Tag Archives: referrals

Pros and Cons of Patient Referral Management Software: All you need to know

Advantages of HealthViewX patient referral management software

Inbound and Outbound Patient 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 the 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 and notify the progress of the referral to all the stakeholders. A referral will be mapped to a status which helps in tracking it better. With this, the providers can always be aware of how the referral is progressing.
Workflow and Task Management – A workflow can be defined on how the referral flow must be(business rules – who sends it, to whom, what data must be included). 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 – HealthViewX is HIPAA compliant and enables secure data exchange of all patient-related documents.
Seamless Integration – Minimal disruption in the existing referral flow by integrating with any EMR/EHR/RIS or Third Party application.
Referral History 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 a complete view of incoming and outgoing referral pipeline, referral volume, referral status, patient follow-ups, etc.
Insurance Pre-authorization – HealthViewX supports automated insurance pre-authorization that reduces the manual work of the referral coordinators and saves 10 minutes of manual work per patient.
Intelligent Provider Match – The solution supports an “Intelligent Provider Match” Feature that helps in finding the right specialist/imaging center easily based on the diagnosis, relevance, location, distance, patient preference.
Seamless communication – HealthViewX solution has an inbuilt audio calling and messaging application which is secure and enables faster communication
HIPAA compliant data security – HealthViewX is HIPAA compliant and offers secure data exchange. It supports almost all formats of files and keeps the patient documents safe.
Referral loop closure – Referral updates are hard to miss making it easier for timely referral loop closure.

Disadvantages of patient referral management software and the hindrance to its usage

Capital investment: Depending on the number of referrals processed and the size of the referral network, healthcare organizations are billed quarterly or annually. This is an additional recurring expense.
Misunderstanding that ‘EMRs are enough’. With EMR implementation being widespread across the USA, its acceptability is increasing. Most health care organizations that have gone through the process of evaluating, comparing different EMR/EHR management systems, choosing, implementing and training their staff on its usage are wary of repeating the process. They definitely see benefits from using EHR systems and feel the satisfaction of process improvement more than the urge to improve further.
Mindset – Psychologically organizations are more open to EMR EHR implementation than patient referral software and often compare the two rather than evaluate wholesome benefits.

HealthViewX Patient Referral Management solution smoothens the referral process and solves most of the inbound and outbound referral challenges for Large Enterprise Hospitals. Do you want to know more about HealthViewX HIPAA compliant Patient Referral Management solution? Schedule a demo with us.

Common challenges of manual patient referral management in 2019

Documentation – During the referral process, referring physicians tend to miss out valuable patient information. Many times vital symptoms and findings from initial tests are often not sent with the referral order, leading to health complications that could have otherwise been avoided.
Leadership disconnects – The leadership team should know which doctors are referring patients to specialists. Well-connected team structure enables educational conversation between leadership and care providers regarding overutilization, referrals to high-cost specialists, or the importance of sending all necessary documentation with every referral.
Lack of coordination among caregivers – Did you know? Lack of coordination among caregivers are endemic and contribute to an estimated 44,000 to 98,000 deaths from medical errors each year.
Follow-ups – Many primary care practices do not follow-up after they’ve referred a patient to a specialist. They vest the responsibility of scheduling a specialist visit with the patient. According to the Archives of Internal Medicine, this process does not happen in 50-60% of referrals that are made, putting patients at risk.
Delays – The patient faces extended delays between the time the referral is sent and the time at which the actual appointment is made. As mentioned previously, delays and frustrations with the scheduling process can cause patients to avoid making an appointment, or they may ultimately cancel an existing appointment if the wait is too long.
High-cost referrals – Primary care practices that refer patients to high-cost providers are harming their own practice and their patients. Exorbitant price tags affect reimbursement for PCPs and scare patients away from the idea of seeing a specialist, despite their medical conditions.

