National Institute for Health Innovation , The University of Auckland.
Appl Clin Inform. 2011 Dec 28;2(4):546-64. doi: 10.4338/ACI-2011-06-RA-0039. Print 2011.
Electronic referral (eReferral) from community into public secondary healthcare services was introduced to 30 referring general medical practices and 28 hospital based services in late 2007.
To measure the extent of uptake of eReferral and its association with changes in referral processing.
Analysis of transactional data from the eReferral message service and the patient information management system of the affected hospital; interview of clinical, operational and management stakeholders.
eReferral use rose steadily to 1000 transactions per month in 2008, thereafter showing moderate growth to 1200 per month in 2010. Rate of eReferral from the community in 2010 is estimated at 56% of total referrals to the hospital from general practice, and as 71% of referrals from those having done at least one referral electronically. Referral latency from letter date to hospital triage improves significantly from 2007 to 2009 (p<0.001), from a paper referral median of 8 days (inter-quartile range, IQR: 4-14) in 2007 to an eReferral median of 5 days (IQR: 2-9) and paper referral median of 6 days (IQR: 2-12) in 2009. Specialists upgrade the referrer-assigned eReferral priority in 19.2% of cases and downgrade it 18.6% of the time. Clinical users appreciate improvement of referral visibility (status and content access); however, both general practitioners and specialists point out system usability issues.
With eReferrals, a referral's status can be checked, and its content read, by any authorized user at any time. The period of eReferral uptake was associated with significant speed-up in referral processing without changes in staffing levels. The eReferral system provides a foundation for further innovation in the community-secondary interface, such as electronic decision support and shared care planning systems.
We observed substantial rapid voluntary uptake of eReferrals associated with faster, more reliable and more transparent referral processing.
电子转诊（eReferral）于 2007 年末引入社区进入公立二级保健服务，涉及 30 家转诊普通医疗实践和 28 家医院服务。
衡量电子转诊的采用程度及其与转诊处理变化的关系。
分析受影响医院的电子转诊消息服务和患者信息管理系统的交易数据；对临床、运营和管理利益相关者进行访谈。
2008 年，电子转诊的使用量稳步上升至每月 1000 次，此后在 2010 年每月增长至 1200 次。2010 年，社区电子转诊率估计为普通诊所向医院转诊的 56%，而电子转诊率为 71%来自至少有一次电子转诊的转诊人。从信件日期到医院分诊的转诊潜伏期从 2007 年到 2009 年显著改善（p<0.001），从 2007 年纸质转诊的中位数 8 天（四分位距，IQR：4-14）到 2009 年电子转诊的中位数 5 天（IQR：2-9）和纸质转诊的中位数 6 天（IQR：2-12）。专科医生在 19.2%的情况下提升转诊人指定的电子转诊优先级，在 18.6%的情况下降级。临床用户赞赏转诊可见性（状态和内容访问）的改善；然而，普通医生和专科医生都指出系统可用性问题。
通过电子转诊，任何授权用户都可以随时检查转诊的状态，并阅读其内容。电子转诊的采用期与转诊处理速度的显著加快有关，而人员编制水平没有变化。电子转诊系统为社区-二级接口的进一步创新提供了基础，例如电子决策支持和共享护理计划系统。
我们观察到大量快速自愿采用电子转诊，这与更快、更可靠和更透明的转诊处理有关。
