RT Journal Article
SR Electronic
T1 Barriers and facilitators for implementation of electronic consultations (eConsult) to enhance access to specialist care: a scoping review
JF BMJ Global Health
JO BMJ Global Health
FD BMJ Publishing Group Ltd
SP e001629
DO 10.1136/bmjgh-2019-001629
VO 4
IS 5
A1 Mohamed A Osman
A1 Kara Schick-Makaroff
A1 Stephanie Thompson
A1 Liza Bialy
A1 Robin Featherstone
A1 Julia Kurzawa
A1 Deenaz Zaidi
A1 Ikechi Okpechi
A1 Syed Habib
A1 Soroush Shojai
A1 Kailash Jindal
A1 Branko Braam
A1 Erin Keely
A1 Clare Liddy
A1 Braden Manns
A1 Marcello Tonelli
A1 Brenda Hemmelgarn
A1 Scott Klarenbach
A1 Aminu K Bello
YR 2019
UL http://gh.bmj.com/content/4/5/e001629.abstract
AB 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.