The 6 Must-Have Qualities of a Patient Referral Management System

Nalaka Withanage Healthcare Digital Transformation

Hospitals with specialist clinics today are challenged to manage the lifecycle of referrals in an effective and efficient manner. This results in longer patient waiting times, Underutilisation of provider organisation resources and assets creating operational inefficiencies and lost revenue. Hospital revenue is determined through the portion of patient referrals who have completed their appointments. Missed appointment slots that remain unfulfilled create missed revenue. Managing referrals through a standardised process helps health services to reduce clinical errors and better utilisation of specialists and resources. Here are the top 6 Must-Have Qualities of Patient referral Management System for Hospitals with Specialist clinics.

1. Multi-channel referral consolidation

Patients are referred to specialist clinics by GPs, specialists and other community-based healthcare providers, as well as clinicians in emergency departments, inpatient units and other areas of the hospital. These referrals arrive via eForm submissions, Secure messages, 1800 number or FAX. Care providers often have different processes for handling referrals that come in through different channels. This creates inconsistency. Some of the challenges I see include referrals falling through the cracks or being buried under other paperwork, human error, and a lack of overall insight into the referral process.

Referral management system can tap into existing channels and capture required actionable data from each referral document the point of origination. Upon data capture, you can apply rules around who needs to be involved, what must happen, and when no matter by what method the referral arrives.

From referrals we need to capture data important for statutory reporting such as VINAH, PCOC, HACC, CHMDS, CHSP, HCP or insurance claiming eligibility data (MBS) and assign the referral to a team.

Referral screening and is an important administrative process to ensure that referrals requiring additional information, clarification or immediate action are not unnecessarily delayed .

The referral acknowledgment conveys information to the referrer about the referral outcome (for example, acceptance or rejection) or requests additional information. Through Referral management system you can standardise the referral screening and referral acknowledgement process, including correspondence via SMS and acknowledgement letter generation.

2. Integrated Provider directory search

The NHSD provides public and private clinical information systems across the health system, enabling service providers to easily find up to date information, manage referrals and discharges. NHSD integration within patient referral management system allows providers to search and filter directory search which can help them narrow down their search; they are able to search for an individual care giver or a health care provider organisation, and filter that based on their location and speciality, among other filters.

3. EMR/EHR integration via HL7

The referral system should be able to read information from Patient Administration System (PAS), insurance plan, ICD-10, and lab results from the EMR, and send and receive documents such as continuity of care documents (CCDs). Information such as a patient’s insurance plan can be used by the referral management system to match specialist recommendations with the needs of the patient.

PAS integration such as iPM via HL7 allows real time patient data lookup without having to leave the referral management system interface.

4. Patient flow and care-coordination

After referrals are screened, they are sent for clinical prioritisation. Clinical prioritisation is a key part of the triage process in specialist clinics, in which a clinician reviews all referrals to make an initial assessment of the patient’s needs and the best service response for the patient. Clinical prioritisation aims to ensure that patients are treated equitably within clinically appropriate timeframes and that priority is given to patients with an urgent clinical need.

Care providers are challenged today with manual filing, retrieval and transfer printed FAX referrals between departments. Responding quickly to referral sources is critical, yet most referral management processes rely heavily on manual follow up which is vulnerable to human error. Opportunities fall through the cracks and revenue can be lost.

Good referral management system can be configured to drive triage and categorisation activates with an electronic workflow to meet specific service level agreements and managing waitlist in an efficient manner.

Health services often work in partnership with local primary and community providers to facilitate effective coordination of care. There is a collaboration between specialist clinics and other areas of the health service to ensure coordination of hospital services. Seamless system integration is incredibly important to driving adoption. User adoption and satisfaction drop dramatically if successful use requires multiple sign-on and manual duplication of patient and appointment information between systems.

Proper care coordination ensures that patients are discharged to community-based settings when clinically appropriate or where there is capacity for a primary or community service to provide appropriate care.

5. Patient-centric appointment scheduling

According to HIMSS Currently, only 54% of patient referrals become appointments. This means nearly half of the time, patients do not receive the care they need and destination providers do not realize the revenue they could have. Health services need effective and efficient use of staff and other resources to support timely service access and patient flow through specialist clinics.

The more important metric, therefore, is not how many referrals are received but how many are converted into appointments and what proportion of those appointments are kept and appropriately paid.

Patient Referral management system help health services are to implement patient-focused booking systems which offer patients choice of a suitable appointment time. The use of patient-focused booking for non-urgent appointments has been shown to maximise clinic capacity, control patient flow and decrease failure to attend rates. Less administrative time is spent cancelling and re-arranging appointments. As a result, health services can improve access, and equality of access, to specialist clinic services with timely and effective communication with patients and referrers at key stages of the specialist clinic pathway.

6. Reporting & referral Analytics

Hospital and health services operates under fee for service, Activity based funding and block funding modes. Health services in scope to collect the specialist clinics Minimum Data Set to report this data to the department in accordance with the specifications listed on the Health Data Standards and Systems. The collection of a Minimum Data Set for specialist clinics will be used to provide clinical, demographic and resource utilisation information necessary for service planning and coordination, and will enable the authorities to meet its state and national accountability obligations.

Health services are required to monitor their specialist clinic performance through collection and analysis of data against a range of internal KPIs and to examine barriers to service efficiency or other management issues. Standardising the referral process through a referral management system allows you to digitally capture key critical data required at every step of the workflow so that you can identify referral patterns and process bottlenecks.

Through analytics, you can identify top referring sources and strategically define them. For some organisations, it may be quantity/volume or dollar value or even by certain products and services that are higher margin. Focus on top referral sources and build a strong network guarantee a continual stream of high-quality referrals.

Integrated Referral Management capability within DC2Vue® platform provides automation and prioritisation of referral handling, mitigating the risk of human error and providing needed insight to stay in control of the referral process. This results in reducing waiting times for specialist clinic appointments, improving the management of patients’ care pathways and patient access. Optimal management of referrals offers many benefits for hospitals which include better quality of care due to more coordinated and preventive care, enhanced patient engagement and satisfaction.