging between providers – In order to attest referral information, telephone tag between providers is common. It is a time-consuming process. With EHR software, physicians can e-message across practices. One situation that benefits in particular from e-messaging is referrals. Rather than playing telephone tag to get an appointment scheduled, the physician electronically sends a message to schedule the appointment.

Patient Referral Management Software

Large Enterprise hospitals have implemented an EHR/EMR system because it helps them manage their patient data securely. Providers face difficulties in managing paper-based patient records. So EHR implementation is indeed a boon to them. Yes, indeed EHR/EMRs are doing a great job but are they doing enough for patient referral management?

The obvious question now will be  “Why HealthViewX?”.

  • Inbound and Outbound Referrals – HealthViewX Referral Management Solution can integrate with both the receiving and referring end. For inbound referrals, it helps in channelizing various sources into one single queue. In case of outbound referrals, it facilitates integration with the existing system to read the patient data and send out referrals.
  • Referral Timeline – Any referral has a timeline, to capture the progress of the referral. It is common to the referring and receiving provider. A referral will be mapped to a status which helps in tracking it better. For e.g. – If a patient does not show up for the appointment, the status of the referral can be changed to no-show and an appropriate reason can also be given. With the help of a referral timeline, the providers can always be aware of what is going on with the referral.
  • Workflow and Task Management – A workflow can be defined on how the referral flow must be(business rules). Tasks can be created to manage referrals by assigning it to the respective person.
  • Improved communication – HealthViewX Referral Management Solution supports messaging and calling features for the referring and the receiving providers to stay connected.
  • Data Management – The solution is HIPAA compliant and enables secure data exchange of all patient-related documents.
  • Seamless Integration – The solution can seamlessly integrate with any EMR/EHR/RIS or Third Party application thus providing minimal disruption in the existing referral flow.
  • Referral Data Consolidation – The consolidated data regarding the referrals and the referral history of any patient can be printed as a hard copy at any time in pdf/excel.
  • Smart Search – HealthViewX Referral Management solution has a smart search facility that helps in finding the right provider for the treatment required.
  • Referral Data Analytics – Referral data-centric dashboard gives clear figures regarding the number of referrals flowing in and out, a number of referrals in various status, patient follow-ups, etc.

HealthViewX Referral Management solution helps in building a secure referral network in no time. Our expert team will guide you in changing to a Patient Referral Management Software with minimal effort. Schedule a demo with us to know more about our solution. Schedule a demo with us to learn more.

Electronic Referral Management To Track Inbound Referrals Effectively

In a year, 15 billion faxes are sent out for referrals in the US. Referrals can be through fax, online forms, direct messaging, email, virtual print, direct walk-ins, etc but the maximum patient referrals are sent through fax. An imaging center or specialty practice or a dental center is a high referral inbound setup. Thousands of referrals flow in and they need an effective referral tracking system to manage the inbound referral traffic.

Let us consider an example to understand how an imaging center is managing the inbound referral traffic, Mr. Samuel is suffering from ear pain. The patient consults his Primary Care Provider who asks him to get an X-ray done. The PCP sends out a fax to the imaging center that contains the patient’s information and the diagnostic tests to be taken. At the imaging center, a referral coordinator has to receive, accept and process the request. The referral coordinator has to manually key in and create a referral, include all the patient information into the EMR/EHR/RIS. The referral coordinator takes around half an hour to process a referral request. The rate of processing is very slow. The referral coordinator finds it difficult to process even 20 referral faxes in a day. It results in piling up of faxes waiting to be processed. The referral coordinator is at loss trying to figure out why he/she is not able to close the referral loop. Patient referral leakage also becomes imminent.

Imaging Centers under constant pressure

An imaging center or a specialty practice gets numerous referrals in a day through phone calls, email, fax, patient walk-in etc. In most of the cases, it is through traditional fax. It is handled by a referral coordinator who redirects the referrals to the respective internal sections. They have an EMR/EHR/RIS in which the patient details will be taken if already present or they will have to key in all the details in the fax regarding the patient and the diagnosis required. As the number of faxes is piling, the time and effort required for them will be more. They are at loss in knowing how many referrals are done and missed. Entering the patient information and processing is a mammoth task and becomes tedious for them to manage manually.

Consequences of a slow referral network

  • The imaging center or specialty practice loses its revenue when referrals are not processed in time.
  • Providers stop referring the center thereby harming its reputation.
  • Patients may be severely ill and must be treated immediately. The waiting time may affect their health.

