Electronic Consultation Services Worldwide: Environmental Scan

J Med Internet Res. 2018 Dec 21;20(12):e11112. doi: 10.2196/11112.


Background: Excessive wait times for specialist care pose a serious concern for many patients, leading to duplication of tests, patient anxiety, and poorer health outcomes. In response to this issue, many health care systems have begun implementing technological innovations designed to improve the referral-consultation process. Among these services is electronic consultation (eConsult), which connects primary care providers and specialists through a secure platform to facilitate discussion of patients' care.

Objective: This study aims to examine different eConsult services available worldwide and compare the strategies, barriers, and successes of their implementation in different health care contexts.

Methods: We conducted an environmental scan comprising 3 stages as follows: literature review; gray literature search; and targeted, semistructured key informant interviews. We searched MEDLINE and EMBASE (literature review) and Google (gray literature search). Upon completing the search, we generated a list of potential interview candidates from among the stakeholders identified. Potential participants included researchers, physicians, and decision makers. The maximum variation sampling was used to ensure sufficient breadth of participant experience. In addition, we conducted semistructured interviews by telephone using an interview guide based on the RE-AIM framework. Analyses of transcripts were conducted using a thematic synthesis approach.

Results: A total of 53 services emerged from the published and gray literature. Respondents from 10 services participated in telephonic interviews. The following 4 major themes emerged from the analysis: service structure; benefits of eConsult; implementation challenges; and implementation enablers.

Conclusions: eConsult services have emerged in a variety of countries and health system contexts worldwide. Despite differences in structure, platform, and delivery of their services, respondents described similar barriers and enablers to the implementation and growth and reported improved access and high levels of satisfaction.

Keywords: electronic consultation; interviews; primary care; quality of care; referral-consultation process; specialist care; telemedicine.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Health Services Accessibility / standards*
  • Humans
  • Interviews as Topic
  • Primary Health Care / methods*
  • Quality of Health Care / standards*
  • Referral and Consultation / standards*
  • Telemedicine / methods*