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Abstract
Introduction 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 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.
Results Among 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.
Conclusion There 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.
- health services research
- review
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Footnotes
Handling editor Soumyadeep Bhaumik
Contributors The authors followed the International Committee of Medical Journal Editors authorship guidelines. AKB and MAO had the original idea for this study. MAO and AKB wrote the first draft of the manuscript. All authors contributed to the study development and reviewed the manuscript for intellectual content. All authors approved the final submitted version of the manuscript.
Funding This work was funded by Northern Alberta Renal Program/AMGEN Inc Supported Care Innovation Grant and the Interdisciplinary Chronic Disease Collaboration (ICDC). The ICDC is funded through an Alberta Innovates Collaborative Research & Innovation Opportunity Team Grant. It was also supported by the Alberta Strategy for Patient-Oriented Research (SPOR) SUPPORT Unit Knowledge Translation Platform, which is funded by Alberta Innovates and the Canadian Institutes of Health Research. BB has been supported by the Kidney Health Translational Research Chair of the Division of Nephrology, Department of Medicine, at the Faculty of Medicine and Dentistry, University of Alberta.
Disclaimer The authors were responsible for data management, analysis and interpretation, as well as manuscript preparation, review and approval, and the decision to submit the manuscript for publication. The funder has no role in these activities.
Competing interests No, there are no competing interests for any author.
Patient consent for publication Not required.
Ethics Approval by a research ethics board was not required as only published and publicly available data with no identifiable patient records were reviewed.
Provenance and peer review Not commissioned; externally peer reviewed.
Data availability statement Dr Osman and Dr Bello had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.