Problems faced

  • Handling many referrals manually in a short period of time.
  • Varied sources of referral make it difficult to get a comprehensive data about the referrals flowing in.
  • The time spent in processing a hard copy fax referral is more.
  • The information about the referral is limited and makes it difficult for the referral coordinator to proceed with the diagnosis.
  • It takes a lot of time for the center to contact the referring provider in case of doubts.

HealthViewX Patient Referral Management solution at your aid

Patient Referral Management is complicated not only by the different sources but also by trying to manage all the referrals manually. The current referral management is no way close to the increasing demands of the referral process. Its inability to communicate between the referring and the receiving ends makes it slow and non-feasible. Relying on EHR/EMR/RIS for managing referrals makes it a costly affair and does not fulfill the optimal requirements of healthcare information technology for referral workflow management.

Electronic Referral Management has been creating buzz for quite a time. Many applications are looking to solve the referral process issues. Before choosing one, the following aspects must be considered.

  • Simplify data sources – Capable of handling numerous referrals from various sources and bringing it to a platform from where it can be processed.
  • Improve Efficiency – Closing the referral loop on time thus preventing patient referral leakage. This will improve the efficiency that is the number of referrals will be processed in a short span of time.
  • Data security – Sensitive patient data must be secured and protected.
  • Data Analytics – Complete analytics of the referrals flowing in, processed, missed etc.
  • Timeline View – To know the history of the referral and to what status it is attached to.
  • Integration with scheduler – To schedule appointments for the patients.
  • HIPAA Compliant – Secure data exchange of patient sensitive documents.

Any imaging center or specialty practice receives a number of referral requests in a day. The referrals usually have an attachment in pdf form which will be noneditable. They will have a form that has to be filled out with the details given in the referral. HealthViewX Patient  Referral Tracking System comes to play here. Using Optical Character Recognition(OCR) the information from the referral will be read and the form is prefilled with the required details. Now the referral coordinator can just validate the details and create a referral and assign it for further action. The referral information can also be channelized based on the request of the user for eg: Two referrals forms can be filled in if it concerns people in different locations. The solution can be integrated with EMR/EHR/RIS and can write the updated information back the system used by them.

Problems Addressed

  • Single Referral Workflow Queue Consolidation – Fax, Phone, Email, Website form referrals are captured, managed and monitored in a single interface. This helps in managing the referrals better.
  • OCR (Optical Character Recognition) – Helps in avoiding manual errors and reduces the referral processing time for referrals through eFax.
  • Timeline View – Both the center and the PCP can view the timeline data of the patient in which the referral history is present. Documents and notes can be attached anytime for one another’s reference.
  • To and fro Communication – At any time of the referral process, the PCP and the center can communicate with the help of the inbuilt secure messaging and voice call applications.
  • Referral Data Consolidation – The consolidated data regarding the referrals and the referral history of any patient can be printed as a hard copy at any time in pdf/excel.
  • Secure Data Management – HealthViewX Patient Referral Management is HIPAA compliant. All patient-related documents are managed securely.
  • Referral Analytics – Helps in tracking the number of referrals and gives complete information about the referrals processed, missed, scheduled etc with the help of a Referral Data-centric Dashboard.

HealthViewX Patient Referral Management solution is on par with the current referral network requirements of an imaging center or specialty practice. Are you an imaging center or a specialist practice looking to track your inbound referrals very effectively? To know about HealthViewX Patient Referral Management System in detail schedule a demo with our team.

Track & Manage The Referral Life Cycle Efficiently for Healthcare Organizations

Referral networks are becoming larger and more complicated day-by-day. This makes closing a medical referral loop nearly impossible and ultimately results in care fragmentation. Tracking and managing a referral life cycle is a tedious task. Providers are at loss in trying to close the referral loop manually.

In a referral loop, a referring provider is the one who initiates the referral. The referring provider faces many difficulties in following up with the imaging centers or specialists and close the patient referral loop. Community Clinics or County Hospitals are clinics that have general physicians or PCPs who mostly refer patients out for specialized care.

For eg: Dr. Felix’s patient is suffering from chest pain. After diagnosing the patient, the doctor wants to refer him to a cardiologist who will have more expertise in this regard. After the referral is done the doctor was not receiving any updates regarding the progress of the referral. Did the receiving provider follow up with the patient? What will happen to the patient referral loop?

When does a referral life cycle remain unclosed?

