The referral process is an important aspect of quality care, and it has become increasingly unreliable in the current provider-centric healthcare system. A referral occurs when patient care is transitioned from one healthcare provider to another for review or further action by a specialist or program. For patients, caregivers and providers, many gaps in the referral process exist, and these gaps can have a dramatic effect on the patient outcomes.
Challenges with referrals are common because of barriers in communication, difficulties with triage, assessment and routing of referrals, lack of collaboration and information sharing with other providers, and limited provider awareness and access to available services. These challenges pose a risk to a patient’s effective continuity of care, often resulting in delayed diagnoses, prolonged wait times, and limited clinical data for informed decision-making.
As the healthcare system moves towards a more patient-centric model, providers will need to develop support processes and technology that improve access and coordination of services; connecting and coordinating patients, primary care providers and specialists.
- Improve communication: Bridging the gaps in communication between the patient, primary care physician and specialist by opening effective channels of communication between each area of care. Developing a process that increases coordination, communication, and information sharing in an effective way will improve the appropriateness of referrals being sent, while including and informing the patient as part of the process.
- Patient empowerment: Putting more control into the hands of patients and empowering them with the tools to be a key part of their referral process through increased visibility into their referrals and control over their care.
- Equity: The referral process as it is today is not consistent or equitable. Ideally, the factors affecting the choice of a specialist by primary care providers should consider medical skill, appointment timeliness, quality of communication, etc. In practice, primary care providers may refer to a specialist or program due to existing relationships, convenience, and lack of awareness and availability of services. An effective approach to finding the most appropriate specialist who is available when needed is the sending of referrals to a central intake program. Central intake programs are typically experienced resources who review the referral request, assess the patient’s level of urgency, and helps the system more evenly distribute referrals among specialists.
Leveraging and developing technology to increase appropriateness, provide secure communication, automate processes, and ensure data is available throughout the referral process is vital to improving the system for everyone, and developing solutions that enhance communication, involve the patient and are equitable is paramount.