A plain guide to electronic referrals
A referral isn't finished when it's sent. It's finished when the report comes back.
An electronic referral moves a patient from one provider to another as a trackable record instead of a fax, a phone call or a paper slip. Here is what it is, how it works, and what to ask.
- Sentfax goes out
- Receivedno confirmation
- Schedulednobody knows
- Seen?
- Report back?
- Closed?
- SentMon 9:02
- ReceivedMon 9:14
- ScheduledThu 2:30
- SeenThu 2:30
- Report backFri 8:41
- ClosedFri 8:41
Times are made-up examples. The point is the shape: each stop either confirms or shows who is waiting.
The short answer
What is an electronic referral?
The journey
Six stops, and who owns each one
| Stop | What has to happen | Who owns it | How it fails on paper |
|---|---|---|---|
| 1. Sent | The referral leaves with the reason and the records the next provider needs. | Referring office | Missing pages, wrong fax number. |
| 2. Received | The other office confirms the referral arrived and is complete. | Receiving office | No confirmation, so the sender assumes. |
| 3. Scheduled | A visit is booked and the patient knows the date. | Receiving office, patient | The patient is told to "call them". |
| 4. Seen | The visit happens. | Receiving provider | No-shows go unnoticed. |
| 5. Report back | Findings return to the referring provider. | Receiving provider | The report sits in a different inbox. |
| 6. Closed | The sender confirms the loop is done. | Referring office | Nobody closes it, so nobody can count it. |
Why it matters
What goes wrong when a referral can't be tracked
Care that never starts
The patient waits to be called, the office waits for the patient, and the visit does not happen. Nobody sees the gap.
Referrals that leave the network
Referral leakage is a referral that goes outside the providers a system or practice meant to use. It is hard to fix when nobody can see where referrals stopped.
A treatment date at risk
When one step before a procedure is still open, the date is at risk. A tracked referral shows which step, and which office, is holding it.
Who it is for
Pick your seat
If you were told "we'll send a referral"
Four questions get you a straight answer. Ask them at the office that referred you.
- Who is it going to, and what is the office's phone number?
- When will I know it arrived, and who will tell me?
- When should I have an appointment date? If I don't, who do I call?
- Will my own doctor get the report afterward?
If the answer is "they'll call you," ask for a date by which you will have heard something. That date is the check.
For navigators, case managers and financial coordinators
Your job is the open loop. The useful questions are the ones a status answers.
- Which referrals have been received but have no appointment?
- Which are scheduled before a treatment date, and which are not?
- Which reports are overdue, and from which office?
- Who is waiting on whom right now?
For specialists, dentists and primary care offices
A good electronic referral is easy to receive and easy to answer.
- It arrives complete: reason, urgency and records in one place.
- Receiving it takes one click, and the sender sees that you did.
- Sending the report back closes the loop without a phone call.
Under the hood
How a referral actually travels
There is no single national eReferral standard in the United States. Referrals move over several channels at once, which is why they still get lost between them.
| Channel | What it is | Where it works best |
|---|---|---|
| FHIR | A modern data standard. A referral is a ServiceRequest with a Task that carries its status. | Systems that have built it. Adoption is uneven. |
| Direct messaging | Secure email between providers, usually with a C-CDA referral note attached. | Offices on different record systems. |
| Record-system modules | Referral tools inside one health system's own electronic record. | Referrals that stay inside one system. |
| X12 278 | The insurance-side request for a referral or authorization. | Asking a payer, not another provider. |
| Fax | A scanned page sent to a number. | Everywhere, which is the problem. |
Questions people ask
eReferral, answered
Is eReferral one product?
No. It is a function that many products provide. Some countries run one national service under that name; in the United States there are many vendors and several data standards.
What is the difference between a referral and an eReferral?
A referral is the request. An eReferral is the same request as a digital record with a status that both offices can see.
Does an eReferral replace the phone call?
It replaces the calls that exist only to ask whether something arrived. Calls about the patient stay.
What is referral leakage?
It is when a patient is referred to a provider outside the network or practice group that was meant to receive them, or never reaches any provider.
What does "closing the loop" mean?
The referring provider has the report back and has confirmed the outcome. Until then the referral is open.
Does this site hold patient information?
No. This is an explainer. It does not collect or store patient records.
Find your hospital
Every US hospital already has a page.
iReferral is a free, public list of 4,790 US hospitals, built from federal data, where a dentist or physician can send a referral and, as hospitals claim their pages, follow it to the report back. Nobody pays to be listed. Start with yours.