The AMA has warned against extending referral validity periods, but the medical software industry is all for it. There is a middle path.
If the Department of Health, Disability and Ageing was hoping for unanimous advice from the medical sphere on how to modernise referral pathways, it will be sorely disappointed.
Two of the major industry players – the AMA and the Medical Software Industry Association – made their respective submissions to the department’s consultation public this week. Each document contains a very different piece of advice on referral lengths.
While broadly supporting modernisation efforts, the AMA warned against increasing the default validity period of GP to non-GP specialist referrals from 12 months to two years, three years or indefinite.
“Exchange of information between GPs and non-GP specialists on at least a yearly basis is essential for patient safety,” the AMA wrote.
“Details of the patient’s medication, medical and family history and allergies must be kept up to date, along with any changes to the patient’s clinical risk, so the referral recipient can prescribe and treat safely.”
If the government were to increase the default validity, the AMA said non-GP specialists “would not agree to any new rules that would mandate them to notify a patient’s GP/referring medical practitioner when there is a change in treatment or medication”.
The MSIA, which represents the major IT vendors across primary and tertiary healthcare, wants to see GP to non-GP specialist referrals remain valid for 24 months by default.
“The 12-month default GP referral period and three-month specialist-to-specialist period reflect outdated episodic care,” the association wrote.
“Contemporary chronic and multidisciplinary care frequently extends beyond these timeframes.
“Appointment lead times alone can consume a significant portion of validity periods, particularly in high-demand specialties.”
To ensure ongoing communication between GPs and hospital specialists, the MSIA suggested strengthening communication expectations and supporting clinical software systems that can track referrals and deliver structured status updates.
“Policy settings should reinforce these communication standards rather than rely on referral expiry as a proxy mechanism for care coordination,” it said.
“Patients deserve this which reflects other aspects of their everyday digital lives.”
There is a middle path, though.
Related
New Zealand implemented a standard for electronic referrals to public hospital specialist services back in 2012.
The average time between a referral being sent and an acknowledgement arriving in the referrer’s inbox is three seconds.
The referrer also receives inbox notifications when the status of the referral changes from received to triaged, accepted or declined.
“We’re doing full referral journey management [in New Zealand], and I think that’s a concept which might not be fully looked at and doesn’t really come up in the [government consultation] paper,” Dr Carmel Cervin, CEO of New Zealand-based referral management software vendor Cervin, told The Medical Republic.
“That particular [submission] that the AMA has written, one of the solutions for that – rather than a new referral – is an addendum to a referral.
“What we have in New Zealand is an addendum function where a GP can update a referral without reissuing it.”
This is somewhere between the enforced GP-to-specialist communications point that the AMA is arguing should stay and entirely opening up referral validity.
According to the Cervin submission to the departmental consult, the addendum function “allows the referring GP to update a referral without starting a new one (e.g., test results, observations, change in condition), maintaining continuity of the referral record”.
“The primary risk [of longer referrals] is clinical drift – where a referral that was appropriate at the time of issue is no longer current by the time it is acted on,” the submission read.
“A patient’s condition, circumstances, or the treating GP’s clinical intent may have changed.
“Longer validity periods should be accompanied by functionality that allows referrals to be updated without being reissued.
“An addendum function – where a GP can update a referral without reissuing it – is one example of how this can be addressed, and is a feature [Cervin software] supports in New Zealand at the request of clinicians.
“Whatever form it takes, the system needs the flexibility to accommodate clinician-requested functionality as longer validity periods surface new operational needs.
“Without that kind of live referral management, a longer validity period is a regulatory change without a functional one to back it up.”
The solution to GPs being unable to manage patient care directly is not shorter referral periods, the consultation paper said, but better referral journey visibility.
