Why half of referrals never complete
The instinct is to blame the fax machine. The evidence does not support it.
Clinicians request more than a hundred million specialist referrals a year, and as many as half are never completed. The obvious explanation is the transmission method: more than half are still sent by traditional fax, forty per cent are handed to the patient on paper, and ten per cent are given verbally.
But the obvious explanation is wrong, or at least incomplete. Providers who use their electronic health records properly — the fifty per cent sending e-faxes and the thirty per cent using EHR referral orders — contribute to the same failure. If the receiving end cannot keep up with the volume, a digitally referred patient experiences exactly the same gap in care as one handed a piece of paper.
Three causes that are not about transmission
First, providers take different approaches to recommending specialists, so the same finding produces different destinations. Second, too much responsibility rests with the patient, who is made the courier and the chaser of a process they cannot see into. Third, the receiving end has no obligation to report back, so nobody learns that the loop did not close.
What follows
If transmission were the problem, digitising it would fix it, and it has not. What fixes it is consolidation of every route into one place, three-way communication that includes the patient, and a tracked status that somebody is accountable for. That is a workflow argument before it is a technology argument.
It also has an uncomfortable corollary for anyone running a screening programme: generating referrals is easy and means nothing. The number worth reporting is how many closed.