Implementing a National Electronic Referral Program: Qualitative Study.

Area of Science:

• Health Informatics
• Information Systems Research
• Sociotechnical Systems Theory

Background:

• Electronic referrals (e-referrals) involve transmitting patient data between providers, facing implementation challenges due to sociotechnical system fit.
• Ireland's National Electronic Referral Programme (NERP) Step 1 focused solely on technical capability for GP to hospital outpatient referrals, omitting sociotechnical considerations.

Purpose of the Study:

• To theoretically frame lessons learned from NERP Step 1 for designing and implementing national health information technology programs.
• To analyze the impact of sociotechnical factors on the success of e-referral implementation.

Main Methods:

• Qualitative case study design utilizing interviews with 41 key stakeholders of NERP Step 1.
• Theory-driven thematic analysis of interview data, applying Barker et al.'s Framework for Going to Full Scale.

Main Results:

• NERP Step 1 improved referral speed, data completeness, legibility, and traceability, with national leadership and digitalized GP records as enablers.
• Inhibitors included policy uncertainty, lack of a central referral office, interoperability issues, and the need for specialist templates.
• Lack of sociotechnical specification hindered testing and refinement of the implementation change package.

Conclusions:

• NERP Step 1 yielded patient safety benefits and enhanced eHealth Ireland's credibility despite resource limitations and interoperability challenges.
• Poor integration with broader Health Service Executive policy and quality improvement agendas were noted limitations.
• Early specification of sociotechnical elements, though not necessarily in tandem with technical ones, is crucial for effective testing and refinement of health IT programs.