Challenges Specific to Patient Referral Workflow in Large Enterprise Hospitals

Handling multiple EMR/EHRs – Large Enterprise Hospitals and Health Systems that are formed as part of mergers and/or acquisitions tend to handle multiple EMRs. EMR interoperability is their greatest challenge.
Finding the right specialist – A Large Enterprise Hospital has a huge number of specialists. PCPs are not aware of specialists who were newly added or who came within their network as a result of mergers or acquisitions. So many times PCPs tend to refer their patients out of their network in spite of having the right provider within the network.
Patient no-show rates – When patients miss/forget or do not show up for appointments, it results in revenue loss for the hospital. Patients miss appointments due to various reasons like no reminders, waiting time, a better specialist within the locality, reputation of the receiving provider, etc.
Referral leakage – Did you know? Referral leakage for any health system can average anywhere from 55-65%! Patient leakage or referral leakage occurs more in an out-of-network referral than in an in-network referral. There could be many factors such as the reputation of a provider, lack of knowledge or insight and patient’s choice that lead to patient leakage.
Patient dissatisfaction – Large enterprise hospitals should keep track of the number of patients moving out of their network. An alarming 25 to 50% of referring physicians do not know whether their patients see the specialist! Patients become dissatisfied with the treatment when specialists or PCPs do not follow-up with them regularly.
Referral Analytics – As a large number of referrals flow in and out of the network, it is difficult to track the exact number. It is also tedious to track the number of referrals in various status and to close referral loops.

Solutions for optimal patient referral management in 2019

HealthViewX introduces a collaborative design that connects primary care providers with specialists on a single and uniform network.
Electronically-connected specialists form a network of care collaboration, where both parties are responsible for the timely care of their mutual patients.
Secure electronic notifications provide quick and reliable information between PCP and specialist.
PCPs now have an enhanced ability to track referrals.
Electronic Referral Management has decreased wait times for face-to-face specialty clinic visits.
With Electronic Referral Management system, each step in the workflow prompts easy follow-ups and automatically closes the loop on all referrals
End-to-End referral lifecycle management with bidirectional EMR/EHR Integration HealthViewX platform supports dynamic forms, workflows, task lists, reports, data visualization and has great integration capabilities. It can automatically pull referral orders from EMR/EHR in real-time. It also helps in configuring all other referral coordinator workflows and tasks with maximum automation.
Multi-channel referral consolidation that brings all the referrals from multiple sources like email/phone/fax/notes into a single queue.
Detailed referral information through which the Specialist receives all the necessary referral details.
Automated Specialist / Patient Notification & Reminders with Customizable templates and configurable channels of communication
Payer-specific prior authorization process automation – HealthViewX platform has a payer management module that maintains and manages

different payer details
their modes of prior authorization
direct authorization procedures
payer forms
online portal links

HealthViewX Patient Referral Management solution smooths the referral process and solves most of the inbound and outbound referral challenges for Large Enterprise Hospitals. Do you want to know more about HealthViewX HIPAA-compliant Patient Referral Management solution? Schedule a demo with us.

How Can An Effective Electronic Referral Management System Improve Care Coordination?

In a traditional referral management set up, there is a huge communication gap between primary care providers and specialists while giving care to their patients. It leads to,

Clinical operational inefficiency
Poor care coordination
Broken referral loops

The relationships between PCPs and specialty care providers must evolve and improve to enhance care coordination. In order to do that healthcare organizations must adopt the advanced medical technologies. However, in the recent decades, the healthcare industry has been slow in adopting new technologies.

General Care Coordination mistakes made by medical practices

Did you know? According to the News & World report, medical errors are the third leading cause of death in the U.S. 10% of U.S deaths are due to preventable medical mistakes!

The following care coordination mistakes by medical practices affect patient experience and optimal care the most,

Documentation – During the referral process, referring physicians tend to miss out valuable patient information. Many times vital symptoms and findings from initial tests are often not sent with the referral order, leading to health complications that could have otherwise been avoided.
Leadership disconnects – The leadership team should know which doctors are referring patients to specialists. Well connected team structure enables educational conversation between leadership and care providers regarding over utilization, referrals to high cost specialists, or the importance of sending all necessary documentation with every referral.
Lack of coordination among caregivers – Did you know? Lack of coordination among caregivers are endemic and contribute to an estimated 44,000 to 98,000 deaths from medical errors each year.
Follow-ups – Many primary care practices do not follow-up after they’ve referred a patient to a specialist. They vest the responsibility of scheduling a specialist visit with the patient. According to the Archives of Internal Medicine, this process does not happen in 50-60% of referrals that are made, putting patients at risk.
Delays – The patient faces extended delays between the time the referral is sent and the time at which the actual appointment is made. As mentioned previously, delays and frustrations with the scheduling process can cause patients to avoid making an appointment, or they may ultimately cancel an existing appointment if the wait is too long.
High-cost referrals – Primary care practices that refer patients to high-cost providers are harming their own practice and their patients. Exorbitant price tags affect reimbursement for PCPs and scare patients away from the idea of seeing a specialist, despite their medical conditions.

How can an effective Electronic Referral Management System improve care coordination?

Value-based care is taking the center stage in the healthcare industry. It is high time that primary care providers and specialists find ways to eliminate communication deficiencies and create a bridge for communication. It will ensure a more well-rounded and positive patient experience.

