Abstract
BackgroundThe ever increasing volume of referrals from primary care to specialist services is putting considerable pressure on resource-constrained health services while effective communication across fragmented services remains a substantial challenge. Previous studies have suggested that electronic referrals (eReferral) can bear important benefits for cross-organisational processes and patient care management.MethodsWe conducted 25 semi-structured interviews and 1 focus group with primary care providers to elucidate General Practitioners’ (GPs) perspectives on information management processes in the patient pathway in NHSScotland, 1 focus group with members of the Scottish Electronic Patient Record programme and one interview with a senior architect of the Scottish Care Information national eReferral System (SCI Gateway). Using Normalisation Process Theory, we performed a qualitative analysis to elucidate GPs’ perspectives on eReferral to identify the factors which they felt either facilitated or hindered referral processes.ResultsThe majority of GPs interviewed felt that eReferral substantially streamlined communication processes, with the immediate transfer of referral documents and the availability of an electronic audit trail perceived as two substantial improvements over paper-based referrals. Most GPs felt that the SCI Gateway system was reasonably straightforward to use. Referral protocols and templates could be perceived as useful by some GPs while others considered them to be cumbersome at times.ConclusionOur study suggests that the deployment and adoption of eReferral across the NHS in Scotland has been achieved by a combination of factors: (i) a policy context – including national mandatory targets for eReferral – which all NHS health-boards were bound to operationalise through their Local Delivery Plans and also (ii) the fact that primary care doctors considered that the overall benefits brought by the deployment of eReferral throughout the patient pathway significantly outweigh any potential disbenefits.
Highlights
The volume of referrals from primary care doctors to secondary care specialists – for advice, a second clinical opinion and diagnosis, further investigations or clinical interventions – has been increasing steadily across health systems worldwide [1,2]
An invitation to participate in the study was sent to General practitioner (GP) practices using a list compiled in April 2011 by the National Health Service (NHS) Information Services Division [28]
The interviews aimed to collect GP views on information management processes in the patient surgical pathway in NHSScotland: information about the GP practice itself, including information management practices and Information & communication technology (ICT) use, the patient consultation and the referral process to hospital outpatient clinics, communication between GPs and hospitals from the point of referral to patient surgery, post-operative discharge information provided by the hospitals, issues identified in the patient surgical journey and areas for service improvement [23,30,31,32,33]
Summary
The volume of referrals from primary care doctors to secondary care specialists – for advice, a second clinical opinion and diagnosis, further investigations or clinical interventions – has been increasing steadily across health systems worldwide [1,2]. Previous studies have suggested that electronic referrals (eReferral) can bear important benefits for cross-organisational processes and patient care management. Implementation of electronic referral systems We performed a comprehensive scoping review on the deployment and evaluation of eReferral systems and found a limited number of studies reporting large-scale (i.e. national or regional) implementation experiences and evaluation of eReferral systems in the scientific literature. In the NHS in England, the ‘Choose & Book’ service was designed to allow patients to choose, during the course of a primary care consultation, the place, date and time of outpatient appointments in hospital with the expectation that this would result in lower Do-Not-Attend (DNA) rates. We were unable to identify in the scientific literature a recent and comprehensive systematic evaluation of the ‘Choose & Book’ service in terms of usage patterns and impact on services and patient care
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