Patient Referral Management
Patient Demographics and Referral Processing
The core driver of Referral Stream™ is delivering the ability for the referral office to receive, review, and act on a request for a consultative services referral efficiently, accurately, and at a lower cost than in traditional models. In the traditional model, a patient's demographic profile belongs to the initiating provider, whether s/he is a PCP or specialist. Where clinically indicated, the provider's office creates a referral form and faxes to a consultant; the choice of the consultant is often based on insurance acceptance. The consultant's organization then becomes responsible for reviewing the referral, verifying insurance, contacting the initiating provider, accepting or rejecting the referral, notifying the patient, requesting other information where needed, delivering the care requested, and transmitting the encounter documentation (consultation notes, labs, radiology or other diagnostic reports) back to the referring provider. The transaction usually closes with the transmission of these documents, and the initiating of billing processes.
Referral Stream™ operates within this space but automates many of the key processes involved. Patients still belong to the initiating provider, in fact, this is a key business rule. This ensures that if two providers are referring the same patient, each will have a distinct demographic profile as this respects the patient's wishes and also provides up-to-date information. The actual creation and transmission of the referral form and supporting documents are key automation features that benefit all parties. Providers can still use the traditional Fax method, but many hospital systems will encourage their providers to use Referral Stream™ to create electronic referrals, and provide this service to their provider pool at little or no cost.
The Referral Stream™ referral template ensures that no provider can exceed the scope of his or her referral privileges. Privileges are based on each hospital center's service offerings and policies reflecting the provider type (e.g., physician, dentist, nurse practitioner, etc.) and the credentialing or other established relationship and professional guideline criteria. This ensures that all providers are treated fairly. The referral office is alerted each time a new referral comes in through Referral Stream™ . Faxed referrals will need to be created by office staff in order to be included in the system workflow and reporting features.
Referral Stream™ guides users through each step of the referral process, from intake review, to clarification, to scheduling. Referral Stream™ coordinates chart requests, monitors PCP pre-surgical consent forms, and generates communications to providers, internal departments, and patients. Providers will always know what prerequisites are required, and will be able to review fulfillment documentation 24x7.
Referral office personnel will enjoy the ability to resolve bottlenecks by monitoring exactly where an individual referral stands in its lifecycle, and what actions need to be taken once the consultation is achieved, e.g., collect consultation notes and labs, close out as a no-show, or other actions.
Patients will enjoy the easier navigation resulting from Referral Stream™ and it serves as the information and workflow integrator for patient-centric care. With Referral Stream™ , all authorized parties can partake in the patient navigation and ensure that the referring provider retains ownership of the patient until the close of the referral transaction.
Referral Stream™ is currently used by the New York City Health and Hospitals Corporation acute care hospital centers to manage more than 12,000 monthly referral transactions at 11 major acute care centers:
- Bellevue Hospital Center
- Coney Island Hospital
- Elmhurst Hospital Center
- Jacobi Medical Center
- Harlem Hospital
- Kings County Hospital Center
- Lincoln Hospital
- Metropolitan Hospital
- North Bronx Hospital Center
- Queens Hospital Center
- Woodhull Hospital