Physical therapist helps a senior woman exercise using a pilates ball.

We Must Simplify the Referral Process

My mother recently took over the care of my grandparents, 93 and 89, which includes shuttling them to their myriad medical appointments.

Most recently, my grandmother’s balance issues worsened, prompting a visit to her primary care physician. Her physician referred her to a physical therapist and said their office would fax over details; the physical therapist’s office would then call to schedule an appointment.

That call never came.


Yeah, I’m not either.

For the entirety of my career in healthcare, we have relied on fax technology to coordinate referrals. It used to be that referrals arrived via a giant fax machine – every office had one. We’d staple the paper records together then start our scheduling process, which took as many as three phone calls to the patient and one to the referring provider to share the outcome of the referral.

Now that offices have gone digital, we’ve mostly eliminated paper, but the process is the same. A fax comes in, there is an attempt to reach the patient for an appointment, and in some cases, the referring provider is notified if the patient is scheduled.

You read that right…most referrals are STILL transmitted via fax — a technology old enough that a Samurai could have faxed Abraham Lincoln. (Fun fact: Fax machines were invented in 1846, meaning Samurai, Lincoln and fax machines overlapped by about 19 years.)

Fax Facts (traditional and electronic)

  1. Faxes take a minute per page to deliver, so a 30-page fax will take 30 minutes.
  2. Traditional faxing has a 5% rate of failure, and electronic fax is between 5-8%…and that percentage gets much higher when the fax page count exceeds 50 pages.
  3. Fax confirmations are not 100% reliable. Confirmations simply show that the sending fax and the receiving fax communicated, but they do not guarantee the fax was sent to the correct number, that the fax machines on the other end printed/captured the documents, or that the documents were seen by anyone.

Most people outside healthcare are shocked to find out that patient referrals still depend on this unreliable technology. Even many within healthcare are surprised to hear this. Believe it or not, most people who work in patient-facing roles don’t realize they are still faxing referrals.

I know this because when I ask them how many faxes they send daily, they say “Not many, I send everything from my EMR,” not realizing that the send button in the EMR and the send button on that physical fax machine do the EXACT same thing.

Patients deserve better

At Centralis, we are working to solve this issue. One of the reasons I’m working on IT interoperability and no longer in a patient-facing role is because I believe that we can simplify the referral process, streamline operations, and create a better experience for patients and providers.

For example, our hReferral solution automates the referral management workflow and tracks patients through to completion. That means patients no longer have to wait for providers to call them to schedule a follow up appointment, and referring physicians know their patients received the care they need.

As health data interoperability improves across the nation through TEFCA-based exchange and other initiatives, the referral process should become even more efficient and reliable, ensuring a clear continuum of care across providers.

Of course, reliability will depend on the entire industry – including small, rural, and independent clinics, home and community-based care, and other last-mile providers – moving off fax technology. And that’s going to take time.

At Centralis, we specialize in helping providers make the transition from legacy fax to modern systems. If your clinic is ready to take a giant step toward seamless care coordination, our team is ready to help. As for my grandmother, we solved her referral problem by driving to her primary care physician’s office to collect the written referral and then hand delivering it to the physical therapist.

Hand-to-hand delivery. It may be more antiquated than faxing, but at least it’s reliable.

by Katie Bradley, Director of Operations

As Director of Operations, Katie is responsible for helping hospitals and medical practitioners transition from their outdated and manual health care communications workflows and processes to embrace Centralis Health’s innovative and cloud-based solutions. This includes transforming existing fax, internal communications, and referral management processes to achieve maximum efficiency, productivity, and cost savings. In addition, Katie leads efforts to encourage and engage greater community participation in health care exchanges between providers and hospitals. Prior to joining Centralis Health in 2015, Katie served in a variety of administrative and operations roles in health care, including as Director of Operations for Digestive Disease Clinic in Tallahassee, FL. She graduated summa cum laude from Florida International University with a Bachelor of Science degree in Health Services Administration. In her free time, she enjoys traveling and spending time with family and friends.