Table 2.

Technical Issues with eReferral

Category	Issue
System design	Referring provider not automatically notified if a patient “no-shows” for their specialty appointment. Inability for someone who initiated communication to send another message until the recipient replied to the previous message. [Message threading redesigned to enable either participant to add an additional message whenever needed.] Notification of an appointment sent only to the referring provider, not other primary care staff. [Notification of additional staff enabled for tracking.] Inability to save a draft of the electronic referral, resulting in the need to re-input the information if the system timed out or lost connectivity or if the user exited the system before submitting the referral request. [“Save draft” feature added.] Need to submit a new referral request rather than re-submit an existing request if the patient missed an appointment. [Modified program to enable resubmission of a scheduled referral request up to 6 months after the appointment date.] Inability to specify patient scheduling availability for a specialty appointment. [Added a field for notes to scheduler on patient’s expected or known constraints.]
Network speed and access	Need to log in to multiple systems/levels. Inability to access system remotely. Slow connections. [Network and computers were upgraded in several referring sites.]
System integration	Need for specialist reviewers to exit eReferral to view imaging studies or lab reports in the EHR. [Feature added to append available test results to the eReferral.] Lack of notification when test results were available, which were needed for the PCP to submit the eReferral request. [Feature added to allow PCPs to flag an eReferral for a designated time period (e.g., 2 weeks, 4 weeks), after which time an automated reminder email is sent to the PCP to check his/her worklist.] Lack of integration with specialty clinic’s scheduling system.