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

Electronic consultation, or eConsult, is a type of telemedicine that involves a secure electronic exchange of patient information between a primary care provider and a specialist. While it has been shown to have clinical benefits, it is not widely adopted in healthcare systems. A recent scoping review investigated factors influencing the adoption and implementation of eConsult services. The review identified key barriers and facilitators of eConsult adoption and implementation across four domains: provider, patient, healthcare system, and cost. The main barriers identified were increased workload for providers, privacy concerns, and insufficient reimbursement for providers. Key facilitators included remote residence location, timely responses from specialists, utilisation of referral coordinators, addressing medicolegal concerns, and incentives for providers to use eConsult.

Despite concerns about increased workload for providers, several studies showed that the time commitment for specialists responding to e-consult requests was less than 10 minutes on average. For primary care providers, the time commitment is less clear, but additional tasks beyond initiating and responding to consultation, such as conducting extra tests and communicating consultation outcomes to patients, were identified. Some of the barriers faced by providers can be addressed through targeted interventions such as academic detailing, audit and feedback, and by soliciting input from providers when eConsult tools are being developed. Using clinician champions to advocate for eConsult among their peers is also an effective way to overcome barriers to use by providers.

From the patient’s perspective, more facilitators for eConsult than barriers were identified. Few studies directly evaluated patient perspectives, but most patients surveyed were highly satisfied with their eConsult experiences, and the majority of providers rated eConsult as ‘very good’ to ‘excellent’ service for their patients. In one study, patients expressed minimal desire to directly engage with eConsult and preferred their primary care providers to take on that role. Overall, the scoping review provides insights into the barriers and facilitators associated with eConsult adoption and implementation at a multinational level.

Osman MA, Schick-Makaroff K, Thompson S, Bialy L, Featherstone R, Kurzawa J, Zaidi D, Okpechi I, Habib S, Shojai S, Jindal K, Braam B, Keely E, Liddy C, Manns B, Tonelli M, Hemmelgarn B, Klarenbach S, Bello AK. Barriers and facilitators for implementation of electronic consultations (eConsult) to enhance access to specialist care: a scoping review. BMJ Glob Health. 2019 Sep 13;4(5):e001629. doi: 10.1136/bmjgh-2019-001629. PMID: 31565409; PMCID: PMC6747903.