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Despite this long standing exchange, only half of the annual 100 million subspecialist referrals are ever completed, while the rest are lost in communication or never followed through. The responsibility of medical care is dumped solely on the patient and becomes misunderstood, uninteresting, or even unavailable from the recommended practitioner. Initial practitioners often forget to follow up with their fellow physician after referring the patient leading to many of these discrepancies and what was intended to be a legitimate and efficient means of redirecting patients has become convoluted and overlooked.
Recent advancements in healthcare legislation have allowed more people to take advantage of these specialized medical services, however, uncompleted referrals still remain an issue. Not only does it prove an economic loss to practitioners but such disconnect may also lead to a decline in average public medical welfare. The Institute of Healthcare Improvement created a panel to devise a mechanism that would address the problem and through this, the Ambulatory Referral Guide was born. “Closing the Loop: A Guide to Safer Ambulatory Referrals in the EHR Era”acknowledges that a definite system is lacking and directly addresses the major issues..
The panel for the Ambulatory Referral Guide proposed the uniform implementation of the nine-step, closed-loop EHR referral process below:
- The primary care physician orders a referral.
- The primary care physician or a designated staff person communicates the referral to the subspecialist.
- The referral is reviewed and authorized.
- An appointment is scheduled.
- The consult appointment occurs.
- The subspecialist communicates the plan to the patient.
- The subspecialist communicates the plan to the primary care physician.
- The primary care physician acknowledges receipt of information from the subspecialist.
- The primary care physician communicates the plan to the patient and the family.
This framework received a lot of praise in an article published by the article published by the American Association of Family Physicians (AAFP). as family medicine is a foremost practice in dealing with these referrals. The AAFP acknowledges that although lost referrals are quite problematic, the guide looks to handle the situation by placing responsibility on the referring doctor and subspecialist, requiring them to comply with documentary requirements and communicate with the patient.
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