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Barriers and Facilitators for Implementation of Electronic Consultations (eConsult) to Enhance Access to Specialist Care: A Scoping Review
37 Pages Posted: 6 Apr 2019
More...Abstract
Background: Electronic consultation (eConsult)-provider-to-provider, electronic asynchronous exchanges of patient health information at a distance-is emerging as a potential tool to improve the interface between primary care providers and specialists. Despite growing evidence that eConsult has clinical benefits, it is not widely adopted. We investigated factors influencing the adoption and implementation of eConsult services.
Methods: We applied established methods to guide the review, and the recently published PRISMA Extension for Scoping Reviews (PRISMA-ScR) to report our findings. We searched five electronic databases and the gray literature for relevant studies. Two reviewers independently screened titles and full texts to identify studies that reported barriers and/or facilitators to eConsult (asynchronous [store-and-forward] use of telemedicine to exchange patient health information between two providers [primary and secondary] at a distance using secure infrastructure). We extracted data on study characteristics and key barriers and facilitators that were analyzed thematically and classified using the Quadruple Aim framework taxonomy. No date or language restrictions were applied.
Findings: Among the 2,579 publications retrieved, 130 studies met eligibility for the review. We identified and summarized key barriers and facilitators to eConsult adoption and implementation across four domains: provider, patient, healthcare system and cost. Key barriers were: increased workload for providers, privacy concerns, and insufficient reimbursement for providers. Main facilitators were: remote residence location, timely responses from specialists, utilization of referral coordinators, addressing medico-legal concerns and incentives for providers to use eConsult.
Interpretation: There are multiple barriers and facilitators to eConsult adoption across the domains of Quadruple Aim framework. Our findings will inform the development of practice tools to support the wider adoption and scalability of eConsult implementation.
Funding: This work was funded by Northern Alberta Renal Program and the Interdisciplinary Chronic Disease Collaboration.
Declaration of Interest: The authors have no competing interests to declare.
Ethical Approval: Approval by a research ethics board was not required as only published and publicly available data with no identifiable patient records was reviewed.
Keywords: Telemedicine; Electronic consultations; Referral; Access to care, Primary care; Specialist care
Suggested Citation: Suggested Citation