Electronic clinical referrals have the potential to be a transformative technology in healthcare. A referral is an electronic letter sent between healthcare professionals via secure means. It provides the ability to send a referral quickly and efficiently helping to streamline the transition of care.

For the patient (who the clinical referral is about), it is a step-in time to help them navigate their healthcare journey. It could be there to provide a routine treatment consultation or the beginning of dealing with a serious illness and therefore a pivotal point in saving their life.

To a healthcare provider, the word referral conjures up a myriad of different use cases and complexities. A referral provides a means to communicate pertinent information essential to providing high-quality consultations and coordinated, safe patient care. For both primary care and specialist services the value of a referral is to exchange information and to provide quality and time-appropriate clinical care for the patient involved.

Unfortunately, within some healthcare organisations there is widespread dissatisfaction with the current referral process. This comes from unnecessary redundancies in the process; for example, missing information in the referral, the time required to write the referral and the mode of communication the referral is sent. A large majority of health organisations are still using written paper, posting or using fax machines.

The fax machine had its use back in the 1980s and 90s – but surprisingly, fax volume in the healthcare industry remains high. As reported by the BBC in the UK, the NHS is still heavily reliant on fax machines. A poll, by the Royal College of Surgeons using freedom of information laws, revealed nearly 9,000 fax machines were currently in use across England.

There are also the ongoing concerns with any paper-based fax process of misplaced and lost referrals. Considering the last decade’s push to eliminate fax machines and move towards adopting electronic forms for document exchange, the continued reliance on fax machines is concerning. In the time‐poor environment of healthcare, it is important that the use of software is incorporated seamlessly into the healthcare professional’s workflow.

A wide variety of technologies are available that would enable practices to abandon the fax machine, and replace it with an electronic referrals solution; Orion Health Clinical Referrals is a notable example. Yet rather than adopt these technologies, many healthcare organisations are still holding onto their outdated fax workflows, why is this?

Attitudes and change-averse behaviours add barriers to the uptake of electronic referrals and electronic communication solutions among healthcare professionals and are a commonly reported limitation. Many do not want to alter their workflow habits and despite electronic referrals being promoted as the more secure alternative, security remains a key concern. There is uncertainty over whether a referral has been received or in fact read is another perceived barrier; however, integration of a ‘Read Receipt’ could be a potential enabler. This last point is interesting, because knowing whether a referral has been received successfully is a key shortcoming of current fax machine systems – unless integrated into a referral receiving solution. In addition, failures in the process such as late or misdirected reports, or reports not being added to the patient’s medical record in a timely fashion by the receiver may affect the clinical response, potentially compromising the patient’s safety.

With so many healthcare organisations using fax machines, unfortunately faxing has remained the most widely accepted way to send referrals. Providers that have already transitioned to electronic document exchange continue to collaborate with those that are less technologically advanced. The consequence is that unless both the sender and receiver adopt digital transmissions, faxing remains inevitable.

How do we break out of this cycle?

Disregarding the existing workflow and the prevalence of fax machines is a recipe for failure. If we want practices to evolve, the best way is to provide an easy-to-use alternative to get healthcare organisations to move away from paper-and-toner faxing to an integrated digital alternative.

Most importantly, a simple vehicle for communication is required – a focus for the exchange of clinical information between providers of care to accomplish a successful transition between one care setting to another – in the context of the patient – for the intent of advice or ongoing consultation and treatment.

An excellent example of a successfully implemented electronic referrals solution, is at Alberta Healthcare. To learn more read the white paper – Clinical Referrals are a critical part of the transition process, what can we learn from Alberta Canada?