Tag Archives: patients

Bridging The Gap Between Community Health Center & Specialists Clinics/Imaging Centers

Community Healthcare Centers and what do they do

A Community Healthcare Center (CHC) is a non-profitable, consumer-directed healthcare organization. CHC serves the underserved, underinsured and uninsured people, and provides them with access to high quality and preventive medical health care. Since 1965 Community Health Systems have provided comprehensive health and wellness support services to more than 22 million Americans, who otherwise would not have had access to quality care.

Community Healthcare Network receives funds through federal and local grants and payments from patients and insurance companies. CHCs must compete once every three years for federal grant funding and use these federal grant dollars to help patients pay for their healthcare costs.

Patient Referral Management in Community Clinics

Community 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. Community Health Centers do not have the facilities for giving specialized treatments or for taking advanced tests. So, when a patient requires any of these, the PCP refers him/her to the most suitable imaging center or specialty practice.

Community Health Systems 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 community healthcare and specialty care

A referral process may become inefficient and ineffective if the community health systems 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, he/she is referred 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 Community Health Systems and Specialist Clinics/ Imaging Centers

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.
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.
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.
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.
Any tool that can give prompt reminders on the appointments, follow-ups to both the patient and the receiving providers can help.
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.
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.

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.

3 Reasons Why A Referral Process Goes Incomplete

15 billion faxes are sent out for referrals every year and 50 percent of it never ends up in doctor visits. A referral cycle starts and ends with a general practitioner to ensure referral completion. When the loop is not closed then the referral is incomplete. Following are the reasons for incomplete referrals:

No Show

Referrals are made to provide better care for patients. It is their responsibility to meet the specialist to whom they are referred. Consider, if every 1 out of 3 patient referrals doesn’t turn up, there will be a huge loss to hospitals and to the consultant who spends their valuable time on this. In some cases, patients meet the specialist but fail to follow up with their referring physicians which makes them unable to close the referral loop they initiated. An incomplete referral means incomplete medical records.

Physicians who refer a patient to a specialist will send the detailed medical history of the patient which helps the specialist to identify the problem while diagnosing. After treatment, the specialist will send the report back to the physician and the physician will update the EMR. When this process is not completed then the patient record will not be updated. So closing the loop is an essential step because sometimes important details may be missed. If a patient wishes to see an outside provider with this incomplete record it may lead to medical errors.

Poor Physician Network

In a day, a physician makes a minimum of 10 to 20 referrals. But do you know whether your physician is making a correct referral or not? It is found that over 19 million clinically inappropriate physician referrals occur each year. The reason for a referral mistake is lack of secure and reliable communication channels between practices. Physicians should be more aware of their referral habits which will be useful in monitoring the problems in their workflow.

More than 65 percent of the physicians lack information about the specialists. Some physicians don’t even know that they have a specialist within their network and they refer their patient to outside providers resulting in losing their valuable patients which are called as referral leakage.
Relationship and networking are important in making correct referrals which helps to build trust and reduce leakage. Relationships and expertise will always help to provide excellent care.

No Improvement in Technology

Most of the hospitals still follow the paper-based method in their practice. To increase the revenue, hospitals should adapt to latest technologies. With technology, it is easy to overcome the above two problems.

Most of the follow-ups don’t happen because patients have forgotten about the scheduled meeting or they do not have time to meet the specialist. This problem can be solved by sending reminders about appointments and allowing them to fix their own appointments. Similarly, updating the specialist list will help physicians to identify the specialist availability and they can perform correct referrals.

It is not only technology and hospital processes that change time to time, but also patient’s mind changes due to external influences. Maintaining a correct patient record is important to give right treatment.
HealthviewX Referral Management Solution is an end-to-end referral workflow management platform which will keep PCPs in the referral loop and specialists can access all the necessary information they may require.

Create and Manage your Medical Referral Network Better!

Referral Management Solution helps providers to send patient referrals and to keep track of them. The purpose of the solution is to achieve a better outcome by improving communication and coordination between healthcare providers and patients.
Electronic Referrals or e-Referral enables endless patient information sharing throughout the care continuum in a secured way without violating HIPAA complaint. It also makes hospital referral process simple, manageable and reviewable at any given point.

Referral software integrates with EMR and will soon eliminate paperwork and documentation. A study suggests that paperless referrals have increased the follow-up rates up to 30-40%.
The Healthcare process workflow is considered to be one of the most challenging environments with regards to the complexity and security involved, Referral Solution helps to extemporize the hospital’s process flow and enables quick referrals.

The followings are the features of Referral Solution:

1. Better Access

The focus of Referral software is to improve the doctor-patient communication to provide better care and to improve health outcome. Physicians can send seamless referrals within or outside the network and the patients can communicate to their specialist anytime. This endless access helps patients to engage better in self-care.

2. Manage Referrals

Referral Solution helps to send right information to the right person at the right time. It also helps the provider to manage the workflow of information back and forth. PCP who usually initiates the referral can view the referral history and can track and drill down to check the status in detail for any number of referrals initiated from their facility.

3. E-Consultation

E-consultation reduces unnecessary face-to-face hospital visits. The well -designed Referral Solution makes it easy for patients and caregivers to exchange messages and medical diagnostic attachments like X-rays, screening images, and clinical notes with the specialists. A specialist or PCP can instantly get connected to their patient for e-consultation either via texts, calls, or video calls.

4. Reminders and Alerts Notification

Both physicians and patients get reminders about their upcoming scheduled meetings. The solution will allow you to manage all these alerts. Automated alerts are also sent to keep physicians informed if they miss any alerts or in case of emergency.

5. Schedule Appointments

The physician can quickly fix appointments with their patients if they are under risk conditions. Scheduled appointments can be managed online through portals in case if they want to postpone or cancel the meeting after seeing improvements in patient’s health condition.

6. Post Feedback and Loop Closure

Feedback along with all treatment details will be sent back to the referred PCP from the specialist for EMR update. Once the patient record is updated PCP will close the referral loop.
Some hospitals find reducing referral leakage and readmissions after implementing Referral Management Solution at their practice.

7. Referral Leakage

Medical records are highly confidential and it requires a safe and secure transfer. Also, the probability of leakage of data is high when PCP is looking at multiple cases on a given day.

In order to avoid leakage, providers need to update the physician’s directory list frequently.
This problem can be solved by encrypting the file with a password. People who have credentials are the only ones who will be able to access, view and share the patient record.

HealthViewX Referral Management Solution helps to send referrals secure and seamlessly, provide quick access to patient data, send notifications and alerts, and share information throughout to ensure closure of referral loop.