In most countries, the two main types of care facilities include clinics and hospitals. As gatekeepers, clinics are expected to provide services for uncomplicated cases. From the clinics, the more serious cases are referred to the hospitals. This pyramid of care facilities results in reducing costs for the payer and improving quality of care within the health system. Apart from the transition from primary to specialist care, referrals occur from specialist to specialist care or from an inpatient setting to emergency care. This post looks at the challenges and enablers to electronic referral management systems.
Referral Management System
The WHO defines a referral ‘as a process in which a health worker at one level of the health system […] seeks the assistance of a better or differently resourced facility at the same or higher level to assist in, or take over the management of, the client’s case’. Broadly, the usage of referral management systems is carried out to improve health outcomes by monitoring the patient’s journey across the care pathway.
Since the need for referrals occurs due to the escalation in need or change in diagnosis, referral management systems play a critical role in effective care provision.
Challenges to Referral Management Systems
The key challenges to referral management include:
- Care provision in clinics is considered to be of a lower quality. This results in people seeking care directly at the tertiary facility.
- Impersonalized system of record keeping, which results in patients feeling lost.
- Paper records result in difficulties in data collection and storage. Because of these problems, there is a lack of accurate information.
- The presence of different languages and standards in healthcare creates difficulties in making use of stored information to improve health outcomes.
- The presence of different record keeping mechanisms results in the fragmentation of information.
- Difficulties in managing care systems.
Enablers of Referral Management Systems:
To a large extent, problems in referral management systems can be overcome with the usage of electronic patient records.
- Electronic record keeping mechanisms result in increased transparency in care systems. This increases patient trust.
- Information is streamlined through different languages, standards, and record keeping mechanisms in order to improve health outcomes.
- Maintaining both provider directories and patient records is easier digitally.
- Communication between care providers is streamlined through the use of a single platform.
In conclusion, referral management systems are effective tools for improving quality of care provision, and reducing costs. Despite its effectiveness, several challenges hinder the effectiveness of referral management systems. However, these problems can be overcome with the usage of technologies, which streamline information to improve outcomes.
Bossyns P and Van Lerberghe W, 2004, The weakest link: competence and prestige as constraints to referral by isolated nurses in rural Niger, in Human Resources for Health 2004, 2-1, available on line at: http://www.human-resources-health.com/content/pdf/1478-4491-2-1.pdf
Cervantes K, Salgado R, Choi M and Kalter H. 2003 Rapid Assessment of Referral Care Systems: A Guide for Program Managers, published by the Basic Support for Institutionalizing Child Survival Project (BASICS II) for the United States Agency for International Development, Arlington, Virginia, available on line at: http://www.jsi.com/Managed/Docs/Publications/WomensHealth/PNACW615.pdf
Department of Health, Republic of South Africa, 2003, The Clinic Supervisor’s Manual, Version 3, see Section 6: Referral System Guidelines, available on line at: http://www.doh.gov.za/docs/factsheets/guidelines/clinical/index.html
Barnett M, Sirui S, Landon B. Trends in Physician Referrals in the United States. Arch Intern Med. 2012; 172(2): 163-170. doi:10.1001/archinternmed.2011.722.