How do hospitals deliver results to referring physicians?

Four methods are common: a secure clinician portal the physician logs into, Direct secure messaging (clinician-to-clinician electronic delivery), an electronic HL7 interface into the physician's own EHR, and fax. Many hospitals use a mix, and fax remains surprisingly common despite its drawbacks.

Why is fax still used for results, and what's wrong with it?

Fax persists because it works with any practice and requires no integration. But it's push-only and point-in-time: the referring physician gets what was sent when it was sent, with no way to pull updated or additional results, no real-time view, and no audit trail the physician controls. Faxed records also arrive late and can be missed, which contributes to gaps in follow-up.

What's the advantage of a portal over Direct messaging or an interface?

Direct secure messaging and HL7 interfaces are good at pushing a result at the moment it's ready, but they deliver a snapshot. A portal lets the referring physician pull the current, complete picture whenever they need it — labs, medications, imaging, documents — for their own patients, on a read-only, audited basis. The approaches are complementary: push notifies, pull gives the full view.

Does results delivery to outside physicians create a compliance risk?

It involves PHI, so it has to be governed: access scoped to the physician's own patients, every view audited, and ideally no data copied out of the hospital's control. A read-only portal that runs in the hospital's environment and logs every access is built to meet exactly that bar.

Referrals & physician engagement

Delivering results to referring physicians: portal, Direct, HL7, or fax

Updated June 2026 · Reviewed by David Higginson, CHIME Innovator of the Year

The referral isn't done when the patient is seen — it's done when the referring physician gets the results back. How a hospital delivers those results decides whether the loop actually closes.

Results delivery is the process of returning a patient's clinical results — labs, imaging, reports — to the physician who referred them. Hospitals do it four main ways: a secure clinician portal the physician logs into, Direct secure messaging (electronic, clinician-to-clinician), an electronic HL7 interface into the physician's EHR, and fax. Each has trade-offs in timeliness, completeness, and how governable it is.

The four methods, and their trade-offs

Fax. Universal and needs no integration — which is why it persists — but push-only and point-in-time. The physician gets what was sent, when it was sent, with no way to pull more, no real-time view, and records that often arrive late.
Direct secure messaging. Electronic and standards-based; delivers a result clinician-to-clinician at the moment it's ready. Still a push of a snapshot rather than an on-demand, complete view.
HL7 interface. Pushes results straight into the physician's own EHR — excellent when the practice has the integration, but it requires building and maintaining an interface per practice.
Secure portal. The physician pulls the current, complete picture for their own patients whenever they need it — read-only and audited. No per-practice interface to build, and not limited to a single moment in time.

Push notifies; pull gives the full picture

These methods aren't mutually exclusive — the best setups combine them. A push (Direct or an interface) is good at telling a physician "a result is ready." A pull (a portal) is what lets them see everything — labs, medications, problems, imaging, documents — in real time, without calling the hospital or waiting on the next fax. For care coordination, the pull view is what closes the gap.

Doing it without creating a compliance problem

Results delivery to outside physicians is PHI by definition, so it has to be governed: access scoped to the physician's own patients, every view logged, and nothing copied out of the hospital's control. A read-only portal that runs in the hospital's environment meets that bar by design — see HIPAA-compliant hospital portals for the underlying requirements.

Where this fits at Bluefish

HealthPoint gives referring physicians a real-time, read-only view of their own patients' labs, medications, problems, imaging and documents — no fax dependency, no nightly batch — alongside referral status tracking. For the bigger picture, start with what a community physician portal is.

Sources: HealthIT.gov (ONC) — health information exchange basics · HL7 International — standards.

Frequently asked questions

How do hospitals deliver results to referring physicians?: Four methods are common: a secure clinician portal the physician logs into, Direct secure messaging (clinician-to-clinician electronic delivery), an electronic HL7 interface into the physician's own EHR, and fax. Many hospitals use a mix, and fax remains surprisingly common despite its drawbacks.
Why is fax still used for results, and what's wrong with it?: Fax persists because it works with any practice and requires no integration. But it's push-only and point-in-time: the referring physician gets what was sent when it was sent, with no way to pull updated or additional results, no real-time view, and no audit trail the physician controls. Faxed records also arrive late and can be missed, which contributes to gaps in follow-up.
What's the advantage of a portal over Direct messaging or an interface?: Direct secure messaging and HL7 interfaces are good at pushing a result at the moment it's ready, but they deliver a snapshot. A portal lets the referring physician pull the current, complete picture whenever they need it — labs, medications, imaging, documents — for their own patients, on a read-only, audited basis. The approaches are complementary: push notifies, pull gives the full view.
Does results delivery to outside physicians create a compliance risk?: It involves PHI, so it has to be governed: access scoped to the physician's own patients, every view audited, and ideally no data copied out of the hospital's control. A read-only portal that runs in the hospital's environment and logs every access is built to meet exactly that bar.