S3010 Auto-Fax Intervention Improves Hepatology Referrals in a Dual EMR Urban Health System

Introduction: Dual electronic medical record (EMR) systems can disrupt referral workflows and patient continuity of care. In our urban health care center, EPIC is the EMR used in the outpatient clinics while Cerner is used for inpatient encounters and transplant institute visits. In September 2024, we implemented an auto-fax system that transmits EPIC referrals to hepatology providers and evaluated its impact on referral completion. Methods: We analyzed hepatology clinic referrals both preceding and following the auto-fax intervention deployed in September 2024. The primary outcome was the number of referrals. Secondary outcomes included completion rates (patients seen by hepatology) and how many previously missed referrals were recovered after the intervention. Results: From February 2024 to April 2025, 161 patients were referred to hepatology: Fifty-seven pre-intervention and 104 post intervention, representing an 82.5% increase. Referral completion improved significantly, with 25 of 57 patients (43.9%) seen before auto-fax, compared to 64 of 104 (61.5%) after (P < 0.001). Notably, 15 patients from the pre-intervention cohort (26.3%) recovered and scheduled through the new system. Conclusion: Dual-EMR systems can result in significant missed referrals and delayed access to care. This simple, low cost auto-fax intervention proved to be a powerful bridge between 2 EMRs without an existing interface. It led to a statistically significant increase in referral completion rates (from 43.9% to 61.5%, P < 0.001) and recovery of 26.3% of pre-intervention referrals. Additionally, the intervention was associated with an 82.5% increase in the number of referrals to hepatology, suggesting enhanced provider engagement and improved referral workflows. Future steps include expanding this model to other specialties and advocating for unified EMR integration to further reduce care gaps.