There are many factors due to which a medical referral loop cannot be closed. Let us see it from the perspective of a referring provider

  1. Time Spent – On an average, the referring provider spends about half an hour to one hour for creating referrals and even more time in following up the same.
  2. No Updates –  The referring provider is not updated on the progress of the referral by the receiving provider or the patient.

Why care about closing a patient referral loop?

  1. Patient’s Benefit – The patient may be in need of immediate care and attention. So processing and closing it at the earliest will be the best for the patient.
  2. Patient’s Experience – If the patient is not followed up on time he/she may not feel good about it and there are high chances for him to move out of the network.
  3. Referral Data Analytics – PCPs require concrete data of how many referrals were converted to an appointment by a specialty care or an imaging center. It will help in analyzing who responds quickly and to whom the PCP can direct future referrals.
  4. Costs of poorly managed referral system – Millions of referrals are clinically inappropriate every year. Almost half of the physicians do not know if their patients saw the specialists. For each missed referral opportunity is a loss of revenue.

Managing referral life cycle with HealthViewX solution

A typical Community Clinic does a lot of outbound referrals where the PCP’s refers his patient to a specialist practice when the patient need expert advice or advanced treatment for a specific problem. The PCP generates a referral request with EHR system to a central team that has referral coordinators. The patient’s insurance is pre-authorized, the patient is referred to the specialist or imaging center. This is how a referral is done. It involves a lot of manual work and keeping track of the referral is highly impossible because a referral coordinator deals with thousands of these in a day.

This is when an automated Healthcare Patient Referral Management System comes in handy. Electronic healthcare referral management system helps healthcare organizations in the seamless processing of the referral process.

HealthViewX solution has implemented a referral consolidator that brings all the referrals in a single queue. The referral coordinator can validate the documents, attach new ones, merge it to an existing referral, create a new referral for it etc. The feature also lets the referral coordinator validate the patient insurance eligibility. Based on the specialist availability the referral coordinator can create a referral. The system can integrate with EMR/EHR and can also coordinate between the referring and the receiving sides. A referral has a status attached to it looking at which the referring provider can understand in what stage the referral is. Any referral has a timeline view which is common to both the receiving and the referring providers. In the timeline view history of the referral can be seen for eg: patiently related notes, previous status of the referral, etc. Documents attachment and status change can also be done at any time of the referral process. With the help of HealthViewX Patient Referral Management solution, the referring and the receiving provider can always have an eye on the referral and also close it in time.

HealthViewX Patient Referral Management Solution features

  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 a 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.
  6. No change in the current process – HealthViewX Patient Referral Management solution can be integrated with EMR/EHR and can write data of referral into any system if required. It is almost zero deviation from the current workflow a practice is using.

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 effectively the referral life can be tracked and managed. To know more schedule a demo with us.

Human-Centric Design In Healthcare

Human-Centric Design in Healthcare – A total game changer to strengthen your referral network, increase your revenue and boost patient engagement

Referrals are key for any Healthcare Specialities or Imaging Centres to generate a steady, strong and sustainable referral pipeline. Health systems need to understand that today’s referral is tomorrow’s repeat patient. Thus, adopting industry’s best practices or solutions will help them to improve patient experience and patient referral rates. Traditionally referrals come through multiple sources like fax, phone, direct messaging, virtual print, etc. and regardless of how they are referred, responding to patients’ health needs and keeping them within the network is vital for all businesses. A good referral relationship requires a systematic, streamlined and scheduled amount of time and attention.

Health Systems and Hospitals should know the financial impact of losing patient referrals and ascertain those lost revenue opportunities.

If, on average, 55 – 65% of revenue is lost from leakage, that means a hospital could lose between $821K to $971K per doctor per year. For a hospital that employs 100 affiliated providers, those numbers skyrocket to between $78M to $97M per year.

The technology in healthcare is exponentially advancing and rapidly changing the industry for the better. Both, small and large health systems, and imaging centers have more options to select a suitable solution than ever before. But, before choosing it is important to evaluate, analyze the options and adopt the right solutions to achieve their business goals or needs.

In the referral process, it is important for the referring physicians to know if their patients actually see the recommended specialist. Research has demonstrated that 25% – 50% of referring providers do not know if their patients completed the referral, both the referring and receiving provider may not communicate, and studies show that around 50% of providers do not have contact with one another. And, 61% of patients would switch providers if it were more convenient to schedule an appointment.

