Patient Referrals — what’s next

Saeed Zeinali
7 min readAug 31, 2018

Canada’s healthcare system is outdated. Physicians, today, continue to rely on fax referrals while there is no certain way to know whether the fax has been received on the other end, or if it has even been received by the intended recipient. Specialists often receive referrals that are not within their scope of practice, and therefore, send it back to the physician resulting in prolonged wait times.

This process causes unnecessary complications that have previously cost some patients their lives. St. Joseph’s Healthcare, in Hamilton, executed a study that identifies wait times for specialist referrals and barriers to getting timely appointments. The study showed that up to 21% of consultation requests did not receive a response from specialists’ offices [1]. This study show how we desperately need better communication between physicians and specialists.

In a previous article, we discussed this issue in detail.

But the good news is that the doctors and policy makers are realizing how inefficient and , and some have already sought out smarter and safer alternatives. In this blog we will explore some of the main emerging alternatives in Canada.

ConsultLoop [2]*

ConsultLoop is first on the agenda as one of the emerging alternatives to referral systems found in Canada. Located in Toronto, Ontario, they are a company founded by family doctors who were sick and tired of the referral system in Canada and found a way to solve it without disrupting a clinic’s day-to-day workflow. This is done through the use of a combination of technology and trained staff which helps cut down wasted administrative time on mismanaged referrals and reduces no-shows. They also have one of the largest directory of specialists in Ontario and the only one with up-to-date wait times which allows you to connect with the right specialist.

For the patients, this product is a way to allow them to get notifications about the e-referral process and learn more about appointment. By engaging the patients in the process of care, ConsultLoop has been able to bring transparency to the process of care.

For family doctors, this allows them to find the right specialist for their patients while not being obligated to follow up with the specialist about the appointment. ConsultLoop also allows family doctors to not worry about the back and forth with the specialist and unattended referrals as ConsultLoop would be the one that will be communicating with the specialists. Also, thanks to ConsultLoop’s patient engagement feature, a sizeable portion of patients confirm their appointments themselves.

For the specialists, it becomes less of a hassle to inform the doctors about the appointments and it reduces the chances of no-shows and referral leakage.

If you want to learn more about ConsultLoop, go to their website at

Ocean Referral[3]

Ocean Referral is a company created by Cognisant MD. Based in Toronto,Canada, they are mainly focused on specialists at hospitals rather than clinics in the community. Ocean allows patients and healthcare providers to securely share health information for the referral process.

There are many features and benefits for both specialist and referring physicians. For referring clinicians, their directory provides a map-based, “virtual shared address book” updates as you scroll across the map. Clinicians also can automatically populate any referral form on the directory with patient contact information and the clinician signature if they are using certain EMRs. Ocean Referral also provide secure document exchange and faster referral process as the referral is done online while its files are encrypted that only the specialist have the key to it. Any details of the referral and its status are automatically updated in the patient chart. They also enable feedback from the specialist (or vice versa) in Ocean Portal. The referring clinicians would get an email notification to alert them of feedback.

For specialist and other referring healthcare providers, the features and benefits are similar to the referring clinician like feedback, customizable referral form but they also have the opportunity to do other things too. They can share their details about their clinic and wait times. Patients also have the choice of confirming their appointment online which saves time and reduces the chance of no-shows.

If you want to learn more about them, visit to learn more.

Novari Health[4]

Another alternative on the agenda is Novari Health with their program “Novari eRequest”. They consist of a platform which includes a series of integrated modules (ex: Novari eRequest) and is the only system available that electronically manages the complete continuum of care, from primary to specialist care and hospital-based care.

Some features that Novari Health provides to their users are providing complete and appropriate referrals, displaying the status of each referral as it moves through the system, better resource planning data, etc. to name a few. Novari also provides referral pathways for pharmacy orders, diagnostics imaging and certain conditions such as mental health.

Novari Health also provides “eConsult” feature which enables clinical two-way conversation in a secure manner and in compliance with privacy legislation. This is important because it saves time that would be wasted in making and waiting for phone calls, waiting for patients referrals to be faxed, etc. It also provides clinicians a way to see whether they are the best fit for their patient’s needs or not.

