A stronger workflow for orthopedic referral management

How orthopedic practices can handle primary and emergency care referrals more efficiently

For orthopedic practices, a steady influx of referrals from primary and emergency care can signal strong demand, but it can also strain referral management workflows. While many clinics have some form of a referral tracking system, sometimes the volumes and complexities of referral backlogs outpace a facility’s ability to manage them.

When that happens, referrals get missed, care gets delayed, and the orthopedic care coordination loop may never close. Ultimately, this happens in about two in three referrals, according to a study comparing scheduling attempts with completed encounters.¹

This gap is an ongoing problem for specialty practices: In 2017, for example, a paper from the Institute of Healthcare Improvement (IHI) discussed the fraught landscape of referral management, including how specialty referrals were surging, leading to missed referrals that jeopardized patient care and outcomes.² Accordingly, the IHI recommended that providers close the loop by taking in the referral, initiating the care plan, and reporting back to the referring provider. This approach also aligns with Agency for Healthcare Research and Quality (AHRQ) recommendations around referral care coordination and management.³ 

Even with a process in place, however, it can be hard for orthopedic practices to manage their referral volumes, despite their best intentions. Caught between rising demand (including from an aging baby boomer population) and tightened supply (including from clinician shortages), orthopedic practices often struggle to close referral loops.⁴

Fortunately, technology — and increasingly, artificial intelligence — can help practices navigate those challenges and build more consistent referral management workflows, supporting teams from intake through recovery. Here are several steps orthopedic practices can take to build a more consistent referral management workflow:

Triage referrals by urgency, symptoms, and protocol

Orthopedic practices can benefit from an organized system in which referrals are triaged by underlying attributes. Triaged groupings may depend on the practice and population’s unique needs, but would commonly include factors such as clinical need, referral reasons, post-operative status, imaging needs, mobility concerns, and others.

For example, consider this grouping model, organized by the following categories:

• Emergency department referrals: acute injuries, suspected fractures, urgent surgical consults, trauma follow-up
• Primary care referrals: joint pain, mobility limitations, suspected orthopedic conditions, imaging review, specialist evaluation
• Post-operative follow-up requests: questions or concerns related to wound care, medications, pain changes, activity restrictions, or recovery complications
• Imaging-dependent referrals: cases requiring X-ray, MRI, CT, or radiology review before scheduling
• Physical therapy concerns: stalled progress, worsening pain, mobility regression, or questions about next steps  

An electronic health record (EHR) with configurable referral management workflows can support this process. For example, the referral tracking system from athenaOne® supports orthopedic referral management with category-based workflows. Additionally, AI capabilities in athenaOne can help accelerate this process.

The AI-powered Document Services workflow in athenaOne can automatically extract relevant clinical information from incoming faxes — a common referral channel — and save that data as discrete, reportable elements directly in the patient chart. Staff can spend less time manually reviewing and routing documents, and more time acting on them.  

Technology designed to support referral workflows can give teams greater visibility into referral status and help coordinate the steps required in closing the loop.

Match patients to the right in-network provider

As with intake triaging, orthopedic referrals need a similarly organized process to facilitate patient-to-provider matching. With clear routing in place, practices can use an EHR like athenaOne to help direct referrals to the appropriate in-network surgeon, joint specialist, or other provider.

When building that template, consider the following factors:

• Specialty, such as sports medicine, joint replacement, back/spine care, trauma, or other specialties
• Location, with a designated geographic radius of proximity for patients
• Appointment availability based on clinical urgency
• Insurance requirements, including prior authorizations and network limitations
• Surgeon's facility affiliation or hospital privileges, if inpatient surgery is needed
• Imaging requirements

Tools allowing patients to book based on their care needs can also help streamline this matching process. athenaOne's patient self-scheduling capability helps match appointment requests to the right visit type, provider, and time. This can help speed up access for referred patients and reduce the manual coordination burden on staff.

