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My Experience with Healthcare Referrals and Why Most Practices Could Face Huge Fines if Caught

Whats your referral storyRecently a friend had some chest pains, thinking it was just indigestion or stress, decided to wait it out, of course till his wife found out and “asked” him to go see their family practitioner.



This is where the story takes a turn for the worse.

After going in for a quick checkup, the doctor referred my friend to a specialist for a stress test to see if anything was out of the ordinary.   This referral was written on a triplicate form and handed to my friend to call the other practice to schedule an appointment.


My friend waited a few days and called to make an appointment. During the call the referral coordinator asked him to fax in the paper triplicate form to their office.


When my friend replied, I do not have a fax machine, can I email it to you.  The staff said “I do not know the practice’s email, but you can email it to my personal gmail account.”


Now for those that do not know, emailing documentation is against HIPAA privacy rules, and even worse, sending it to a staff’s private account where they can view personal information about the patient is against the law and carry huge fines. I have heard many similar stories from other people, so its a lot more common than you think. This is a huge problem that has not been addressed in today’s healthcare referral system.

Great infographic discussing the fines

Check out this detailed infographic about our healthcare system and the fines that could be coming your way soon.


Want more details about HIPAA Breaches? Look no further, check out an article we wrote called “Healthcare’s Dirty Secret – 15 Million Patient’s Private Information Exposed Since 2009

My Family Experience

Unfortunately these stories are not just about my friends. My personal story is one of my mother that has been in and out of the hospital and doctor offices for my entire life. Having to see her deal with her illnesses pains me everyday, but seeing her stay strong keeps me motivated to work hard and fix some of the issues plaguing the healthcare industry. The constant stream of misplaced and lost referrals has been the norm for over 30 years of my mother’s life and is the reason I started ReferralMD in the first place.


I have heard so many horror stories about patients asking to courier their own documents and the doctors not having access to up-to-date information about the patient’s reason for referral.  It upsets me that the communication gap between providers has grown so big.

Taking Action

Everyday I see my mother’s health slowly deteriorate due to a car accident in her youth and Parkinson’s disease that is aggressively getting worse where she can no longer walk without assistance.  With the ever changing cocktail of drugs that are assigned for her to take, her body can no longer manage which causes her to fall a lot. I hope to make things better in some small way for her and others in her position by changing how we communicate information. The fax machine is outdated and has no place in modern society.

Please share your story

If you have a personal story to tell about a loved one and how our current healthcare system can be improved, we would love to hear from you.



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Jonathan has a proven record of entrepreneurial success in the healthcare field. As the founder and CEO of ReferralMD, he is responsible for designing the framework of ReferralMD, while managing enterprise sales, marketing and channel development.
  • Pam Brammann

    I couldn't agree with this article more.

    Because I work within international healthcare, I have noticed that all the other countries use an advanced technology called email. It's time for the USA to catch up.

    Email is convenient, fast and most everyone has access to email whereas only businesses have access to fax machines.

    Plus if the doctor and patient agree to use email communication, why does the government need to intervene?

    • Glad you mentioned this, standard email like gmail etc are not HIPAA secure due to the fact that they transverse normal internet lines and are not protected. But we at referralMD are making an application that functions like email, simple inbox/outbox functionality for referrals.

      Stay in touch and thanks for the comment, look forward to working with you.

  • Pam Brammann

    I couldn't agree with this article more.

    Because I work within international healthcare, I have noticed that all the other countries use an advanced technology called email. It's time for the USA to catch up.

    Email is convenient, fast and most everyone has access to email whereas only businesses have access to fax machines.

    Plus if the doctor and patient agree to use email communication, why does the government need to intervene?

    • Glad you mentioned this, standard email like gmail etc are not HIPAA secure due to the fact that they transverse normal internet lines and are not protected. But we at referralMD are making an application that functions like email, simple inbox/outbox functionality for referrals.

      Stay in touch and thanks for the comment, look forward to working with you.

  • referralmd

    Glad you mentioned this, standard email like gmail etc are not HIPAA secure due to the fact that they transverse normal internet lines and are not protected. But we at referralMD are making an application that functions like email, simple inbox/outbox functionality for referrals.

    Stay in touch and thanks for the comment, look forward to working with you.

  • referralmd

    Glad you mentioned this, standard email like gmail etc are not HIPAA secure due to the fact that they transverse normal internet lines and are not protected. But we at referralMD are making an application that functions like email, simple inbox/outbox functionality for referrals.

    Stay in touch and thanks for the comment, look forward to working with you.