For more information about their service as a whole or specifically Novari eRequest go to


Up next on the agenda for an emerging alternative to fax referrals is ezReferral. Based in Edmonton, Alberta, ezReferral is similar to many other alternatives talked about here with the fact that they focus on using electronic referral system to help build a secure, efficient process. EzReferral allows patients to bein the loop with referral status, appointment reminders, email or phone calls, name a few features that ezReferral offers with their product.

For ezReferral, they want to help build a better system than the current referral system that will benefit patients, referring physicians, specialists, and staff members. All four have different problems with the current referral system and ezReferral does their best to provide the best solution to these problems.

For referral physicians, they would have access to tracking, confirmation, e-consult, and audit trails while keeping their patients happy. This will allow for better patient relationship and care for referring physicians.

For specialists, ezReferral promises for accurate, correct and complete information while allowing you to focus more about patient care and less about administration. Specialists also have access to e-consult which is something that few companies provide currently.

If you want to learn more about them, go to

Alberta Netcare[6]

Alberta Netcare is the name for the projects relating toAlberta’s public electronic health record (EHR). The e-referral system leverages the already existing information on Netcare such as demographics

Launched in 2014 where it was only limited to hip and knee joint replacement and routine medical/radiation oncology for breast and lung cancer, it is now used for other types of medical specialization like nephrology, urology, etc. It was developed by clinicians in Alberta for their fellow clinicians who felt the pains of using the old referral system.

According to their website, the e-referral system is being used for different specialties in different zones (Calgary zone, Edmonton Zone and Central Zone) but Ophthalmology referrals are managed through their e-referral platform province-wide.

In all, Alberta Netcare e-Referral system is something that already a big thing in Alberta and if the project is successful, this can be a model to be followed by other provinces as well.

If you would like to learn more about their e-Referral service, go to


As discussed here, there are quite a few private and publicly funded initiatives in the space. For private companies, the challenge is to make money and for public initiatives the challenge is to get uptake as their solutions usually does not appeal to the doctors. It appears that the ultimate solution is not a software. As there is no possible integration between different EMRs used at different clinics, a software solution will only add to the workflow of the referring physician and the consultant. Also, a sizeable percentage of clinics, are still using a fax machine to send and receive fax referrals (and not an API fax). So a software solution can never have 100% penetration.

Another challenge is the incentive structure. The current payments and billing codes, do not incentify or penalize any of the parties to manage referrals. This lack of accountability and motivation, makes innovation in this space in particular challenging. Except a few specialists who are actively looking for referrals, majority of consultants have a long wait time and are not looking for more patients. Family doctors do not make any more money if the patient gets their appointment faster. Majority of them think its on the specialist to receive the patient as they are billing for that visit. A big portion of specialists send the appointment time back to the family doctor office and expect them to let the patient know. All and all, the current system is a chaos! This makes it very hard to define a business model around referrals. The only party who seems to be incentified to care about referrals is the patient themselves.

A tech-enabled service solution could be a viable solution though, if the payer is identified. Imagine a group of trained staff empowered by OCR technology and advanced CRM tools to take care of referrals efficiently.


[1] Guerriere, M. (2017, July 28). Beyond the fax machine. Retrieved from

[2] “Patient E-Referrals Toronto, Patient E-Referrals Ontario.” Consultloop, Accessed: 22 May 2018.

[3] Ocean Referral. Ocean by Cognisant MD, Accessed: 24 May 2018.

[4] “EzReferral.” EzReferral,, Accessed: 23 May 2018.

[5] Vincent, Denis. “Why the Fax Machine Is an Essential Referral Tool.” EzReferral Blog, EzReferral, Accessed 23 May 2018.

[6] eReferral. Alberta Netcare EHR, Accessed: 23 May 2018.

[7] Healthcare Software, Medical Software — Access to Care

*I have a working relationship with the ConsultLoop team.



Saeed Zeinali

Healthcare, Business and Tech enthusiast. Passionate about arts, food, and road-running.