Barriers and facilitators for implementation of electronic consultations (eConsult) to enhance access to specialist care: a scoping review

Abstract

IntroductionElectronic 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.MethodsWe applied established methods to guide the review, and the recently published Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews to report our findings. We searched five electronic databases and the grey literature for relevant studies. Two reviewers independently screened titles and full texts to identify studies that reported barriers to and/or facilitators of 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 were analysed thematically and classified using the Quadruple Aim framework taxonomy. No date or language restrictions were applied.ResultsAmong the 2579 publications retrieved, 130 studies met eligibility for the review. We identified and summarised key barriers to and facilitators of 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, utilisation of referral coordinators, addressing medicolegal concerns and incentives for providers to use eConsult.ConclusionThere are multiple barriers to and facilitators of 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.

Design and Validation of a Questionnaire to Measure the Acceptance of Telemedicine by Healthcare Professionals in Germany

“…Looking into the literature, aspects of this digital collaboration emerge that are similar to those for eConsult platforms (exchange of knowledge about patient cases between HCPs via a digital platform). These aspects were considered for the development of this dimension [62,63]. When dealing with interactions between people, trust is an important form of social capital [64,65,66].…”

“…The quick monitoring of inaccessible (see item REL7) and immobile patients (see item REL8) can be seen as an advantage for the patient-physician relationship. The goal would be to increase the treatment adherence (compliance) of a patient (see item REL6) [58,62].…”

“…Trust can also be created by certi cation (see item TRU2) and standard processes (see item TRU8), as well as by xed and stable personal contacts (see item TRU4) with the HCPs involved (see item TRU5), which can be described as institutional trust (see item TRU3) [65]. Also, distrust can appear when there is the fear of losing control of the treatment (see item TRU6) or of not getting su cient information when passing on responsibility to colleagues (see item TRU7) [62,63].…”

Teledermatology in Times of COVID-19 Confinement: Comparing Patients’ and Physicians’ Satisfaction by the Standardized Brest Teledermatology Questionnaire

“…So far, studies evaluating TD as a pathway for patient-physician interaction have mainly studied the technical quality of TD, security, and reimbursement aspects [1]. Recently, TD was used in the follow-up of acne patients during the COVID-19 crisis in Italy [2].…”

Understanding How to Improve the Use of Clinical Coordination Mechanisms between Primary and Secondary Care Doctors: Clues from Catalonia

“…Cross-level clinical coordination mechanisms can play an important role in addressing this challenge [ 3 , 4 ] due to their potential to improve the transfer of clinical information and communication between primary care (PC) and secondary care (SC) doctors [ 5 , 6 ], thus reducing delays, duplication of exams and medical errors, as well as SC patient consultations and waiting times [ 7 , 8 , 9 , 10 ]. Despite their importance, previous studies highlight the limited use (or problems in the use) of cross-level coordination mechanisms, both at a national and international level [ 11 , 12 , 13 , 14 ], suggesting that they have not been adopted as expected. Health systems need to gain further understanding of the factors and difficulties influencing the utilization of coordination mechanisms in order to adapt them and improve their adoption rates and thus, their effectiveness.…”