Barriers to eConsult implementation using the quadruple aim framework
| Provider perspective | Patient perspective | Healthcare system | Cost | |
| PCP | Specialist | |||
| Increased workload and workflow disruptions* ✗ It was a lot easier and quicker for me to write a consultation on…paper…Now I’m having to go through a longer process with a few more hurdles in it54 | Increased workload * ✗ Specialists also experienced greater workload in the form of pre-consultative exchange and virtual management, which also served as a barrier to implementation16 | Some patients preference to see specialists face-to-face ✗ It’s important to see the specialist to feel more secure.59 | eConsult system design challenges* ✗ To find an application able to integrate seamlessly with diverse systems is often challenging82 | Insufficient remuneration for providers* ✗ A key barrier to widespread adoption of preconsultation exchange is the development of reimbursement models77 |
| Technical challenges to use eConsult* ✗ When I added a follow up question it never seems to go through and the consult disappeared. I had to request a new consult with my follow up question.76 | Concerns with liability ✗ Another challenge unique to electronic consultation and integrated eCR [eConsult] systems but not referral systems was specialist concern about liability78 | Perceived decrease in accessibility to specialist care* ✗ And if I feel like my doctor is brushing off that information, is not communicating other symptoms48 | Lack of resources* ✗ Health systems or practices initiating telehealth programs need to provide a base investment in the technology and then provide an ongoing and available infrastructure67 | Provider payment structure (salaried physicians vs fee-for-service models) ✗ And might only be cost-effective in a non -fee-for-service model such as one found in the VHA [Veterans Health Administration]83 |
| Loss of specialist contact ✗ PCP concerns included…unable to select the specific consultant15 | Loss of patient contact ✗ A minority of them prefer not to use VCs [virtual consults] because of…discomfort with an impersonal process79 | Concerns about safety/ appropriateness of eConsult ✗ I asked someone [a specialist] and he told me to give you this. If something happens to you, it’s not my responsibility because the other doctor prescribed it48 | Variation in licensure requirements across provinces/states ✗ In fact, licensure requirements also differ from state to state, and this introduces a significant possible variation in practice67 | |
| Unfamiliarity with using eConsult service ✗ The preparation…what kinds of tests have to be done.53 | Challenges with the quality/content of eConsult ✗ Referrals that lack a clear consultative question and relevant clinical data often render a specialist unable to make a clear diagnosis or a fully developed management plan80 | Privacy concerns* ✗ Concerns over privacy remain a barrier to the adoption of electronic platforms or innovations among health care providers59 | ||
| Insufficient remuneration to use eConsult ✗ Lack of reimbursement for PCP to submit the consultation request electronically44 | Challenges with the use of technology ✗ However, until a more slim-line IT system is developed reducing the number of steps involved in completing an eC (electronic consultation),…it appears to be beneficial for all parties except secondary care81 | |||
| Challenges related to patient follow-up ✗ Concern about how and when to communicate with patients regarding a consultant’s recommendations55 | Insufficient remuneration to use eConsult ✗ Concerns included… the need for adequate protected time and credit15 | |||
| Receiving timely responses from specialists ✗ PCPs were not satisfied with the depth of the answer that was provided76 | ||||
✗Selected quotes supporting the theme from the literature.
*Preidentified theme (deductive).
PCP, primary care provider.