Table 1 E-referral challenges in Mashhad University of Medical Sciences
From: New experience of implementing patient e-referral in the Iranian health system: a qualitative study
Main Topic | Subtopic | Sub-subtopic |
|---|---|---|
Structure | Internet Infrastructure and Sina System | Internet Disconnection, Slow Internet Speed, Lack of Internet Coverage in Some Villages |
Lengthy Procedures and Forms, High Volume of Daily Records, Slow and Frequent Crashes of the Sina System, Unreliable Records in Patient Files | ||
Patients’ Choice of Desired Specialists | Unavailability of Desired Specialists, Absence of Certain Specialties in Some Areas, Mandatory Referrals to Other Cities, Inability to Refer to Private Sector | |
Process | Receiving Payment for Services | Inability to accept and issue invoices without a bank card, illegal collection of cash from patients, elderly individuals’ inability to use bank cards, and lack of capability to refund payments to patients in case of appointment cancellations |
Appointment Scheduling | Slow operation of the appointment booking system, limited daily appointment slots, irregular presence of specialists, inability to book appointments in rural areas, delayed loading of specialists’ availability, lengthy booking dates, reluctance of rural residents to book evening appointments, and non-specialized reception staff with inability to schedule appointments | |
Interdepartmental Coordination | Conflicting patient identity information among different departments, slow updates of patient information, lack of sensitivity from insurance organizations towards validity dates, delayed entry of test results into the system, and lack of cooperation from related organizations in promoting system use. | |
Recording Definitive Diagnosis Codes Before Referral | Requirement to record definitive diagnosis codes before referring patients to specialists, rejection of certain diagnoses by specialists, persistence of incorrect codes in patient files and their non-editable nature, absence of certain diagnosis codes in the system, and presence of some codes that are rarely used | |
False Referrals | Requesting referral stamps without physician approval, dissatisfaction of specialists with unprofessional referrals, making false referrals for the purpose of obtaining credit, visiting physicians with others’ appointment cards, lack of link to private sector in appointment booking system, lengthy and time-consuming electronic referral process, frivolous referrals, increase in workload for specialists, and subsequent dissatisfaction | |
Outcomes | Dissatisfaction | Time-consuming process and potential for errors in registering referral tracking codes, delay in providing services to patients, physicians’ dissatisfaction with the inability to electronically document services in remote areas, mandatory requirement for referral stamps, restriction on the number of daily appointments. |
Feedbacks | Lack of impact of recording patient feedback on specialists’ ratings and earnings, failure of many specialists to record and submit patient feedback, frequent completion of patient feedback by non-specialist staff, low quality, brevity, generality, and lack of specialization in patient feedback | |
Health Indicators | Inaccurate measurement of health indicators for referrals and patient feedback, decrease in health indicators due to patients’ reluctance to participate in referrals and appointment scheduling, decrease in health indicators due to offline referrals, contradictions and discrepancies between recorded referrals and cases in the Sina system |