In the treatment process, patient referrals have become a major concern. When patients are referred from one clinician to another, ideally the transition of patient and information would be seamless and complete. However, a study found that twelve million adults experience a diagnostic error in the ambulatory setting in the US every year. Gaps in the referral process were involved in 20 percent of diagnostic errors in primary care. In addition, half of malpractice claims at CRICO/Risk Management Foundation of the Harvard Medical Institutions were due to “some kind of failure to follow up”. This is increasingly problematic, as patient referrals in ambulatory settings are on the rise in the US, growing from 40.6 million in 1999 to 105 million in 2009.

Institute of Healthcare Improvement (IHI) partnered with CRICO to propose a series of recommendations for improving the referral process. Through evaluation, they found there was a “lack of standard protocols, ambiguous roles and responsibilities, shortage of staff to monitor the process, and a lack of clear policies and instructions”. If left unfixed, these gaps can eventually lead to missed or delayed diagnosis, such as patients not showing up for appointments, and delayed treatment. The solution involves a nine step, closed loop process where each person receives the correct patient information through the appropriate channels on time. Each step has recommendations of action for each participant, from patient, to primary care physician, to healthcare organizations. However, current healthcare systems lack efficient communication and coordination required to execute steps and close the loop across transitions of care. There is a lack of real time communication between referrer and specialist, leading to an ambiguity about which clinician holds responsibility for “follow-through on the care plan”, as well as an absence of an effective system ensuring the referral is carried out. Other general barriers also include patient engagement and patient-centeredness in the referral process.

This is where Medssenger can help. At each step of the process where the provider or patient can get lost, Medssenger uses its patent-pending technology to support key steps for closing the loop in healthcare. Each step in the closed loop referral process would be tractable on Medssenger as different participants act, facilitating the hand off of information and action items from one to another both within and across organizations. Medssenger also emphasizes coordination and transparency between health care groups; as the patient is referred from one clinician to a specialist, Medssenger could provide necessary information for extended care and track when primary care physician orders a referral, or appointments are scheduled. Rather than a provider needing to call to check up on whether the patient has been successfully referred, Medssenger constantly keeps all providers informed through shared communication and workflow. At the end of the loop, primary care physician can also monitor the progress of care plans and patient conditions through Medssenger. Such processes facilitated by Medssenger help both providers and patients carry out proper steps to close the loop in care delivery for better outcomes.