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Electronic consults (e-consults) improved access for veterans. Key factors for successful e-consult implementation included compatibility, networks, training, and information access, according to a study using the Consolidated Framework for Implementation Research (CFIR).

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Area of Science:

  • Health Services Research
  • Implementation Science
  • Health Informatics

Background:

  • The Veterans Health Administration (VHA) introduced electronic consults (e-consults) in 2011 to enhance specialty care access and reduce veteran travel.
  • Understanding the factors influencing the successful adoption of e-consults is crucial for optimizing healthcare delivery.

Purpose of the Study:

  • To evaluate the variation in e-consult implementation within the VHA.
  • To identify the determinants of successful e-consult adoption using the Consolidated Framework for Implementation Research (CFIR).

Main Methods:

  • A qualitative case study approach was employed, examining 3 high- and 5 low-implementation e-consult pilot sites.
  • Data collection involved structured surveys with site leaders and open-ended interviews with primary care providers, specialists, and support staff.
  • CFIR constructs were systematically rated and compared between high- and low-implementation sites.

Main Results:

  • Four CFIR constructs significantly differentiated high- from low-implementation e-consult sites: compatibility, networks and communications, training, and access to knowledge and information.
  • High-implementation sites demonstrated greater consensus among participants regarding these constructs.
  • An example of compatibility included standardizing e-consult options to appear first for all specialties.

Conclusions:

  • The CFIR provides a valuable framework for analyzing implementation determinants of e-consults.
  • Identifying common patterns across settings can inform future strategies for widespread adoption of health IT innovations.
  • Successful implementation hinges on site-level factors such as organizational compatibility, robust communication, adequate training, and accessible information resources.