What does the ideal referral process look like?


Referrals between doctors is a really important part of healthcare that has an outsized impact considering how our current processes for handling them does such a poor job of meeting needs for doctors and patients alike.

Consider first that the majority of referrals are fax-based. This means that 21% get lost to the detriment of patient care and worry for admins and doctors alike. Additionally, faxes go out as flat pdfs with information distributed among siloed and incompatible EMR environments – this means that you can’t do anything meaningful with aggregate data and must copy over patient data through manual data entry. We then leave it to family doctor’s offices for the most part, to contact patients and tell them about their appointments by phone. All told, it costs doctors millions of dollars in direct overhead. And additionally, how about those no-shows? A referral system that produces less no-shows could prevent a significant loss of revenue for specialists. There must be a better way.

The following are key aims for the ideal referral system.

  1. It should be reliable, safe and secure: This means that referrals do not get lost. That patient privacy is respected. That patient information be electronically protected.
  2. It should give family doctors the choice of where to refer: This respects that family doctor’s continuity and knowledge of the patient and their experience with the specialist. Siloing specialists by parallel electronic or form-based referral systems goes against this principle.
  3. It should catalogue specialists by the conditions they see and do not see: It should be easy to find the right specialist for the right patient, and avoid wasting time sending referrals for conditions that are outside that doctor’s scope.
  4. It should capture wait times and other key data: Tracking wait times, response times (time from request to assigning a time) and rejection rate could make an impact by providing them at the time a referral is made, thereby improving access metrics across the board.
  5. It should centralize information-gathering: Changes to the specialist landscape happen continuously, and once central monitor enables an efficient way to update all stakeholders across the system.
  6. It should be very cost-effective for physicians offices: Doctors must foot the bill for administration and the referral system. It should require as little resources as possible, especially costly labour that could be used to enhance other aspects of patient care and support clinic, rather than administrative work.
  7. It should provide a better experience for patients: Could this current system be considered patient-centred? Consider lost referrals, calling offices, being on hold, worrying about that to do… Patients rate the status quo as 3.3 out of 5.
  8. It should address the 8% gender gap in referrals: Female specialists receive 8% less referrals than their male counterparts. Easing a return from mat leave and democratizing how specialists promote themselves are two important things for a referral system to achieve.
  9. It should promote higher quality referrals: Specialists are often frustrated by incomplete referrals, missing key lab results, a referring doctor’s billing number, or important patient demographics. A good system should eliminate this source of work and frustration.
  10. It should reduce the no-show rate: Patients that miss appointments cause delays for other patients and represent lost income to physicians. A referral system should reduce the number of appointments through better patient engagement rather than punitive measures.

These are ten principles that we keep in mind as we grow the network of physicians. We are building a referral system that meets these goals. It’s taken a lot of work to meet with dozens of clinics and understand their workflows and processes prior to and after implementation, and to hear from patients about what is important to them in the referral process. By doing this work, 15,000 referrals later, we have a good sense of what the ideal referral system looks like, improving things for everyone. Talk to us about joining our network.


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