This is when an electronic referral management system comes to play. An electronic referral management platform improves care coordination workflows in the following ways,

Introduces a collaborative design that connects primary care providers with specialists on a single and uniform network.
Electronically-connected specialists form network of care collaboration, where both parties are responsible for the timely care of their mutual patients.
Referral management technology allows primary care providers to ensure quality and optimize their practices’ reimbursements by exceeding patients’ expectations
Secure electronic notifications provide quick and reliable information between PCP and specialist.
PCPs now have an enhanced ability to track referrals.
Electronic Referral Management has decreased wait times for face-to-face specialty clinic visits.
With Electronic Referral Management system, each step in the workflow prompts easy follow-ups and automatically closes the loop on all referrals

Technology has made amazing achievements in the healthcare industry. From treatments to artificial organs, recent changes in innovations have performed incredible feats. Care coordination, however, has just arrived at its technological infancy.

Soon, primary care providers and specialists across multiple practices within a region will be integrated under one care coordination system that will seamlessly

connect providers
enhance the patient experience by closing communication gaps
fill in the entire picture of a patient’s journey across the continuum of care

Are you interested in learning more about how automated care coordination work-flows can improve referral management? Schedule a demo with us!

Reference

https://khn.org/news/coordination-of-care/

Three Best Practices For Large Hospitals To Improve Patient Experience Through Optimal Referral Management

It is crucial for large hospitals to build a high performing referral network as they serve a huge community by providing them services in primary care and a variety of specializations. Large organizations spend months or even years building a referral management solution for their network which appears to have the right components on paper, but the patient referral volume continues to decline.

Usually, the problem with such Large Hospitals is that they overlook small but impact operational issues that are necessary to retain patients within their network. Making just a few changes to the existing referral strategy can have a huge impact on

Retaining more number of patients within the network
The quality of care given to their patients

Here are the 3 best practice solutions that can create a high impact in improving the existing referral management process in Large Hospitals.

1. Putting the patient first to build loyalty

The primary step to retain patients within the network is to accommodate their preferences. It is important for the health system to consider patient’s preferences before initiating a referral. Most patients prefer to choose the receiving provider based on a number of convenience factors like insurance, language, availability and distance. When a patient is paired with the receiving provider who best matches his/her preferences, it is more likely for the patient to visit the provider. Also, when the patient’s experience with the referral is good, it is more likely for the patient to stay within the network.

HealthViewX Patient Referral Management Software takes care of updating your provider database with details of specialists newly added to the network. The “Intelligent Provider Match” feature allows physicians to filter and search providers based on patient’s convenience factors like operating hours, location, language, insurance, distance etc.

2. Supporting EMR/EHR Interoperability to improve care coordination

A patient may need to see a specialist in a different facility within the same hospital. In most cases, the EMRs will be different. EMR Interoperability will allow facilities to share the patient’s records in real time without compromising patient security or privacy. Providers, patients and insurers all benefit from increased access to the patient’s medical information.

Also, interoperability is an essential part of the Government’s Meaningful Use Stage 2 requirements. Meaningful Use Stage 2 will affect Medicare payouts for health care providers in stages, eventually leading to reduced payouts to all providers that take Medicare and do not follow the guidelines.

Seamless functioning between EMRs like Epic, Cerner, Athena Health, Greenway Health, Allscripts, Nextgen, etc is important. HealthViewX Patient Referral Management Software acts as a bridge and enables seamless communication of data between the referring and receiving ends.

3. Tracking referral data to know where to make changes in the referral network

Tracking referral data is often the most underestimated and impactful component of a high-performing network. By having real-time visibility of the complete referral ecosystem, health systems can gain actionable insights on how to take meaningful decisions on referral process, provider relationships, etc. Large Hospitals should be able to track referrals in various status, referral loop closures, percentage of referrals flowing in and out of network, referrals sent to different specialities, insurance provider, etc.

HealthViewX Patient Referral Management has a customizable referral-centric dashboard that helps in tracking the number of referrals and gives complete information about the referrals processed, missed, scheduled etc. It can also be customized for different locations based on the priority of the large hospital.

HealthViewX Patient Referral Management solution smooths the referral process and solves most operational challenges for Large Health Systems. Do you want to know more about HealthViewX HIPAA-compliant Patient Referral Management solution? Schedule a demo with us.

HealthViewX Blogs rated in Top 100 Healthcare Blogs

How Can Large Enterprise Hospitals Tackle Operational Problems Effectively?

Did you know? There are about 8000+ large enterprise hospitals in U.S. How is a hospital classified as a large enterprise hospital?

