Healthcare data problem and why better referral management is the solution

Data collection is not the main hurdle behind big data issues in healthcare and how it hampers the referral process. In this article, Curtis Gattis, CEO and co-founder of LeadingReach, explores the problems inherent in the current orientation process of the American medical system and how to improve it.

It’s no secret that healthcare has a huge data problem. Many point the finger at data collection, but that’s just not the case. With over 500 electronic health record (HER) systems to choose from and hospitals using an average of 16 distinct EHR platforms across their entire network, 1 or a combination of multiple EHRs should tick the boxes necessary to data collection. However, collectively, we have failed to identify and address what EHRs are missing, what they are not designed to do, and the real crux of the healthcare data problem: data sharing.

Treasures of data and communications that could be used to move patients through their healthcare journey faster and more efficiently are currently locked in EHR silos. If we’re serious about solving the healthcare data problem, it’s time to embrace a new way of using data and technology to solve problems by embracing solutions that help connect these data silos. Leveraging the right data at the right time provides the necessary context organizations and providers need to improve overall patient outcomes and the time it takes for patients to receive quality care.

Data gaps and treatment of referrals

The medical referral process has long been a thorn in the side of primary care providers (PCPs) and specialists. The problems stem from poor, if any, communication between care coordination teams via outdated fax technology that results in inadequate referral tracking – a lack of connectivity and usable data. In contrast, the shift from paper-based to digital processes has revolutionized communication and data sharing in the business world. Digital documents are easier to manage and harder to lose. In offices where the transition has not taken place, the typical office worker spends around 30-40% of their day searching for printed materials.

In today’s world, an important pillar of an effective healthcare ecosystem is digital connection. It improves communication and coordination of care across a network, the ability to help all clinicians understand a patient’s unique care plan, and helps patients navigate to the next appropriate care facility. The researchers note that up to 50% of referring physicians do not know if their patients have been seen by the specialist to whom they were referred. This gap in visibility of care among referring physicians poses a particularly critical challenge to GPs in a value-based care system, as they are tasked with being an advocate for patient health and longevity.

Miscommunication is the root of the problem in the traditional referral system. An analysis of referral process studies and literature found that up to 45% of referrals resulted in no communication from the specialist to the referring provider. Additionally, about a quarter of US patients reported that results and records from one provider did not reach another provider in time for their appointment. Additionally, poor referral tracking leads to a host of problems, including delays in care, low patient satisfaction, and malpractice lawsuits. Ultimately, this lack of coordination in modern care means countless patients fall through the cracks every day.

Understandably, physicians expressed frustration with the inadequacies of the referral system. In a recent survey of physician attitudes at a tertiary care academic medical center, 63% of PCP respondents and 35% of specialists said they were dissatisfied with the managed care referral system. They also identified the lack of communication between them as the main pain point in the SEO process. Half of PCPs were dissatisfied with the timeliness of feedback from specialists, and 48% of specialists were dissatisfied with the timeliness of information from PCPs. Additionally, 68% of specialists said they did not receive information prior to the baseline visit and PCPs said they only received specialist follow-ups within 7 days of the visit 36% of the time. . Four weeks after the baseline visit, 25% of PCPs had still not received appropriate information from specialists.

The low conversion rates of referrals actually scheduled as appointments are an obvious result of this malfunction. A study of a large primary care network analyzed more than 100,000 referral scheduling attempts over the course of a year and found that less than 35% resulted in documented full appointments.

What is the solution to patients who get lost in the system?

For value-based healthcare organizations, data is the most essential currency to flow between patients, PCPs and specialists. Without data, organizations lose patients and revenue on a damaging macro scale, and on an individual level, patients are not connected to critical care in a timely manner, become frustrated with the system, often give up before even getting the answers they need, and ultimately suffer poorer health outcomes. A clear example of this can be found when high-risk patients are discharged from hospital and require additional follow-up care. If not immediately contacted and scheduled for this all-important referral – an action that often fails alarmingly – high-risk patients are more likely to end up in the emergency room, leading to high costs that could have been avoided. .

With a greater share of the burden and risk of negative outcomes falling on providers, health systems need to find better ways to manage patient referrals effectively, efficiently, and in a timely manner. Technology-based solution makes referrals more convenient and accessible, enables seamless sharing of information between care teams and patients, engages all parties of care, including patients, and uses data to change behaviors and get better results.

Technology, which is unlikely to completely replace patient-provider interaction, is our greatest asset in consolidating the referral process with a platform that unites all teams involved. Technology-driven connectivity and collaboration tools enable primary care providers to guide patient care, while empowering patients to make more informed and strategic decisions about their own health and care journey. By embracing collaborative tools that empower providers, the focus is put where it should be: on patient health and positive patient healthcare journeys.

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