In the practice of medicine, doctors are ethically obligated to decline patients if they are not capable of providing the quality of care required. But instead of rejecting them outright, they refer these patients to colleagues or acquaintances who are better equipped with the knowledge to carry out the needed medical care. With this practice of referral, practitioners earn much of their living from interdisciplinary referrals and this arrangement has been in place since time immemorial.
However, there is a glaring problem with such a system: of the annual 100 million subspecialist referrals, only an optimistic half are actually completed. The rest are lost in communication or never followed through. What was intended to be a legitimate and efficient means of redirecting patients to more appropriate services became a jumbled toss up. Medical care is left to the patient’s inability to follow instructions, a loss of interest, or the unavailability of the receiving practitioner. Initial practitioners often forget to follow up with their fellow physician after referring the patient.
Recent advancements in healthcare legislation have allowed more people to avail of the specialized medical services. However, uncompleted referrals still remain a threat. Not only does it prove an economic loss to practitioners but it 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.
Hence, the Ambulatory Referral Guide was born. Following through with the theme “Closing the Loop: A Guide to Safer Ambulatory Referrals in the EHR Era”, the guide acknowledges that a definite system is lacking.
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.
The guide received a lot of praise in an article published by the American Association of Family Physicians (AAFP). Family medicine is one of the larger fields of practice that refer their patients to subspecialists. The AAFP acknowledges that the the current situation with referrals getting lost is quite problematic. The guide looks to handle the situation by putting the responsibility on the referring doctor and the subspecialist to comply with documentary requirements and communicate with the patient.
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