Facilitators and barriers to implementing electronic referral and/or consultation systems: a qualitative study of 16 health organizations
Open accessAbstract
BACKGROUND: Access to specialty care remains a challenge for primary care providers and patients. Implementation of electronic referral and/or consultation (eCR) systems provides an opportunity for innovations in the delivery of specialty care. We conducted key informant interviews to identify drivers, facilitators, barriers and evaluation metrics of diverse eCR systems to inform widespread implementation of this model of specialty care delivery. METHODS: Interviews were conducted with leaders of 16 diverse health care delivery organizations between January 2013 and April 2014. A limited snowball sampling approach was used for recruitment. Content analysis was used to examine key informant interview transcripts. RESULTS: Electronic referral systems, which provide referral management and triage by specialists, were developed to enhance tracking and operational efficiency. Electronic consultation systems, which encourage bi-directional communication between primary care and specialist providers facilitating longitudinal virtual co-management, were developed to improve access to specialty expertise. Integrated eCR systems leverage both functionalities to enhance the delivery of coordinated, specialty care at the population level. Elements of successful eCR system implementation included executive and clinician leadership, established funding models for specialist clinician reimbursement, and a commitment to optimizing clinician workflows. CONCLUSIONS: eCR systems have great potential to streamline access to and enhance the coordination of specialty care delivery. While different eCR models help solve different organizational challenges, all require institutional investments for successful implementation, such as funding for program management, leadership and clinician incentives.
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Little evidence exists about factors influencing eConsult adoption and implementation.
“However, little evidence exists about these factors and how they influence eConsult adoption and implementation.16”
From Barriers and facilitators for implementation of electronic consultations (eConsult) to enhance access to specialist care: a scoping review (2019) · cites this paper as [16]
The Methods (Analysis) mention previously published factors influencing eCR adoption, and the Results identify drivers and facilitators in the organizations studied. Neither passage assesses whether evidence about those factors or their influence on eConsult adoption and implementation is scarce. Searches for statements about limited evidence and few prior studies found no such assessment in our copy. (LLM, conf=0.68)
Experimental — accuracy not yet measuredThere are gaps in the existing evidence on the spread and scale-up of video consulting, particularly in relation to interorganizational networking, which is critical in enabling and sustaining innovation and yet is not explored in-depth.
“There are gaps in the existing evidence on the spread and scale-up of video consulting. This was particularly the case in relation to interorganizational networking, which is critical in enabling and sustaining innovation [24,30,64], and yet is not explored in-depth.”
From Spread, Scale-up, and Sustainability of Video Consulting in Health Care: Systematic Review and Synthesis Guided by the NASSS Framework (2021) · cites this paper as [64]
Findings from the review pointed to potential enablers of spread and scale-up of video consulting services, notably the presence of a telehealth champion, especially during initial spread, as well as leadership at multiple levels, appropriate reimbursement mechanisms, user-friendly technology, pre-existing relationships between staff, and adaptation of technology and services over time.
“Findings from the review pointed to potential enablers of the spread and scale-up of video consulting services, notably regarding the influence of the presence of a telehealth champion, especially during initial spread [63], as well as leadership at multiple levels, appropriate reimbursement mechanisms, user-friendly technology, pre-existing relationships between staff [64], and adaptation (of”
From Spread, Scale-up, and Sustainability of Video Consulting in Health Care: Systematic Review and Synthesis Guided by the NASSS Framework (2021) · cites this paper as [64]
Findings from the review raised challenges including technically challenged staff, resistance to change, cost, reimbursement, patient characteristics, project management, patient recruitment, leadership involvement, funding, absence of a long-term strategic plan, workflow changes, lack of resources, and liability.
“Findings also raised a number of challenges including the following: technically challenged staff, resistance to change, cost, reimbursement, and patient characteristics [24], as well as project management, patient recruitment, leadership involvement, funding, absence of a long-term strategic plan, resistance to change, workflow changes, lack of resources, and liability [64-66].”
From Spread, Scale-up, and Sustainability of Video Consulting in Health Care: Systematic Review and Synthesis Guided by the NASSS Framework (2021) · cites this paper as [64]
Interorganizational networking is critical in enabling and sustaining innovation.
“This was particularly the case in relation to interorganizational networking, which is critical in enabling and sustaining innovation [24,30,64], and yet is not explored in-depth.”
From Spread, Scale-up, and Sustainability of Video Consulting in Health Care: Systematic Review and Synthesis Guided by the NASSS Framework (2021) · cites this paper as [64]
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References 25 · Cited by 98
Research works printed but not linked: 2
- [14]Tuot DS, Murphy EJ, McCulloch CE, Leeds K, Chan E, Chen AH: Leveraging an electronic referral and consultation system to provide high quality corrindated specialty care. Health Care: The Journal of Delivery Science and Innovation In press.
- [26]Liddy C Rowan MS Afkham A Maranger J Keely E Building Access to specialist care through e-consultation Open Med 2013 7 1 31 8 PMC3654501 23687533
- Authors
- Tuot, D. S., Leeds, K., Murphy, E. J., Sarkar, U., Lyles, C. R., Mekonnen, T., & Chen, A. H.
- Affiliations
- San Francisco General Hospital (US)
- Corresponding author
- Tuot, Delphine S.
- Venue
- BMC Health Services Research
- Published
- 2015-06
- Volume
- 15
- Issue
- 1
- Pages
- 568-568
- ISSN
- 1472-6963 (ISSN-L)
- PMC
- PMC4684927
- OpenAlex
- W2203273726
- Cited by
- 98
- References
- 25
- Citations by year
- 2026: 1 · 2025: 6 · 2024: 9 · 2023: 7 · 2022: 17 · 2021: 12 · 2020: 11 · 2019: 8 · 2018: 13 · 2017: 9 · 2016: 5
- FWCI
- 19.79
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- BMC Health Services Research (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- eScholarship (California Digital Library) (submittedVersion)
- Funders
- California Health Care Foundation
- Department of Science and Technology, Ministry of Science and Technology, India
- National Institutes of Health (UL1TR000004, 5k23dk094850-04, TR000004)
- University of California, San Francisco (TR000004, UL1-TR000004)
- National Institute of Diabetes and Digestive and Kidney Diseases (K23-DK-094850)
- National Center for Advancing Translational Sciences (UCSF-CTSI Grant Number UL1 TR000004, TR000004)
- Topics
- Social Sciences › Business, Management and Accounting › Organizational Behavior and Human Resource Management › Healthcare Systems and Technology
- Health Sciences › Health Professions › Health Information Management › Electronic Health Records Systems
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Telemedicine and Telehealth Implementation
- Keywords
- electronic referral system, e-consultation, access to specialist care, implementation barriers and facilitators, clinician leadership, clinician workflow, health care delivery organization, referral management
- MeSH terms
- Automation, Diffusion of Innovation, Health Facilities, Humans, Interviews as Topic, Primary Health Care, Referral and Consultation, Specialization, United States, Qualitative Research
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