Long wait times for elective services are seen as one of the major challenges for Canadian healthcare. Canadians report that they wait longer for specialists than citizens in other countries. An average of 25% of patients are waiting longer than evidence-based benchmarks in priority areas. One reason for this is that the referral process is poorly coordinated and leads to delays in care. Electronic referral is seen as a potential means of improving the referral process and enabling faster access to care. There is a major national initiative and multiple provincial initiatives that are looking to implement or expand electronic referral. However, existing projects have encountered challenges with user adoption. Therefore, it is critical that information about user perspectives on electronic referral inform future implementation. Before examination of the literature, frameworks for the evaluation of health information systems that could be relevant to electronic referral were examined. Then a literature review was conducted and aligned to the most suitable evaluation framework. This literature review found that the evidence from the Canadian perspective on electronic referral is sparse and that further study is needed. In addition, validated instruments have not been used to determine user perspectives and a formal qualitative methodology was only used in one study. Therefore, a mixed methods approach was undertaken to address these deficiencies. The System and Use Survey developed by Canada Health Infoway is a validated tool that was used to survey both users of faxed based referral as well as users of electronic referral. These two groups of users were then compared. As well, thematic analysis was used for the qualitative study to analyze interviews of users of electronic referral. This approach yielded a rich source of information that added significantly to the findings in the literature and addressed most components of the evaluation framework. The quantitative findings showed that most family physicians using fax were satisfied overall with the process. This highlighted how challenging any changes to this process would be to implement. Correspondingly, the overall user satisfaction was not significantly different between family physicians using fax and those using eReferral. There were, however, some significant results between family physicians using fax and those using eReferral, which were response time, the overall quality of referral information, completeness of the information, the timeliness of the information, and the format and layout of the referral information. It seemed that family physicians using eReferral were more satisfied by performance in these domains than family physicians using fax, although further research needs to be completed to verify this. The qualitative analysis highlighted user perspectives on the impact of electronic referral on the referral process, the usability of electronic referral, the experience with deployment, the effect on process outcomes, the improvement of patient outcomes as well as patient experience, the interaction with information technology, the importance of the content of the system, and the impact on society. The contribution from this mixed methods study to the currently available evidence can help to inform future deployment of electronic referral. / Graduate

Referrals to the Halifax Infirmary Neurosurgery Department are submitted with regards to spinal conditions with different degrees of complications. Although there exists a Spinal Condition Consultation Protocol to standardize spinal referrals, the information provided from referring physicians is frequently inadequate to accurately triage the patient's condition, partly due to missing diagnostic therapies. The Neurosurgery Department receives a high volume of referrals each year, which imposes a significant administrative workload on the staff. We propose to develop a protocol-driven decision support system to: 1) Provide primary care physicians with timely access to condition specific consultation treatment protocols; and 2) Automate the referral assessment process to eliminate processing delays and administration burden. To this aim, we transformed the Consultation Protocol into a semantic knowledgebase. The decision support services are integrated within a standardized electronic referral system. We believe this system can significantly improve the referral process at the Neurosurgery Division.

In the last decade, the deployment of Electronic Health Records has increased tremendously in many developed countries. This increasing trend intensifies the need for developing countries like South Africa to implement electronic health record systems in state owned hospitals to facilitate e-referral processes to improve health care delivery. The aim of this research was to investigate the current process of patient record keeping, management, and the referral process of patients within the same hospital and to other hospitals and based on the findings compile an Electronic Health Record (EHR) framework to facilitate e- referral processes. This research study was based on a qualitative case study approach. A multiple data collection technique was used which included group interviews, questionnaires, document analysis and informal discussions with the hospital workers. Data were analysed by categorization and thematic approach. The findings obtained from state hospitals indicated that there is no EHR system which accommodates patient health record systems to facilitate e-referral processes. These findings led to a compilation of the Limpopo Electronic Health Record System (LEHRS) to aid e-referral processes in state hospitals. The increasing need for accurate, reliable, available and accessible EHR will be addressed by the implementation of LEHRS as information will be stored in a central database in a useable format and will be easily accessed. / Computing / M. Tech. (Information Technology)

In the last decade, the deployment of Electronic Health Records has increased tremendously in many developed countries. This increasing trend intensifies the need for developing countries like South Africa to implement electronic health record systems in state owned hospitals to facilitate e-referral processes to improve health care delivery. The aim of this research was to investigate the current process of patient record keeping, management, and the referral process of patients within the same hospital and to other hospitals and based on the findings compile an Electronic Health Record (EHR) framework to facilitate e- referral processes. This research study was based on a qualitative case study approach. A multiple data collection technique was used which included group interviews, questionnaires, document analysis and informal discussions with the hospital workers. Data were analysed by categorization and thematic approach. The findings obtained from state hospitals indicated that there is no EHR system which accommodates patient health record systems to facilitate e-referral processes. These findings led to a compilation of the Limpopo Electronic Health Record System (LEHRS) to aid e-referral processes in state hospitals. The increasing need for accurate, reliable, available and accessible EHR will be addressed by the implementation of LEHRS as information will be stored in a central database in a useable format and will be easily accessed. / Computing / M. Tech. (Information Technology)