Today’s patient referral system is a paradigm shift from fee-for-service to value-based-care. This shift towards increased collaboration, improved overall access to care, lower cost, better outcomes, etc., demands a technology that is human-centric. Such design will improve communication and collaboration, transparency, efficiency for coordinated care to align with the business objective to improve efficiency and deliver better patient care. In order to achieve this, healthcare systems need to change their longstanding approach to keep the referrals within their network and learn to be agile. The new solution should enable workflow optimization and improve financial performance when combined with operational best practices to provide timely care, improved appointment conversion, and completion rates.

So how to get a steady, strong and sustainable growth for your business?
1. Invest in the right technology
2. Diversify – build a strong referral network, keep your referring physician informed, collaborate better for an improved outcome and have a steady patient inflow
3. Grow and sustain your revenue stream

Then, sustain and grow to the next level
1. Learn to be agile – agile provides compelling competitive advantages
2. Follow industry best practices – Engage| Interact| Build Trust
3. One of the most important responsibility is to make your patients feel safe and truly valued
4. Keep your referring physicians informed about the referral, build trust and get more patients referred to you

Most PCP’s and other healthcare providers remain the most important source of new patient acquisition. Driving new patient acquisitions and retaining them within the network is an ongoing requirement for successful practices. To succeed in business, providers need to

– Effectively manage referrals from multiple sources, utilize a standard deep-rooted process
– Communicate instantly with referral sources to fill in the missing information
– Respond to referrals quickly to reduce referral leakage
– Customizable dashboards to give instant information for informed decisions
– Ensure to have a key metrics to track, study and measure real-time metrics for referral volume and patient leakage
– Improve overall quality of care across the care continuum
– Have a well-orchestrated customizable workflow

Once a referral comes in it is important to analyze – who needs to be involved, what has to happen, and when – the timelines. This has to be documented and technology can be of great help to have all the parties involved. With the help of industry experts, human-centric designs often involve out-of-box thinking and lead to creative and highly innovative solutions when compared to that of traditional designs. To create a successful human-centric design it is important to share and discuss what you’ve made with the people you’re designing for and further refine it according to their requirement and current business challenges. By understanding the customer needs, technology providers will be primed to innovate successfully.

Our powerful solutions are tightly focused to give your business the winning edge, improve your patient experience and achieve operational excellence. Understanding the customer needs and developing solutions is our hallmark. Sustainable development means adopting solutions that best suit your business needs. The sustainable growth of any business is the result of forces working together. Let’s get started!

How Not to Share Patient Information For Referral

The medical referral process is an important part of ambulatory care in the US. Medical referrals have a direct connection to patient health outcome and the provider’s revenue flow. Patient-specific information and the need to keep it safe is even more important.
To protect patient information from falling into the wrong hands, healthcare providers use various procedures and processes to ensure maximum security but when it comes to referral workflow there are no standard procedures nor any secure technology to ensure information safety.

Gigabytes of patient records are compromised each year because providers do not have processes, the required technology or is unaware of HIPAA regulations. Here is how not to share patient information during referral.

Email Is Not What You Think It Is:

Many providers rely on emails to send and receive patient information instantly. Emails are easy and a lot faster than faxes but the problem with emails is that the files sent through with emails are generally un-encrypted when transmitted or when saved leaving patient information sensitive to theft. Using emails to share patient-related data is against HIPAA compliant and according to HIPAA, the provider is held responsible for any breach.

Beware Of Faxes:

Faxes are the most common format to send and receive patient information between practices. Regular faxes are affected by the problem of encryption; since these files are not encrypted, this information could be accessed by an individual with access to phone lines and basic knowledge of the system. Faxes are slow and time-consuming and do not support all type of file formats. Received faxes are usually kept in the machine for some time exposing patient information to unauthorized people. Faxes leave a paper trail of patient information which will practically result in making EMR/EHR systems useless.

Triplicate Form:

Although triplicate forms sound straightforward, practically triplicate forms transfer the process of referring a patient from provider to patient or patient’s skin. The patient is left with the challenge of coordinating between physician offices – calling referral coordinators, faxing files to specialists’ office. Often a patient will have to request an appointment with multiple specialists which means sending sensitive patient information to specialists office who may not be taking care of the patient at all.

Sharing patient information is crucial in the medical referral process, but the systems that the healthcare providers use are incompetent to do a fast transfer of patient file and transfer it securely to authorized providers.
Hospitals need to establish clear-cut procedures in case of sharing patient information. Such a procedure should be able to track the flow of patient data and establish standard norms and practices to minimize the possibilities of compromising data.