Table 2.

Identified barriers and facilitators to electronic consultation implementation and use.

Normalization Process Theory domain	Barriers	Facilitators
Coherence	Lack of understanding regarding its purpose and intended use	Development of protocols, strategies, and guidance, including medicolegal advice Patient and staff education Focused marketing Wider consultation with patients and staff members prior to implementation
Participation	Low uptake Mainly administrative requests Suitability for certain patient groups and conditions Contextual factors including practice size, deprivation, and geographical location Cost Limited patient involvement	Staff training Strategic/targeted patient use for those most likely to benefit from electronic consultations Electronic consultation champion
Action	Purposeful patient selection. Additional time or increased workload Medicolegal concerns The potential to “game” the system Information technology reliability	Effective signposting informing patients of when to use electronic consultation and when not Notification alerts to alleviate administrative issues related to contacting patients Integration of technology and adequate resourcing Pairing of general practitioner with prior patient contact