A qualitative evaluation of general practitioners’ views on protocol-driven eReferral in Scotland

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.

Application of normalisation process theory in understanding implementation processes in primary care settings in the UK: a systematic review

“…Eleven studies evaluated the impact of an innovation in terms of delivery and engagement [31, 33, 37, 38, 40-43, 47, 50, 51, 53, 55, 59]. For instance, Bouamrane et al used NPT to interpret factors identified as facilitating and challenging the work of GPs during patient consultations, and to understand stakeholder perspectives on the implementation of a primary care e-referral system [34,35]. Seven studies used NPT prospectively to explore the behavioural change required ahead of implementation [34-36, 44, 46, 48, 52, 54, 60].…”

Managing Interoperability and Complexity in Health Systems

“…In the UK, eHealth systems interoperability is becoming all the more important as the adoption of patient electronic medical records within primary care is now wide-spread. This situation now provides opportunities to transfer and share patient electronic information across organisation within the National Health Service (NHS) that were previously unimaginable with paper-based records [9][10][11][12][13]. The next integration challenges will thus consist in enabling secure and efficient information sharing with other health organisations (e.g.…”

“…In developed countries, most of the clinical encounters take place in a primary care settings and hence family doctors are often the gate-keepers to data-rich, longitudinal patient records containing a wealth of information about patients' conditions and their evolution over-time [11]. Ethier et al present an interoperability framework called the Clinical Data Integration Model using an ontology to support data integration of heterogeneous primary care electronic repositories in order to support research activities (i.e.…”

Referral system in rural Iran: improvement proposals

“…This study was financed by a grant (5/95/4762 in January 13, 2015) provided by the research deputy of Tabriz University of Medical Sciences. We would like to thank all the participants of the study.…”

“…For this reason, some countries have carried out several interventions to improve their referral systems and positive results have been obtained 12 . These results comprise items such as communication improvement between health service providers at different levels, knowledge management improvement, reduction of waiting time, documentation improvement, reduction of the offering of unnecessary specialized services, and increase of access to health services 13 .…”