  • One frustrated doctor

    If patients themselves choose to share his/ her medical information, no matter if it electronically or by snail mail, which can be opened, but nobody seems to sweat that one, then it is not against HiPAA. Using that fax machine is no more “secure” than standard email, but it is used all the time. How often are these forms of communication hacked?

    Furthermore, there are guidelines regarding use of normal email and fax lines for the sharing of information in order to facilitate patient care. BUT, because of the extreme measures demanded like in this blog, practices are now deciding that they are forced to use “HIPAA Secure” fax and email, etc., only increasing the cost of your healthcare. How much does the secure email service provided here by ReferralMD cost? Who will pay for that?

    Now there is HIPAA secure text. ($$) What is next? HIPAA secure telephones? They are no more “secure” than that fax or email. Are landlines OK, but cell phones are not? Secure rooms for doctor to doctor discussions? Top secret booths for nurses to share patient information on hospital patients?

    Where does this end?

    • I agree with your points, there needs to be an easier way to transmit this info, issue with email is that there is no real tracking methods or reporting. Also if the staff quit, she has access to information that she shouldn’t have. Texting also can not be audited properly, although it is a good method to get information instantly.

      Appreciate the comments!

      • one frustrated doctor

        Who needs to “track” or “report”? when did medicine become something tracked, audited, reported, etc?
        Who audits text messages? For what purpose?

        What happened to medicine being between a patient and the physician?

        • If you refer all your patients somewhere, do you not want to know that they were actually seen, and when? and how long that referral took to process? These questions come up a lot when using a FAX based system that does not have any tracking features built in. Also 70 percent of the time referrals are not handled correctly, and its a good idea to have a proper audit to how these referrals were handled, and by whom.

  • One frustrated doctor

    If patients themselves choose to share his/ her medical information, no matter if it electronically or by snail mail, which can be opened, but nobody seems to sweat that one, then it is not against HiPAA. Using that fax machine is no more “secure” than standard email, but it is used all the time. How often are these forms of communication hacked?

    Furthermore, there are guidelines regarding use of normal email and fax lines for the sharing of information in order to facilitate patient care. BUT, because of the extreme measures demanded like in this blog, practices are now deciding that they are forced to use “HIPAA Secure” fax and email, etc., only increasing the cost of your healthcare. How much does the secure email service provided here by ReferralMD cost? Who will pay for that?

    Now there is HIPAA secure text. ($$) What is next? HIPAA secure telephones? They are no more “secure” than that fax or email. Are landlines OK, but cell phones are not? Secure rooms for doctor to doctor discussions? Top secret booths for nurses to share patient information on hospital patients?

    Where does this end?

    • I agree with your points, there needs to be an easier way to transmit this info, issue with email is that there is no real tracking methods or reporting. Also if the staff quit, she has access to information that she shouldn’t have. Texting also can not be audited properly, although it is a good method to get information instantly.

      Appreciate the comments!

      • one frustrated doctor

        Who needs to “track” or “report”? when did medicine become something tracked, audited, reported, etc?
        Who audits text messages? For what purpose?

        What happened to medicine being between a patient and the physician?

        • If you refer all your patients somewhere, do you not want to know that they were actually seen, and when? and how long that referral took to process? These questions come up a lot when using a FAX based system that does not have any tracking features built in. Also 70 percent of the time referrals are not handled correctly, and its a good idea to have a proper audit to how these referrals were handled, and by whom.

  • One frustrated doctor

    Furthermore, how will the medical office worker not see the information the man provides on his triplicate form? He has already discussed the medical problem with her/ him, so why the agitation about fax vs email? I agree that the practice should be using only an practice email, not a personal email account, but the office worker will see the information, no matter the route of transmission. That worker is bound by HiPAA not to share the info with her family during dinner that evening.

    • I think the real concern with referrals though is that patients lose the referral form a lot, I know my mother and sister do. And putting private info that can be lost in the hands of patients is not always the best idea, 1. They can miss out on treatment that could be time sensitive, and 2. their information could be found by someone else that should not be seeing it. Even worse is the fact that patients are asked to courier this information, and if they forget it when they go to the office for the appointment they are asked to go back and get it. The current system is just not patient friendly.

      • one frustrated doctor

        I could not disagree more. First the issue is the “security” of electronic transmissions, now the issue is lost referrals? If the referral is lost, then couldn’t a simple phone call suffice to obtain a new one? So now patients are at risk of losing their own information, and we have to protect them from that? That is not a HIPAA violation. HIPAA is for the purpose of the medical community to protect the privacy of patient’s medical information, not the purpose of protecting the patients from how they themselves handle their own private medical information; that is their business, and they are not children. We have moved away from paternalistic medicine.

