Posted by Karen Grace Larsen
In November 2024, the Veterans Community Care Program came under scrutiny for exacerbating wait times instead of reducing them.
Designed to provide timely medical services to veterans, the program’s challenges with long appointment wait times, scheduling issues, and record-sharing constraints between healthcare providers have raised concerns about the timeliness of patient care.
This situation underscores a broader issue within the healthcare system:
Referral processing delays can have severe, sometimes life-threatening, consequences.
For practice leaders, understanding these referral process bottlenecks and addressing them with the right healthcare technology is crucial to ensuring that every patient receives the care they need when they need it.
The Culprits Behind Referral Processing Delays
Contrary to what many expect, the referral management process is nowhere near linear. It comprises multiple steps that branch into different phases and face various obstacles. The complex nature of referral processing can cause inefficiencies and is a massive pain point for many healthcare practices.
Without a streamlined system, referrals can get stuck in limbo and negatively impact your practice and patients. Here are a few factors that contribute to referral processing delays:
1. Existing Backlogs
Administrative bottlenecks, especially those caused by manual workflows, often lead to a pile-up of unprocessed referrals.
Without an efficient system to organize, sort, manage, and prioritize your practice’s referrals, your team could end up misplacing or overlooking them when more referrals get added to the list.
2. Inefficient Eligibility Screening
If your clinic doesn’t properly and promptly evaluate referrals before sending them to a specialist or entity, it won’t take long before unqualified referrals—cases that don’t meet the necessary criteria for approval—clog up your workflow.
This creates unnecessary back-and-forth between referring and receiving providers, wastes time and resources, increases administrative burden, and causes delayed medical referrals.
3. Insufficient Updates
When patients don’t get accurate and timely referral updates, they get frustrated and often call your clinic repeatedly to get information. This takes up much of your team’s time, energy, and resources.
Patients left in the dark about their care journey are also more likely to feel neglected by your service, and this dissatisfaction could make them consider switching to a different provider.
4. Ineffective Hand-Off Communication
Referral management also includes transitioning patients from one provider to another. Unfortunately, poor communication during this stage can result in information gaps.
To avoid redundant tests, inaccurate diagnoses, and inappropriate treatments, primary care providers must ensure that all pertinent patient information is accurately and promptly conveyed to the receiving specialist or entity.
5 Ways EHR Systems Accelerate Patient Referral Management
In the study Leveraging the Electronic Health Record to Get Value from Referrals, researchers Poku, Behkami, and Bates assert that electronic health record (EHR) systems can “drive transformational value” by giving providers much-needed referral decision support. And we agree!
If you want to maximize patient-centered outcomes at the lowest possible cost, streamlining your patient referral system is a great place to start. Here are a few ways an EHR-integrated referral management tool can help you do that:
1. Comprehensive Documentation
The primary purpose of EHR software is to provide your team with quick and easy access to patient information by securely storing and managing their digital versions. A robust EHR solution centralizes this data and ensures it’s readily accessible throughout the referral process.
IMS, for example, is an all-in-one practice management, billing, and EHR system. This unique feature enables your team to create and maintain comprehensive documentation in all areas of the practice—from patient demographics and insurance data to detailed visit notes and billing transactions.
Comprehensive documentation reduces the risk of information gaps. It ensures that whoever is at the receiving end of the patient referral has all the details they need to provide appropriate care.
2. Eligibility Screening Automation
Eligibility checks help you determine whether or not a patient meets the criteria for a specific referral. Unfortunately, manually screening for each patient’s eligibility is time-consuming and error-prone, especially when your practice handles dozens of referrals every day.
Automating eligibility checks with EHR-integrated referral management software is an excellent way to keep your referral processing accurate and efficient. IMS, for example, leverages the following features to ensure that only qualified referrals move forward in the process:
- Appointment Scrubber: IMS identifies potential problems like missing pre-authorization or insurance eligibility issues before a patient’s visit.
- Real-Time Patient Eligibility Checks: IMS ensures that every patient's insurance information is current and accurate at the point of care.
- Authorization Workflow Automation: IMS can automatically send out authorization and referral documents right after you sign off on a patient’s visit note.
3. Third-Party Integration
Seamless third-party integration can help facilitate instant verification of patient coverage, authorizations, and referrals. This reduces referral delays by automating your workflows without the need to sign into a different application.
Tried-and-tested EHR systems like IMS integrate with established healthcare networks and services to help practices enhance the overall efficiency of their referral processing. These networks include:
- Availity
- Aegis
- Labcorp
- Quest Diagnostics
- Data Dimensions
- Surescripts
- GlobalPayments
4. Real-Time Notifications
Real-time updates keep your patients and your team informed about the status of referrals. This level of workflow transparency helps reduce uncertainty, minimize the call volume in your office, and enhance patient satisfaction by keeping them engaged in their care journey.
The IMS Authorization/Referral module lets you view and manage authorization requests and referrals on one comprehensive screen. It comes with real-time alerts and notifications that your team can customize and automate depending on your practice pace and patient needs.
5. Secure Messaging System
If you have a HIPAA-compliant messaging platform integrated into your EHR, you can facilitate direct communication between referring providers, specialists, and patients without having to sign in and out of several accounts. This ability to immediately exchange information helps your team address concerns, minimize delays, and improve care coordination.
IMS Chat is an excellent example of a secure messaging platform that works hand-in-glove with an EHR system (in this case, IMS). It enables your team to have real-time and bidirectional communication with fellow clinic staff, patients, pharmacies, and other entities. Here are other ways you can leverage IMS Chat for referral processing:
- Use IMS’s reference tagging tool to easily retrieve and share patient names, ICD codes, medications, insurances, pharmacies, etc., on an encrypted channel.
- Send patient data, files, and images through an encrypted channel.
- Automatically send customized reminders to patients.
- Track practice-related SMS correspondences through detailed audit trails.
IMS: The Key to Faster, Smoother Referral Management
Our referral tracking module is robust; it allows us to make sure our patients are getting the care they need, get results back in real time, interface with a hospital, and receive results directly back into IMS.”
Rhonda Hughes
Director of Clinical Operations, Big Sandy Health Care
Referral processing delays can disrupt care, frustrate patients, and burden staff members—but they’re not insurmountable, and they shouldn’t hold your practice back.
By leveraging IMS and its in-built referral management solution, you gain a powerful system that reduces administrative burdens, improves coordination, and accelerates patient access to care.
Struggling with referral bottlenecks? With IMS, you won’t have to for long! Reach out to our EHR specialists today and discover how IMS can help move referrals seamlessly from start to finish.
