Your practice’s referral management may only be as good as the EHR you’re using

The days of manually managing patient referrals are largely over for most medical group practices — but there’s still room for improvement in getting the most out of the data being monitored.

A Feb. 18, 2025, MGMA Stat poll found that more than three medical groups out of four (76%) are using their EHR (66%) or referral management software (10%) to manage their patient referrals, Meanwhile, only about one in five (21%) still rely on manual tracking, and  3% responded “other.” The poll had 309 applicable responses.

Despite increased automation, some practices continue to use manual tracking due to challenges such as faxed paper referrals or EHR limitations; for example. the inability to support everything that would normally be listed in a Continuity of Care Document (CCD). As one practice leader told MGMA, “EHR interoperability CCD’s features still lack elements that a referral would otherwise have.”

Additionally, primary care practices often face challenges when specialists require referrals on their own forms instead of using digital tools designed to simplify the workflow. As one respondent told MGMA, this reluctance to adopt technology “keeps them stuck in outdated methods of operation.”

More in MGMA Connection magazine

• The January issue of MGMA Connection magazine features “Impact on volume and revenue of referral management monitoring,” by Robert J. LaGesse, with in-depth suggestions on using external third-party insurance data aggregators and referrals of internal organizational providers to better monitor and manage referral patterns.

Top referral management challenges today

Respondents shared their organization’s top challenges in referral management, with the most common challenges being data and analytics bottlenecks, either due to a lack of data to analyze patterns and/or a need for better communication between providers:

• Lack of referral data: Without adequate data, practices struggle to gain insights on trends, optimizing processes, tracking outcomes and identify inefficiencies.
• Communication gaps: Poor coordination between referring and receiving providers can delay treatment, create confusion and result in poor patient experiences.

Similarly, practice leaders voiced issues with scheduling difficulties, overall referral tracking and follow-up and high no-show rates:

• Scheduling difficulties: Getting in touch with patients to schedule referred appointments often causes delays in care.
• Limited referral tracking: Many organizations lack visibility into referral status, making it hard to ensure those patients follow through.
• High no-show rates: A significant portion of referred patients fail to show up for scheduled appointments.

Additionally, some practices noted prior authorization and insurance approvals are a challenge, though these appear to be less significant compared to the other operational and logistical issues.

Strategies for improvement

These findings suggest that while some barriers are external, the biggest hurdles in referral management tend to stem from internal inefficiencies stemming from technology gaps and workflow inconsistencies. Depending on specific pain points, practice leaders can consider the following strategies:

• Seek out updated referral management tools offered by your EHR vendor or invest in referral tracking software with real-time analytics to identify bottlenecks using trend analysis.
• Implement direct messaging systems within your EHR and establish clear provider communication workflows between referring and receiving providers.
• Use patient self-scheduling tools, automated reminders and, where appropriate, telehealth referral options to reduce friction.
• Set up automated follow-up workflows to confirm appointments, update referring providers and track referral outcomes.
• Leverage engagement tools such as patient navigators and AI-driven chatbots have shown varying levels of efficacy to improve patient education and follow-through.
• Implement automated prior authorization tools and explore pre-approved referral pathways for common procedures.

Join MGMA Stat

Your contributions are vital to MGMA’s ongoing work to provide great resources, education and advocacy for medical group leaders. Sign up for MGMA Stat to make your voice heard in our weekly polls. Simply text “STAT” to 33550 or visit mgma.com/mgma-stat. Polls will be sent to your phone via text message.