Improving the Effectiveness of Electronic Health Record-Based Referral Processes

Abstract

Electronic health records are increasingly being used to facilitate referral communication in the outpatient setting. However, despite support by technology, referral communication between primary care providers and specialists is often unsatisfactory and is unable to eliminate care delays. This may be in part due to lack of attention to how information and communication technology fits within the social environment of health care. Making electronic referral communication effective requires a multifaceted “socio-technical” approach. Using an 8-dimensional socio-technical model for health information technology as a framework, we describe ten recommendations that represent good clinical practices to design, develop, implement, improve, and monitor electronic referral communication in the outpatient setting. These recommendations were developed on the basis of our previous work, current literature, sound clinical practice, and a systems-based approach to understanding and implementing health information technology solutions. Recommendations are relevant to system designers, practicing clinicians, and other stakeholders considering use of electronic health records to support referral communication.

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

“…The need for greater coordination across specialties and the development of mutually agreed referral protocols between primary and secondary care practitioners has been recommended in several recent studies [14,19,40,44,49]. Such a collaborative approach between primary and secondary care practitioners has for example been reported by Dennison et al, albeit at a localised/pilot implementation level [50].…”

“…The lack of feed-back from secondary care on referral progress was a common complaint among GPs and has been identified in other recent studies of eReferral [8,40,49]. A system implementing electronic notifications to the referring primary care providers has been described by Kim et al [13].…”

The impact of EHR and HIE on reducing avoidable admissions: controlling main differential diagnoses

“…External medical history examination implies a more thorough patient examination that can help avoid redundant admissions. Esquivel et al [9] proposed that flexibility in the referral process is necessary for effective system use by staff. These findings, regarding interoperability, provide insight on the benefits of adopting, implementing and using EHR IS and HIE networks in order to improve healthcare delivery by allowing more interaction with and transfer of information about patients to caregivers, and clinical care coordinators, and therefore, increasing efficiencies related to clinical and administrative tasks.…”

“…We examined the impact of medical information that is provided to a decision-maker in the highly stressful environment of an ED, with its complex conditions. Esquivel et al [9], for instance, related unsatisfactory referral communication between primary care providers and specialists to the lack of attention on how the communication technology should fits with the social environment in which it is implemented. Moreover, the use of EHR has been suggested to be even more crucial during medical emergencies [10].…”

Understanding the Potential for Patient Engagement in Electronic Consultation and Referral Systems: Lessons From One Safety Net System

“…eCR systems have been implemented across the United States and internationally (Esquivel et al. ; Palen et al. ; Scherpbier‐de Haan et al.…”