Hospitals which have typically 500 or more beds are categorized as Large Enterprise Hospitals. They are capable of serving the whole population in the community by offering them wide range of services related to primary care and specialties. Some larger hospitals offer a combination of acute and long-term care services while also providing research opportunities in some cases and accommodating a variety of specializations.

Operational challenges faced by Large Enterprise Hospitals

Considering the huge number of patients in such hospitals, the patient referral volume is also high. In order to improve patient satisfaction and retain patients within their network, a large enterprise hospital must have a seamless referral process. Below are the most common operational challenges that affect the patient referral workflow in large enterprise hospitals.

Handling multiple EMR/EHRs – Large Enterprise Hospitals and Health Systems that are formed as part of mergers and/or acquisitions tend to handle multiple EMRs. They spend millions of dollars having to migrate from one EMR/EHR to another. It is also possible that if one EHR faces a down time, the entire patient referral workflow is affected. Data security in communication between multiple platforms is crucial to protect patient interests. In a merger or acquisition, patient experience must never be compromised despite the backend operational challenges that may occur. Seamless functioning between EMRs like Cerner, Athena Health, Greenway Health, Allscripts, Nextgen, etc is important.
Training their staff – Staff in each division in the hospital might be comfortable with using a different EMR system. The user interface and familiarity affects speed of operations. The health system has to train and migrate all staff to a single EMR which costs millions of dollars and time to get the staff up-to-speed.
Patient no-show rates – When patients miss/forget or do not show up for appointments, it results in revenue loss for the hospital. Patients miss appointments due to various reasons like no reminders, waiting time, better specialist within the locality, reputation of the receiving provider, etc.
Referral leakage – Did you know? Referral leakage for large health system can average anywhere from 55-65%! Patient leakage or referral leakage occurs more in an out-of-network referral than in an in-network referral. Enterprise hospitals use different systems to track out-of-network and in-network referrals. There could be many factors like reputation of provider, lack of knowledge or insight and patient’s choice that lead to patient leakage.
Patient dissatisfaction – Large enterprise hospitals should keep in track of the number of patients moving out of their network. An alarming 25 to 50% of referring physicians do not know whether their patients see the specialist! Patients become dissatisfied with the treatment when specialists or PCPs do not follow-up with them regularly.
Referral Analytics – As a large number of referrals flow in and out of the network, it is difficult to track the exact number. It is also tedious to track the number of referrals in various status, referral loop closures, percentage of referrals flowing in and out of network, referrals sent to different specialities, insurance provider, etc.

HealthViewX Patient Referral Management Features for Large Enterprise Hospitals

In order to solve the operational challenges faced by large enterprise hospital, the process has to be improvised. This can be done with web-based referral management which will optimize patient satisfaction and care.

HealthViewX has completely analyzed the workflow of large enterprise hospitals. We have implemented the following features for many of our enterprise hospital clients thus improving their operational efficiency

Multi-channel referral consolidation – The HealthViewX solution can capture fax, phone, email, online form referrals or any other referrals in a single interface. It makes it easy to monitor and manage all channels of referrals in a single queue.
Insurance pre-authorization process – HealthViewX automates the insurance pre-authorization process. The provider need not coordinate with the insurance company for prior authorization. The HealthViewX solution will do it for them. This reduces the manual effort of the referral coordinators.
Patient coordination framework – After finding the receiving provider, the referral coordinator refers the patient. When the receiving provider receives the referral, the provider will get notified of the referral. Even the patient will be notified of the referral. The receiving provider can schedule appointments based on the patient’s comfort. This will cut down patient no-show rates.
Timeline View to track referrals – With the help of a referral status, the referring provider can get to know what stage the referral is. A timeline view shows a history of stages through which the referral has progressed. The chances of a referring provider missing out on referral updates are very less.
Referral closure and feedback – The referring provider can close the referral when it gets completed. The receiving provider and the patient can give a feedback on the referral process to the referring provider. Thus the referring provider can make it easy for the other the next time.
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. It can also be customized for different locations based on the priority of the enterprise hospital.

HealthViewX Patient Referral Management solution smooths the referral process and solves most operational challenges for Large Enterprise Hospitals. Do you want to know more about HealthViewX HIPAA-compliant Patient Referral Management solution? Schedule a demo with us.

Reference

https://www.beckershospitalreview.com/lists/50-largest-hospitals-in-america.html

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

https://www.beckershospitalreview.com/lists/52-great-health-systems-to-know-2018.html

How Can Large Enterprise Hospitals Achieve Seamless EMR Interoperability And Operational Efficiency?

