Our experience of designing a HIPAA-compliant referral management system

Masha Panchenko

A few months ago Eleken started working with Refera, an electronic referral management system that helps dentists connect their patients with specialists. That is when we discovered a whole world of healthtech and found out that this kind of software requires a special approach in design.

Building a referral management system is not as easy as it may seem. Although our agency did not design it from scratch, we would like to share some valuable insights from this project.

But let's start with the basics, first.

What is a referral management system?

Patient referrals happen when a general doctor wants a patient to see a specialist, an ophthalmologist, for example. Referral management systems, or RMS, simplify the process of transferring all the patients’ data from one doctor/hospital to another, and help schedule an appointment.

Referral management systems need to synchronize data from different EHR (electronic health records) systems and comply with national standards of sensitive patient health information protection, also known as HIPAA (The Health Insurance Portability and Accountability Act). 

Some examples of these systems are par8o, Equipo, Docman RMS. Our experience with electronic referral management systems started when Refera, an app created specifically for dentists. The company asked us to redesign their website.

Refera landing page

What are the challenges of RMS design?

When we started working with Refera, the whole world of healthtech was kind of a challenge for us: it is full of regulations, and the software has to take into account the needs of all stakeholders, including patients, doctors, and medical institutions. And the level of responsibility is higher, too.

Design for an electronic referral management system requires deep research in the field. In this article, we would like to get beyond the standard research-design-prototype-test process and focus on the challenges that are specific to this type of software, so that you know what to expect. (By the way, we have an article about UX challenges in general healthcare that might be worth your attention).

So, there is a system that connects patients with the doctors they need. Patients are interested in seeing a doctor, doctors are interested in getting an appointment. What can go wrong?

We were surprised to find out that a study from 2009 showed that about half of the referrals don’t result in a successful appointment. Seems like a lot, right? What is more, less than 25% of referrals are completed as intended by the sending provider. From the UX professional’s point of view, these numbers are really low, and, I guess, from healthcare professionals’ point of view as well.

Some of the failed referrals may be due to personal reasons: people change plans, choose other doctors or simply freak out. Yet, the percentage of failed referrals can be decreased by simplifying the process and improving user experience. This is one of the main objectives of electronic referral management systems.

It felt good to realize that by making software efficient and usable we don’t only make doctors’ workflow simpler, but also increase the number of patients who get to the right specialist. Projects in healthcare are challenging, yet rewarding.

Here are the main challenges we discovered during our work on the medical referral management system:

Integrations

In essence, electronic referral management software is an intermediary: it unites general doctors, patients, and specialist doctors; it connects different medical offices, hospitals, and electronic health records systems. For this software, integrations are not just a nice bonus: it is the key element.

When we talk about designing a HIPAA-compliant referral management system, we can’t really say that we just “build it from scratch”. Here, we have to first study what data is already used in different EMRs and how we can connect existing electronic systems. And sometimes connecting already existing pieces is harder than just creating a new database.

In case of Refera, integration with practice management software is included only in the premium version: this is an element that makes the patient management cycle complete.

Databases

In a product that connects hospitals, doctors, patients, and keeps their medical records, a functional database is paramount. RMS software has to unify all the different ways of entering data (for example, a phone number can be written in different ways).

After that comes the updating of the information. For successful functioning, it has to be decentralized. Each office has to be able to change data that is relevant to them and their patients.

Efficient scheduling

Scheduling an appointment is one of the key elements of the referral process. This is another hard task of integrating different scheduling systems that dentists use into one. And what is more important, keeping it up-to-date so that appointments will be scheduled correctly.

Don’t forget about keeping track of the referrals. It is a good idea to send a reminder to a patient who did not follow the referral. General doctors need to see how the process of medical assistance went after the referral. For example, in dental offices, back referral is needed only in 5% of cases, but all doctors want to know whether their patients received good care afterwards.

How to design an electronic referral management system. Eleken experience

Research phase

Every design process should start with the research. For such a narrow niche as electronic referral management, it is highly important to talk in person to people who will be using the system. It’s not that easy to catch a busy healthcare professional for a one-on-one talk, but this is the crucial information for the project we're talking about. If you're interested to learn more, check out our short guide on how to talk to users.

Architecture

If the research was done properly, the ideas of app structure will be there already. If it’s a referral management system, we need a “create a referral” screen, but what else? Let’s take a closer look at Refera. 

There is the Insights screen that shows the list of referrals showing the status of each of them, along with general statistics on referrals’ success. General dentists can see a list of specialists with referral statuses.

Refera Insights screen

The app looks different for general dentists and other specialists. The latter have the OpReports screen, where they can send the results of the appointment back to the general dentist to keep track of the treatments.

Refera Create Op Report screen

Notice a little visual detail that makes dentist referral easier: to indicate the tooth that went through treatment, a doctor just needs to click on the image of the oral cavity instead of entering the number of the tooth manually.

Designing for all stakeholders

When creating the system architecture and designing user interface, it is obvious that you need to focus on the needs of doctors, as they would be the ones interacting with the app directly. However, it is important to think of patients, too, as they are no less valuable.

For example, Refera does not just give the information about the specialist they are referred to. A patient receives a message with the time and place of the appointment. They don’t even need to bring an X-ray or other documents: it is all sent automatically. By simplifying referral process on the patient side, referral management systems get to improve a key metric: referral success rate.

Keeping the data consistent

We have already mentioned that functional databases are one of the most important things in referral management solutions. Another challenge related to data is bringing together information from different systems. This is all about small things like the way addresses are written, situations when one doctor works in a few dentist offices, and so forth. And even more important is the  regular data update, so that a patient wouldn’t be sent to a doctor who is not available.

To ensure proper data management, work of both developers and designers helps to avoid confusion.

User interface for healthtech. Design tips

There are many arguments for and against using trendy design in functional apps, but with healthcare, things are clear. No need to be a psychologist to understand that people prefer simple and classic interface rather than flashy and complex one when they want to schedule a doctor’s appointment.

  • It is vital for a referral management system to evoke trust in patients, and people trust real persons who look professional. That is why we replaced flat illustrations with real pictures of doctors. Illustrations would work great in fintech or edutech, but healthcare asks for a different approach.
HIPAA-compliant referral management system design. Before and after
Before and after: Referral landing page redesign
  • As we know, colors influence emotions and evoke specific associations. That is why, most healthcare websites and apps would have blue color in visuals: it signals calmness. For Refera, we went for green, which is associated with medicine since old times. For the accent color, a contrasting hue can be used (we chose orange). 

Flashy neon colors and complex gradients are not the best choices for healthcare software. Here is another example of an app related to healthcare and work safety that we designed: the interface is in neutral hues of blue.

Haven diagnostics healthtech design
Haven diagnostics. Design by Eleken
  • Use animations only when necessary. This is a rule of thumb for every simple and minimalist interface. Actually, we prefer functional animation in other types of apps, too.
  • There is no place for jokes in medical applications, so we recommend using a neutral tone in UX writing. On the other hand, some medical terms and language-specific words for medical documents should be simplified when possible, especially in an interface that is aimed at patients. However, many doctors would appreciate short and easy-to-read text as well.

You can read more about when to use trendy design in our article on UI/UX trends.

Final thoughts

Working with HIPAA-Compliant electronic referral management systems requires a lot of attention to details, regulations, privacy, and ethics. Here we have unveiled just a cap of one of the icebergs floating in the ocean flooded with healthtech projects.

Want to get a personalized consultation regarding your SaaS product in healthcare? Contact us!

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