. Author manuscript; available in PMC: 2021 Jan 1.

Published in final edited form as: Acad Pediatr. 2019 Aug 9;20(1):16–22. doi: 10.1016/j.acap.2019.08.002

Table.

Referral Process Steps, Potential Barriers, and Potential Telehealth Strategies.

Referral Step	Potential Barrier	Examples of Telehealth or Health Information Technology Strategies Addressing Barrier
1. Referral Decision	PCP uncertainty about need for referral or optimal referral	Electronic consultations Electronic messaging
2. Pre-consultative communication	Information not sent, not received, or not reviewed	Telehealth-enabled intake with nonphysician staff Electronic consultations
3. Appointment Scheduling	Scheduling process barriers	Electronically-transmitted referrals Patient portals
	Lack of appointment availability (e.g., demand exceeds supply; excessive wait times)	Tele-Mentoring Electronic consultations
	Difficulty tracking referrals	Electronically-transmitted referrals
4. Consultative Visit	Geographic/travel barriers	Live interactive telemedicine Store-and-forward telemedicine
4. Consultative Visit	Need for urgent or immediate consultation	Live interactive telemedicine (on-demand)
5. Post-consultative communication	Patient-subspecialist communication barriers	Remote patient monitoring Patient portals
5. Post-consultative communication	Generalist-subspecialist communication barriers	Electronic messaging Tele-Mentoring