By Dr. Andrew Albert, CMO

Almost 20,000,000 times a year, patients are sent to their provider and found to be in the wrong place. This essentially means that the provider they are seeing is not the correct provider for their ailment. Ultimately this can lead to poor health outcomes, ineffective use of time and exorbitant patient and health care cost.  Seventy-five percent of specialists receive one to two clinically inappropriate referrals every month.  Overall, 7.8% of referrals are clinically inappropriate and 87% of physicians believe this happens on a routine basis.  There is nothing they can do about it.  The system is broken.

Imagine a clinic schedule of 30 patients a day.  The ability for a clinic to troubleshoot each and every referral that comes through the door is an arduous process. Imagine the awkward encounter in the exam room: The specialist: “Mr. Jones, how can I help you?”  The patient: “Ummm, my doctor sent me.” When this happens, the specialist’s office frantically calls the referring primary care physicians office to find out the reason for the visit.  Most of the time, getting through to the office  to obtain clinical information in a timely manner is almost impossible.   A message is left at the referring primary care office and panic ensues.  The specialist’s office spends a significant amount of time trying to determine the extent of the referral patient’s illness as well as the rationale for the referral.

“My doctor sent me” is all you have as a clinician. These patients are often without symptoms. Herein lie two problems: (i) the patient is potentially in the wrong office and (ii) the reason for the referral can extrapolate to any ailment. Both parties look at one another expecting to better understand the issue at hand.  After a thorough history and physical of the patient, the patient leaves with scripts in hand; scripts for tests she likely don’t need 75% of the time. Imagine the patient’s surprise when she finds out she was sent to the wrong physician and underwent tests she didn’t need. If only the communication could have been better.

Referrals can be wasteful. Proactive doctors’ offices will ask patients why they’re coming in. Unfortunately not all doctor have the staff time to dedicate to this process. Administrators are buried in paperwork at baseline.

As a clinician I do my best to avoid wasteful referrals. Ultimately an erroneous referral leads to significant waste in the healthcare system. This leads to unnecessary expense for the insurance company and hospital system. The doctor’s job is to determine if something is terribly wrong. Therefore a referral is not as simple as the patient showing up the wrong physician; doctor and patient shrugging their shoulders and the patient leaving. There are tremendous legal ramifications. If something is truly wrong, i.e. a concerning EKG result or arrhythmia, the physician is responsible.

A streamlined process is absolutely necessary. A process that facilitates the handoff from one doctor’s office to the other, with the appropriate clinical information. If the referring physician is truly dedicated, the clinical information must be conveyed in a seamless fashion. Fibroblast offers a comprehensive and efficient system to facilitate an appropriate and safe referral.

It is important to consider a setting of multiple referrals.  A primary care doctor can evaluate a diabetic patient and generate up to three or four referrals for that patient. Often times the diabetic will need to see a nutritionist, a cardiologist, an endocrinologist, an ophthalmologist and a podiatrist. How can we minimize errors and facilitate a safe “hand off?” Who is going to oversee this process?

If the referral process is broken and unnecessary referrals are made to the wrong physicians in the setting of a system where referrals are necessary to improve health outcomes, a very thoughtful and careful system needs to be in place. EMR’s are not dedicated to this process. There is a high level of complexity to an EMR and if we are going to fix the referral process, the technology needs to match the need. Fibroblast can reconcile these disparities in a careful, easy and efficient manner.

Ultimately, when a patient states that his or her doctor sent them, the appropriate information will be at hand and hospitals and healthcare systems can ensure patient safety and provide better care for their community.

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