When an organization considers purchasing a patient Referral Management System (RMS), one of the first points management considers is whether or not its existing EMR/EHR can provide the missing functionality with an add-on, or perhaps already does but is not being used. In general, use cases that are exclusive to employed healthcare providers working within the provider system will favor using an EMR alone. However, once an organization wants to do complex tiering of its networks and/or work with provider resources outside its organization, a Referral Management System becomes critical.

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1
Top 6 Reasons
Why You Need A Referral
Management System
Even Though You Have An EMR/EHR
www.healthviewx.com
Learn how a patient referral software can help

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When an organization considers purchasing a patient Referral Management
System (RMS), one of the first points management considers is whether or not
its existing EMR/EHR can provide the missing functionality with an add-on, or
perhaps already does but is not being used.
Referral Management System
In general, use cases that are exclusive to employed healthcare providers working
within the provider system will favor using an EMR alone. However, once an
organization wants to do complex tiering of its networks and/or work with provider
resources outside its organization, a Referral Management System becomes
critical.
Below, we provide the top 6 reasons a Referral Management System is a necessary
tool for a healthcare system in addition to an EHR/EMR.

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Referral Management Systems Enable Healthy
Provider Network Utilization6
A healthy referral network should be able to distribute referrals evenly
among comparable resources in a given geography. It is essential to
maintain active participation among all the providers in the network.
Often a favored specialist at the top of the list keeps getting more and
more referrals at the expense of others who might be just as qualified.
An effective Referral Management System can provide load-balancing
algorithms so that referrals are distributed evenly among comparable
providers.

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Referral Management Systems Provide End-to-
End Patient Referral Tracking5
Part of the clinical opportunity for referral management stems from the
fact that referrals typically occur when there is a change of diagnosis or an
escalation in care.
As such, a referral is often the first indication that a patient will likely trigger
significant downstream consumption.
A well-implemented patient referral solution enables an organization to
track patients in real-time and better guide patients towards high-quality
low-cost care settings.

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Referral Management Systems Provide End-to-
End Patient Referral Tracking5
Further, the system needs to encourage specialist staff to report
appointment attendance or noncompliance, as well as return clinical notes
to primary care offices for better patient care and better patient outcomes.

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Referral Management Systems Facilitate Real-
Time Referral Reporting4
The ability to report highly granular referral analytics that illustrates referral
patterns is essential for any Referral Management System. Organizations
taking on risk as well as organizations optimizing referral patterns need to
stay vigilant about network performance and network adequacy.

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Referral Management Systems Facilitate Real-
Time Referral Reporting4
Referral analytics should help organizations identify particular areas of
concern as well as provide reporting that impacts referral patterns and
facilitates change. Furthermore, robust Referral management software
should be able to provide this data within the application itself as well as
have the ability to export this data in any suitable format.

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Referral Management Systems Create Dynamic
Referral List Based on Location3
Many organizations must be able to manage referrals across large
geographic areas. Indeed, the Service Level Agreements (SLAs) that many
provider organizations enter into with payers as part of risk-sharing
arrangements have network requirements that dictate how far away a
specialist referral can be for a patient.
A patient referral management solution can store the SLAs from the
different payers, and then generate a geo-specific list of referral resources
that can be based on the primary care provider’s location or the patient’s
home.

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Referral Management Systems Create Dynamic
Referral Lists Based on Payer Selection or Plan
Design
2
Referral networks tend to have networks within the network, where
different payers or insurance plans have preferences or rules where
patients can go for care. A referral management solution can generate a
referral list for each patient based on the plan each patient carries.

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Referral Management Systems Connect
Healthcare Clinics Across Different EMRs1
Once an organization wants to manage referrals across networks (e.g.
among affiliates), chances are high that many offices will be using different
EMRs. An effective referral management solution will be able to provide
workflow and integration solutions that can work across multiple different
EMR/EHR vendors and networks.