Over the past six months, I’ve made the transition from practicing as an Allergist/Immunologist at a large academic medical center to working at Ohio ENT and Allergy, a smaller multi-specialty private practice. In addition to cultural differences between these two settings, I’ve seen firsthand the differing communication infrastructure — and lack thereof — and how it impacts patient care.

Here’s one recent example: A patient was referred to me from her Ob/Gyn. After seeing the patient, I wanted to speak to the referring doctor to discuss her case, so I had my nurses call the Ob/Gyn office and leave a message with my cell phone number. She never called me back, but most disturbingly, I couldn’t be sure she ever received my message and number. She has her EHR system, and my practice has our own. They are not integrated, and if two specialists from different practices want to confer with one another, there’s usually no secure closed loop system that is compliant with patient privacy laws.

Yes, this is inconvenient and frustrating for doctors, but the real loss is felt by patients who risk falling through the cracks of the healthcare system due to inefficient coordination and the absence of a shared communication platform among their medical team.

So what are we in private practice to do? To start, we can take a glimpse at how communication is handled in academic medicine.

What Academic Medicine Is Doing Right

At the academic medical center where I used to work, our EHR system allowed physicians across various specialties to easily communicate. If a patient was referred to me by an orthopedic surgeon, a cardiologist, or an infectious disease specialist within our system, I could quickly review their notes. This level of transparency was crucial in managing complex cases because it provided a complete view of the patient’s medical history. More importantly, I could message these doctors directly within the EHR, seeking clarification or coordinating care plans, and I would receive a timely response.

For patients with complicated conditions requiring input from multiple specialists, this system was invaluable. It wasn’t uncommon for us to set up quick consultations or conference calls involving multiple specialists — for instance, allergists, oncologists, dermatologists, and infectious disease experts — all working together to ensure we offered the most comprehensive care.

The Private Practice Reality

After transitioning to private practice, I quickly realized that communicating with other specialists is much more cumbersome in this setting. For example, when a primary care physician refers a patient to me, their referral note is typically faxed, yes, faxed, over — using antiquated technology that feels straight out of the 1980s. My team faxes back a summary of the patient's visit, and while this system technically works, it is far from efficient.

In private practice, we rely on fax machines, phone calls, and even texting to communicate with other physicians. My practice colleagues and I share laminated cards with our cell phone numbers with referring doctors, making it easier for them to reach us. While this is a step in the right direction, it is far from ideal. Cell phones are not dedicated communication devices for patient care, and even though we can use HIPAA-compliant language, the system feels clunky, unreliable, and prone to breakdowns.

The Impact on Patients

Needless to say, the lack of a unified communication system among private practice physicians creates silos. This fragmentation can delay patient care, lead to miscommunications, and even produce conflicting treatment plans. I’ve had patients come to me confused by contradictory advice from multiple specialists, and I’ve had to piece together fragmented information because I couldn’t easily contact the other doctors involved.

This problem is exacerbated in cases where multiple specialists need to collaborate on a patient’s care. For instance, consider a condition like eosinophilic esophagitis, which requires close coordination between an allergist like me and a gastroenterologist. In an ideal system, we’d be able to quickly consult with one another about changes in the patient’s condition or treatment plan. Instead, we’re left relying on fax machines and phone messages.

The Solution: Modernizing Communication

The private practice ecosystem needs to adopt communication systems that mirror those used at large academic medical centers. I know there are companies working on solving some of these challenges and I’m curious if anyone in private practice has experience with them. I’d love to learn from you all what has worked (and not) as I look for solutions at my practice.

In my opinion, powerful approaches to chipping away at this problem include:

Utilizing Integrated, HIPAA-Compliant Messaging Platforms.

Private practices need secure messaging systems that allow physicians to communicate directly with those of another practice, regardless of which EHR they use. Whichever platform is used should be HIPAA-compliant and designed specifically for physicians to discuss patient care. By adopting systems that integrate with various EHRs, we could streamline communication between specialists and primary care doctors, leading to better-coordinated care. When necessary, this might even allow for case discussions similar to those in academic medicine.

Here’s some good news: a secure messaging system already exists through Doximity. On rare occasions, I’ve even been contacted by a colleague at an outside institution through the Doximity network. While this does not seem to have been widely adopted in practice, there is evidence that it can be achieved.

Centralized Record-Sharing Systems

One of the biggest advantages of working in an academic medical center was the ability to view a patient’s complete medical record, including notes from all specialists involved in their care. Implementing a secure system that facilitates record sharing between team members, even across different private practices, would allow physicians to access the information they need without relying on outdated fax machines and the numerous steps required to use them.

Changing the Culture

In addition to technological solutions, we also need to change the communication culture in private practice. Physicians should feel empowered to reach out to their colleagues without fearing they’ll be seen as intrusive or bothersome. This collaborative mindset is second nature in academic centers, but private practices often operate in silos, with each physician focusing primarily on their own domain.

Building a culture of communication in private practice will require time and effort, but the benefits are clear: better-coordinated care, fewer medical errors, and improved patient outcomes. If we can promote this culture and adopt technology that enables it, we can significantly improve how we deliver care in the outpatient setting.

Join the Discussion

What can we do to increase collaboration and coordination among specialty practices? When have you seen this done right? Is leveraging what works in academic medicine a viable solution? I’d love to hear from you all, learn your perspective, and share best practices.