The referral black hole, closed.
The fax-based referral loop closes about 30% of the time. We make every referral trackable and bidirectional — sent in under 60 seconds.
The signature mechanic
A state machine, not a fax and a prayer.
Every referral is a tracked object that advances through six states — and a stall is a system event, not a patient's phone call. The fax loop completes about 30% of the time; the closed-loop target is 80% reaching Report Received within 60 days.
Outbound and inbound are two halves of one flow: a referral sent with a complete clinical bundle, and a consult report that attaches back to the originating ServiceRequest and writes into the chart — closing the loop whether or not the specialist runs rev.health.
The problem
Print, fax, wait, hope.
The PCP faxes a referral letter and waits for a callback that rarely comes. The patient has no visibility. The consult report returns as an unstructured fax that gets scanned and filed without reconciliation. Inbound referrals are worse: phone calls and paper mail, re-keyed with errors, never linked back to the sender.
Bidirectional by default
Outbound and inbound are two halves of the same flow, not separate features. Outbound referrals carry a complete USCDI v3 clinical bundle assembled from the patient's global record. Inbound referrals arrive via Direct Trust, parse automatically into structured fields, and schedule without re-keying. Responses — accept, decline, modify, appointment date, consult report — attach to the original referral.
Standards, not lock-in
Direct Trust messaging with FHIR ServiceRequest and Task profiles covers both directions. When the receiving specialist has no Direct address, the referral routes through the TEFCA QHIN endpoint instead. rev.health exchanges with external specialist EHRs on open standards — the loop closes whether or not the other side runs our software.
Key capabilities
Every referral, tracked to the report.
60-second composer
One screen: pick the specialist, the USCDI bundle attaches itself, send. If referral creation takes longer than a fax, adoption fails — so it doesn't.
Closed-loop state machine
Created → Sent → Acknowledged → Scheduled → Completed → Report Received. Every transition logged; stalled items surface on the coordinator's worklist.
Insurance-aware directory
NPI registry plus payer provider-directory data, filtered by the patient's active in-network plan, specialty, and accepting-new-patients status. Sub-2-second search.
Inbound auto-parse
Inbound referrals parse into structured fields with no re-keying — the primary source of inbound referral errors, removed.
Patient visibility
The patient sees the referral, the receiving specialist, the appointment date, and the consult report in the portal — with status notifications along the way.
Standing referrals
Twelve PT visits over six months as one referral: visit counts decrement per completed encounter, expiration enforced.
TEFCA fallback routing
No Direct address? The referral routes via the QHIN sub-participant endpoint, extending reach beyond Direct Trust coverage.
Overdue escalation
Referrals stalled in Sent for 7+ days without acknowledgement flag automatically — broken transports get noticed by the system, not by the patient.
PA-aware
When a referral requires prior authorization, the flag routes into the eligibility and payer workflows before the patient is scheduled.
Workflow
Same-visit cardiology referral, start to finish.
Click “Refer” inside the visit
The composer opens with the patient's context already loaded.
Pick from the live directory
Filtered to in-network cardiologists accepting new patients. The patient's plan does the filtering, not a sticky note.
Send with the full picture
The USCDI bundle — problems, meds, allergies, recent labs, the signed note — assembles from the global record and goes out via Direct Trust. Status: Sent.
Watch it move
Acknowledged that afternoon. Scheduled the next morning. The patient gets portal and SMS updates at each step.
The report comes home
The consult report attaches to the original referral and writes back to the clinical record. The coordinator's worklist shows: loop closed.
Who benefits
~15 outbound referrals a week composed without breaking visit flow — and consult reports that return to the chart on their own.
Lives in the worklist: every state change visible, stalls flagged, zero phone tag to find out whether a specialist ever called the patient.
Gets a complete structured bundle instead of a 40-page fax — and a clean channel to send the response back.
Sees where their referral stands without calling two front desks. No more being the messenger between their own doctors.
Performance targets
The numbers this module is built to hit.
| Metric | Target |
|---|---|
| Outbound referral creation time | < 60 seconds median |
| Closed-loop completion (Report Received ≤ 60 days) | ≥ 80% — vs. ~30% on fax |
| Outbound referrals with complete USCDI v3 bundle | ≥ 95% |
| Referrals stalled unacknowledged > 7 days | < 5% |
| Direct Trust first-attempt delivery | ≥ 99.9% |
| Inbound referrals auto-parsed, zero re-keying | ≥ 90% |
| Patients viewing referral status within 7 days | ≥ 70% |
| Specialist directory search | < 2 seconds p95 |
Standards & transports
Open standards in both directions.
The referral state lives on a FHIR Task bound to the originating ServiceRequest; standing referrals decrement a visit count per completed encounter and enforce expiration, and a prior-auth flag routes into the eligibility and payer workflows before the patient is scheduled.
Connected modules
The loop touches everything.
Clinical Documentation
The USCDI bundle assembles from the global record; consult reports write back to it.
Module 01 →Task Management
Status transitions, overdue acknowledgements, and inbound reports create tasks automatically.
Module 09 →Patient Portal
Referral status, the specialist, the appointment, and the report — visible to the patient.
Module 08 →Stop losing patients to follow-up.
Closed-loop referrals with the records attached and the patient in the loop.
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