What are Large Enterprise Hospitals?

Hospitals which have typically 500 or more beds are categorized as Large Enterprise Hospitals. They are capable of serving the broader needs of the community. Some larger hospitals offer a combination of acute and long-term care services while also providing research opportunities in some cases and accommodating a variety of specializations.

What is EMR Interoperability?

Large Enterprise Hospitals which are mergers or acquisitions tend to handle multiple EMRs. In such cases, facilities within the hospital will have to share patient information with each other. EMR Interoperability is the ability to effectively communicate health information electronically between different EMRs. There are essentially 2 fundamental components, ability to,

Securely transport the data
Interpret and use that data

Why is EMR Interoperability important for Large Enterprise Hospitals?

Providers’ benefit – Providers within the large enterprise hospital will have easy access to patient records because of EMR interoperability. While referring patients, the referring provider can avoid hassles faced in sharing patient information. It will make the referral workflow a lot easier.
Patient Benefits – EMR interoperability allows patients’ medical records to follow them throughout the healthcare system. Patients benefit from
- Increased access to their medical records
- Faster communication
- Better quality of care

Speedy transfer of information has a real impact on the patient’s health, as many conditions require immediate intervention to save the patient’s life or minimize long-term effects on their health.

Cost Benefits – There is debate about how much EMR adoption and EHR interoperability will reduce the cost of healthcare. Some studies point to a reduction of upto $100billion/year. The primary cost savings result from reducing
- Malpractice lawsuits
- Hospital stays
- Patient visits
- Redundant or inapplicable testing
- Unnecessary procedures

In the past, healthcare providers viewed patient data as their property, unable or unwilling to share data with other providers outside their organizations. Today these barriers are coming down with benefits of all parties involved.

Major challenges faced in achieving EMR interoperability

The following are the challenges faced by healthcare stakeholders that prevent them from achieving true interoperability for optimal care delivery and improved patient health outcomes.

1. Lack of a strategic approach to identify patients – There is no way to consistently identify a patient across multiple EMR systems. Patients give their name, date of birth, and other identifying data. As different EMR systems store this information in different ways, the data is prone to errors. There is a push towards having a unique patient identifier. This code could be used to categorically identify the same individual no matter in what EMR system the data is. Unfortunately, there is a long way to go before getting this functionality in place.
2. No standardized way to measure and analyze the impact of EMR interoperability – It is difficult to quantify the cost, error rate and other issues caused due to the lack of interoperability. When there is no room for measurement, then there is no way of improving the process. Once providers can measure issues across the end-to-end healthcare supply chain, they can analyze problem areas, make improvements, and monitor how those changes are improving the quality of care and patient outcomes.
3. Vendors Blocking Information or Charging Fees for Interoperability – Some EHR and healthcare system vendors are holding patient data for ransom. They charge fees for transmitting data outside the system, increasing operational costs and making providers less likely to send data to others in the healthcare supply chain. The government is acting to encourage interoperability, but not all vendors have taken this on board.

HealthViewX Patient Referral Management Features for Large Enterprise Hospitals

Multi-channel referral consolidation – The HealthViewX solution can capture fax, phone, email, online form referrals or any other referrals in a single interface. It makes it easy to monitor and manage all channels of referrals in a single queue.
Intelligent Provider Match – The HealthViewX “Smart Search” feature makes it easy for the referring provider in finding the right provider. It has smart filters and search options that help in narrowing down the specialist based on the requirements. This saves a lot of time for the referring provider.
Insurance pre-authorization process – HealthViewX automates the insurance pre-authorization process. The provider need not coordinate with the insurance company for prior authorization. The HealthViewX solution will do it for them. This reduces the manual effort of the referral coordinators.
Patient coordination framework – After finding the receiving provider, the referral coordinator refers the patient. When the receiving provider receives the referral, the provider will get notified of the referral. Even the patient will be notified of the referral. The receiving provider can schedule appointments based on the patient’s comfort. This will cut down patient no-show rates.
Timeline View to track referrals – With the help of a referral status, the referring provider can get to know what stage the referral is. A timeline view shows a history of stages through which the referral has progressed. The chances of a referring provider missing out on referral updates are very less.
Referral closure and feedback – The referring provider can close the referral when it gets completed. The receiving provider and the patient can give a feedback on the referral process to the referring provider. Thus the referring provider can make it easy for the other the next time.
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.

Are you a large enterprise hospital looking to solve EMR interoperability challenges? HealthViewX Patient Referral Management Software and seamlessly integrate with your existing EMR. Schedule a demo with us to know how we solve EMR interoperability issues!