{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,3]],"date-time":"2026-08-03T23:50:49Z","timestamp":1785801049987,"version":"3.56.0"},"reference-count":21,"publisher":"Oxford University Press (OUP)","issue":"6","license":[{"start":{"date-parts":[[2018,2,17]],"date-time":"2018-02-17T00:00:00Z","timestamp":1518825600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/academic.oup.com\/journals\/pages\/about_us\/legal\/notices"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2018,6,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Objective<\/jats:title>\n                  <jats:p>To evaluate the impact of a referral manager tool on primary care practices.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Materials and Methods<\/jats:title>\n                  <jats:p>We evaluated a referral manager module in a locally developed electronic health record (EHR) that was enhanced to improve the referral management process in primary care practices. Baseline (n\u2009=\u200961) and follow-up (n\u2009=\u200935) provider and staff surveys focused on the ease of performing various steps in the referral process, confidence in completing those steps, and user satisfaction. Additional metrics were calculated that focused on completed specialist visits, acknowledged notes, and patient communication.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Of 1341 referrals that were initiated during the course of the study, 76.8% were completed. All the steps of the referral process were easier to accomplish following implementation of the enhanced referral manager module in the EHR. Specifically, tracking the status of an in-network referral became much easier (+1.43 [3.91\u20132.48] on a 5-point scale, P\u2009&amp;lt;\u2009.0001). Although we found improvement in the ease of performing out-of-network referrals, there was a greater impact on in-network referrals.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Discussion<\/jats:title>\n                  <jats:p>Implementation of an electronic tool developed using user-centered design principles along with adequate staff to monitor and intervene when necessary made it easier for primary care practices to track referrals and to identify if a breakdown in the process occurred. This is especially important for high-priority referrals. Out-of-network referrals continue to present challenges, which may eventually be helped by improving interoperability among EHRs and scheduling systems.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>An enhanced referral manager system can improve referral workflows, leading to enhanced efficiency and patient safety and reduced malpractice risk.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/jamia\/ocy004","type":"journal-article","created":{"date-parts":[[2018,1,7]],"date-time":"2018-01-07T12:08:15Z","timestamp":1515326895000},"page":"715-721","source":"Crossref","is-referenced-by-count":18,"title":["Closing the loop with an enhanced referral management system"],"prefix":"10.1093","volume":"25","author":[{"given":"Harley","family":"Ramelson","sequence":"first","affiliation":[{"name":"Information Systems, Partners HealthCare, Somerville, MA, USA"},{"name":"Division of General Internal Medicine, Brigham and Women\u2019s Hospital, Boston, MA, USA"},{"name":"Department of Medicine, Harvard Medical School, Boston, MA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amanda","family":"Nederlof","sequence":"additional","affiliation":[{"name":"Information Systems, Partners HealthCare, Somerville, MA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sam","family":"Karmiy","sequence":"additional","affiliation":[{"name":"Information Systems, Partners HealthCare, Somerville, MA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pamela","family":"Neri","sequence":"additional","affiliation":[{"name":"Information Systems, Partners HealthCare, Somerville, MA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Kiernan","sequence":"additional","affiliation":[{"name":"Information Systems, Partners HealthCare, Somerville, MA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rajlakshmi","family":"Krishnamurthy","sequence":"additional","affiliation":[{"name":"Newton Wellesley Hospital, Newton, MA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adrienne","family":"Allen","sequence":"additional","affiliation":[{"name":"NorthShore Physicians Group, Danvers, MA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David W","family":"Bates","sequence":"additional","affiliation":[{"name":"Information Systems, Partners HealthCare, Somerville, MA, USA"},{"name":"Division of General Internal Medicine, Brigham and Women\u2019s Hospital, Boston, MA, USA"},{"name":"Department of Medicine, Harvard Medical School, Boston, MA, USA"},{"name":"Department of Health Policy and Management, Harvard School of Public Health, Boston, MA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2018,2,17]]},"reference":[{"issue":"1","key":"2020110612361256200_ocy004-B1","doi-asserted-by":"crossref","first-page":"56","DOI":"10.1001\/archinternmed.2010.480","article-title":"Referral and consultation communication between primary care and specialist physicians","volume":"171","author":"O\u2019Malley","year":"2011","journal-title":"JAMA Intern Med."},{"issue":"4","key":"2020110612361256200_ocy004-B2","doi-asserted-by":"crossref","first-page":"1341","DOI":"10.1542\/peds.2005-3010","article-title":"Determinants and impact of generalist-specialist communication about pediatric outpatient referrals","volume":"118","author":"Stille","year":"2006","journal-title":"Pediatrics."},{"issue":"9","key":"2020110612361256200_ocy004-B3","doi-asserted-by":"crossref","first-page":"626","DOI":"10.1046\/j.1525-1497.2000.91119.x","article-title":"Communication breakdown in the outpatient referral process","volume":"15","author":"Gandhi","year":"2001","journal-title":"J Gen Intern Med."},{"key":"2020110612361256200_ocy004-B4","doi-asserted-by":"crossref","first-page":"163","DOI":"10.1186\/1472-6963-9-163","article-title":"Bridging the care continuum: patient information needs for specialist referrals","volume":"9","author":"Ireson","year":"2009","journal-title":"BMC Health Serv Res."},{"key":"2020110612361256200_ocy004-B5","volume-title":"Managing Risk in the Referral Lifecycle","author":"Hoffman"},{"issue":"8","key":"2020110612361256200_ocy004-B6","doi-asserted-by":"crossref","first-page":"270","DOI":"10.5489\/cuaj.4314","article-title":"Improving access to urologists through an electronic consultation service","volume":"11","author":"Witherspoon","year":"2017","journal-title":"Can Urol Assoc. 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