Track the referral lifecycle

While triaging and routing orthopedic referrals set up those referrals for success, those loops can remain open if the referral isn’t tracked from that point onward. This is why having a dedicated process to monitor referral status from intake through completion is essential.

Key milestones to track in that process include the following:

• Referral received
• Referral reviewed and triaged
• Patient contacted
• Visit booked
• Encounter completed
• Care plan generated
• Care plan initiated
• Follow-up scheduled
• Referrer notified

Because referral management depends on collaboration across care teams, interoperable technology can support the exchange of available referral information, imaging, visit notes, care plans, and follow-up updates across connected systems and participants. Having an AI co-pilot embedded into an Advanced Intelligence Layer and acting on data from a network of 173K+ clinicians can make a real difference in this capacity.⁵

athenaOne's Chart Assistant with Sage™ uses generative AI to scan all available clinical data across documents, charts, and clinical events to help clinicians get answers to key questions regarding longitudinal patient data. Chart Assistant can also generate summaries relevant to individual patients to assist with pre-encounter preparedness. For orthopedic teams managing high referral volumes, this means faster, more informed decision-making at every stage of the referral lifecycle.

Keep referred patients engaged

Referred patients may be lost to follow-up or have difficulty completing recommended care, particularly when communication gaps, cost, transportation, scheduling, or other access barriers interrupt the process. Patients may also experience uncertainty during clinician handoffs about medications, activity restrictions, and ongoing physical therapy — often not knowing whom to ask or where to go for information.

To reduce confusion and support follow-through, orthopedic specialists can aim to deliver clear, ongoing communication that keeps referred patients informed and connected to the next step in their care. Here again, athenaOne enables this type of sustained orthopedic patient engagement through appointment management and reminders, portal instructions, secure messaging, status updates, and patient education.  

For example, athenaOne's AI-powered communication tools — including Patient Conversations — allow staff to text directly with patients, while AI agents triage incoming messages, identify patient needs, and respond or escalate automatically as necessary. Additionally, proactive appointment waitlist scheduling will use AI to automatically identify and contact patients when appointment slots open, helping fill schedule gaps and get referred patients seen faster, even on the same day.

Support continuity after the referred patient's procedure

Care continuity after orthopedic procedures can include medication guidance, wound care, activity restrictions, device education, follow-ups, imaging, physical therapy, and more. Keeping referred patients engaged during that recovery process is critical to care coordination, given the prevalence of non-adherence to post-op care plans: one study found physical therapy compliance after surgery was just 64.3%, for example.6

athenaOne helps orthopedic practices extend referral tracking through those post-op recovery needs. AI-powered Intelligent Summaries in athenaOne can generate overviews of diverse clinical data, enabling clinicians to quickly access the insights they need to make more informed post-op decisions. And with the Clinically Inferred Diagnoses capability, native AI in athenaOne can leverage real-time updates from vitals, encounter summaries, lab results, and other chart data to surface insights that may help flag recovery complications earlier.

Get referral-ready with ortho-specific tools

Fueled by steady demand and an aging population, rising orthopedic referral volume can create significant operational pressure for specialty practices. By triaging referrals, matching patients to providers, tracking referral status, engaging patients, and extending coordination into post-op care, orthopedic practices can prepare for higher referral volumes with a practical, repeatable plan.

Importantly, purpose-built, AI-native technology provides more clarity and promotes care coordination to close those referral care loops. Designed to handle referrals at scale, athenaOne features the following essential components for everyday orthopedic workflows:

• Referral tracking
• Care coordination across specialties
• Patient communication through a single platform
• Automated reminders
• Interoperability
• Orthopedic-specific support

athenaOne for Orthopedics integrates these features and more into a single solution combining EHR, revenue cycle management, and patient engagement software and services. With shared visibility for multiple clinician stakeholders, orthopedic referral tracking, communication capabilities, and other ortho-specific tools, orthopedic practices like yours can get and stay referral-ready. Learn more about how athenaOne for Orthopedics can help.