Case Study: University Hospital Department

Challenge

• Approximately 10% of patient referrals were delayed, incomplete or missing due to an outdated, fax-based referral process

• Existing workflow required staff to process referrals on-site without any remote work capabilities

• Fax devices shared by multiple departments causing incomplete documents, delayed and missed referrals, and PHI compliance challenges

• Manual, fax/paper-based procedure taking hours to days to process a patient referral and prioritize appointments

• Lack of systematic referral tracking, reporting or PHI/HIPAA compliance auditing capabilities

• Traditional phone line-based fax machines with uptime challenges due to periodic break downs, busy signal, out of toner, etc.—impacting response time to patients and clinical staff

Referrals are a significant component of healthcare delivery, particularly in the age 65-plus demographic which is expected to comprise nearly 20% of the U.S. population by 2025. Among this population, studies show one in three people will need two or more referrals to other medical specialties. Yet, the vast majority of healthcare systems have a fax- and paper-based referral process that leads to phone tag between patients and care providers, referrals loss, and delay in getting appointments—all of which impacts patient care and satisfaction. This manual process also prevents physicians from helping more patients and distinguishing their practices from competitors—which can impact financial viability and practice revenue.

Like most other health systems, the University Hospital Department solely depended on a traditional paper-based fax process for handling referrals from in-network and out-of-network providers. The department shared fifteen stand-alone fax machines with other surgical subspecialty departments, resulting in referrals and corresponding clinical documents missing, misplaced or left unattended. Because the legacy fax process was paper-based, faxed referrals were managed on a first-come, first-serve basis rather than by urgency or case complexity. In addition, busy signals, out-of-paper, low toner, jammed devices, or simply unreadable faxes further complicated matters. This legacy referral process missed or delayed, on average, two of every five referrals leading to less-than-optimal patient experience, staff frustration and revenue loss.

For physicians, providing a high-quality consultation during patient visits meant having up-to-date patient charts. To accomplish this, staff would gather a multitude of clinical documents sent via fax and attach them to each referral to assemble a patient chart. Next, in collaboration with the HIM department, staff would scan each paper-based clinical document to complete the electronic patient chart. For incomplete or missing documents, it could take days before the correct information was attached to the patient chart—causing appointment delays and patient dissatisfaction. The entire process could take anywhere from a few hours to a few days.

Adding to the complexity was the sharing of patient records between the various electronic health record (EHR) systems used by the three locations where the University Hospital Department admitted patients. There wasn’t clear visibility into referrals because the department didn’t have a dashboard to track the status of referrals and actionable insights to improve the process. Auditing and tracking of protected health information (PHI) handling was a very difficult, time consuming and laborious process. Also, dependency on paper-based faxes made remote work impossible and required department staff members to work at the facility.