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BMC Health Services Research
Published in: BMC Health Services Research 1/2015

Open Access 01-06-2015 | Research article

Facilitators and barriers to implementing electronic referral and/or consultation systems: a qualitative study of 16 health organizations

Authors: Delphine S. Tuot, Kiren Leeds, Elizabeth J. Murphy, Urmimala Sarkar, Courtney R. Lyles, Tekeshe Mekonnen, Alice Hm Chen

Published in: BMC Health Services Research | Issue 1/2015

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Abstract

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.
Appendix
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Literature
1.
Cook NL, Hicks LS, O’Malley AJ, Keegan T, Guadagnoli E, Landon BE. Access to specialty care and medical services in community health centers. Health Aff (Millwood). 2007;26(5):1459–68.CrossRef
2.
Forrest CB, Nutting PA, von Schrader S, Rohde C, Starfield B. Primary care physician specialty referral decision making: patient, physician, and health care system determinants. Med Decis Making. 2006;26(1):76–85.CrossRefPubMed
3.
Felt-Lisk S, McHugh M, Howell E. Monitoring local safety-net providers: do they have adequate capacity? Health Aff (Millwood). 2002;21(5):277–83.CrossRef
4.
Singer SJ, Reyes Nieva H, Brede N, Ling J, Leydon N, Weissman JS, et al. Evaluating ambulatory practice safety: the PROMISES project administrators and practice staff surveys. Med Care. 2015;53(2):141–52.CrossRefPubMed
5.
Gandhi TK, Sittig DF, Franklin M, Sussman AJ, Fairchild DG, Bates DW. Communication breakdown in the outpatient referral process. J Gen Intern Med. 2000;15(9):626–31.CrossRefPubMedPubMedCentral
6.
Kim Y, Chen AH, Keith E, Yee Jr HF, Kushel MB. Not perfect, but better: primary care providers’ experiences with electronic referrals in a safety net health system. J Gen Intern Med. 2009;24(5):614–9.CrossRefPubMedPubMedCentral
7.
Kim-Hwang JE, Chen AH, Bell DS, Guzman D, Yee Jr HF, Kushel MB. Evaluating electronic referrals for specialty care at a public hospital. J Gen Intern Med. 2010;25(10):1123–8.CrossRefPubMedPubMedCentral
8.
Warren J, White S, Day KJ, Gu Y, Pollock M. Introduction of electronic referral from community associated with more timely review by secondary services. Appl Clin Inform. 2011;2(4):546–64.CrossRefPubMedPubMedCentral
9.
Liddy C, Maranger J, Afkham A, Keely E. Ten steps to establishing an e-consultation service to improve access to specialist care. Telemed J E Health. 2013;19(12):982–90.CrossRefPubMedPubMedCentral
10.
Vimalananda VG, Gupte G, Seraj SM, Orlander J, Berlowitz D, Fincke BG, et al. Electronic consultations (e-consults) to improve access to specialty care: A systematic review and narrative synthesis. J Telemed Telecare. 2015;21:323–30.CrossRefPubMedPubMedCentral
11.
111 United States Congress: Patient Protection and Affordable Care Act.; 2010.
12.
Horner K, Wagner EH, Tufano J: Electronic Consultations between primary and specialty care clinicians: early insights. The Commonwealth Fund Issue Brief; October, 2011.
13.
Hsieh HF, Shannon SE. Three approaches to qualitative content analysis. Qual Health Res. 2005;15(9):1277–88.CrossRefPubMed
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.
15.
McAdams M, Cannavo L, Orlander JD. A Medical Specialty e-Consult Program in a VA Health Care System. Fed Pract. 2014;31:26–31.
16.
Palen TE, Price D, Shetterly S, Wallace KB. Comparing virtual consults to traditional consults using an electronic health record: an observational case–control study. BMC Med Inform Decis Mak. 2012;12:65.CrossRefPubMedPubMedCentral
17.
McGinn CA, Grenier S, Duplantie J, Shaw N, Sicotte C, Mathieu L, et al. Comparison of user groups’ perspectives of barriers and facilitators to implementing electronic health records: a systematic review. BMC Med. 2011;9:46.CrossRefPubMedPubMedCentral
18.
Scholle SH, Asche SE, Morton S, Solberg LI, Tirodkar MA, Jaen CR. Support and strategies for change among small patient-centered medical home practices. Ann Fam Med. 2013;11 Suppl 1:S6–13.CrossRefPubMedPubMedCentral
19.
Wan TT, Demachkie Masri M, Ortiz J, Lin BY. Willingness to participate in accountable care organizations: health care managers’ perspective. Health Care Manag (Frederick). 2014;33(1):64–74.
20.
Carrier E, Dowling MK, Pham HH. Care coordination agreements: barriers, facilitators, and lessons learned. Am J Manag Care. 2012;18(11):e398–404.PubMed
21.
22.
23.
Kirsh SR, Ho PM, Aron DC. Providing specialty consultant expertise to primary care: an expanding spectrum of modalities. Mayo Clin Proc. 2014;89(10):1416–26.CrossRefPubMed
24.
Davis A, Gilchrist V, Grumbach K, James P, Kallenberg R, Shipman SA. Advancing the Primary/Specialty Care Interface through Econsults and Enhanced Referrals. Ann Fam Med. 2015;13(4):387–8.CrossRefPubMedPubMedCentral
25.
Chen AH, Murphy EJ, Yee Jr HF. eReferral--a new model for integrated care. N Engl J Med. 2013;368(26):2450–3.CrossRefPubMed
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.
27.
North F, Uthke LD, Tulledge-Scheitel SM. Integration of e-consultations into the outpatient care process at a tertiary medical centre. J Telemed Telecare. 2014;20:221–9.CrossRefPubMed
Metadata
Title
Facilitators and barriers to implementing electronic referral and/or consultation systems: a qualitative study of 16 health organizations
Authors
Delphine S. Tuot
Kiren Leeds
Elizabeth J. Murphy
Urmimala Sarkar
Courtney R. Lyles
Tekeshe Mekonnen
Alice Hm Chen
Publication date
01-06-2015
Publisher
BioMed Central
Published in
BMC Health Services Research / Issue 1/2015
Electronic ISSN: 1472-6963
DOI
https://doi.org/10.1186/s12913-015-1233-1

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