        If one feels patients lose referrals or should not be expected to courier their own information, then we pick up the phone and request a new referral be faxed. Even xrays can be sent electronically. Easy fix, has been in place for years. As noted earlier, all businesses have fax. we understand that many people do not have them in their homes.

        Why does nobody get upset about mailing information? I get my personal lab results in the mail from my primary doctor in the mail. It never bothered me that this is not “secure.’ Who really cares what my most recent cholesterol levels are?

        • For one, the FAX is 50 years old, just because everyone has one does not mean its a good piece of technology.

          Also just given the time and cost to process referrals using paper and fax and how much it is to manage the system is one reason to change. Most offices we work with spend 3 to 8 hours a day processing referrals the old way, with an electronic referral tracking software it can be reduced to minutes.

          Also…Here is some facts for you about healthcare and referrals.http://getreferralmd.com/2012/04/healthcare-infographics/

          Our studies show that using an electronic referral system can save most practitioners 1,000s a year in direct labor and hard costs. Ask your staff how much time they spend faxing and get back to us.

          Thanks for the great debate.

          • One frustrated doctor

            The system you propose here could be more efficient than current measures, which is wonderful, so why not market it as such?

          • Appreciate your comments, have you had a chance to review our homepage for this type of information – http://getreferralmd.com . I would like to hear your feedback and what ideas you have to optimize our site further.

      • Kelly Osburn

        It still isn’t. Just TRY to get a referral to a pain management clinic. Be sure and try not to trip over the many hoops you must jump through to do so.

  • One frustrated doctor

    Furthermore, how will the medical office worker not see the information the man provides on his triplicate form? He has already discussed the medical problem with her/ him, so why the agitation about fax vs email? I agree that the practice should be using only an practice email, not a personal email account, but the office worker will see the information, no matter the route of transmission. That worker is bound by HiPAA not to share the info with her family during dinner that evening.

    • I think the real concern with referrals though is that patients lose the referral form a lot, I know my mother and sister do. And putting private info that can be lost in the hands of patients is not always the best idea, 1. They can miss out on treatment that could be time sensitive, and 2. their information could be found by someone else that should not be seeing it. Even worse is the fact that patients are asked to courier this information, and if they forget it when they go to the office for the appointment they are asked to go back and get it. The current system is just not patient friendly.

      • one frustrated doctor

        I could not disagree more. First the issue is the “security” of electronic transmissions, now the issue is lost referrals? If the referral is lost, then couldn’t a simple phone call suffice to obtain a new one? So now patients are at risk of losing their own information, and we have to protect them from that? That is not a HIPAA violation. HIPAA is for the purpose of the medical community to protect the privacy of patient’s medical information, not the purpose of protecting the patients from how they themselves handle their own private medical information; that is their business, and they are not children. We have moved away from paternalistic medicine.

        If one feels patients lose referrals or should not be expected to courier their own information, then we pick up the phone and request a new referral be faxed. Even xrays can be sent electronically. Easy fix, has been in place for years. As noted earlier, all businesses have fax. we understand that many people do not have them in their homes.

        Why does nobody get upset about mailing information? I get my personal lab results in the mail from my primary doctor in the mail. It never bothered me that this is not “secure.’ Who really cares what my most recent cholesterol levels are?

        • For one, the FAX is 50 years old, just because everyone has one does not mean its a good piece of technology.

          Also just given the time and cost to process referrals using paper and fax and how much it is to manage the system is one reason to change. Most offices we work with spend 3 to 8 hours a day processing referrals the old way, with an electronic referral tracking software it can be reduced to minutes.

          Also…Here is some facts for you about healthcare and referrals.http://getreferralmd.com/2012/04/healthcare-infographics/

          Our studies show that using an electronic referral system can save most practitioners 1,000s a year in direct labor and hard costs. Ask your staff how much time they spend faxing and get back to us.

          Thanks for the great debate.

          • One frustrated doctor

            The system you propose here could be more efficient than current measures, which is wonderful, so why not market it as such?

          • Appreciate your comments, have you had a chance to review our homepage for this type of information – http://getreferralmd.com . I would like to hear your feedback and what ideas you have to optimize our site further.

      • Kelly Osburn

        It still isn’t. Just TRY to get a referral to a pain management clinic. Be sure and try not to trip over the many hoops you must jump through to do so.