Implementing a Patient Ereferral Booking System

Abstract

Background: Poor communication and coordination of care between primary care and specialty care providers leads to major inefficiencies in health care delivery. As a signatory of the Millennium Declaration, Kenya is committed to achieve the targets of MDGs 4–6 which include: access to affordable healthcare. Like many other developed countries, Kenya faces a big challenge in terms of misappropriation of funds and poor service delivery to its citizens. Most of the government facilities are ill equipped even to cater for the bare minimum care. In 2020, the number of people in need of specialized medical care due to corona virus (covid-19) was in excess of 20 million worldwide with nearly 5 million hospitalized. This goes to show how important good referral systems are. A good referral system, as an essential part of primary health care, is fundamentally important for the provision of optimal health services. The goal of establishing a functional referral system has yet to be achieved in Kenya. This study aimed to explore health expert’s viewpoints about challenges of developing and implementing referral system in Kenya. The researcher developed a Web-based electronic referral system (eReferral) that enabled patients to chat with their healthcare providers, book appointments and make follow ups. Methods: the eReferral system was evaluated in three ways, firstly: use of questionnaires, interviews and focus group questions were administered and analyzed to get user views. This was to enable the researcher to assess attitudes toward eReferral and to identify best practices in implementing the system. Secondly, analysis of healthcare documents and records to get a clear picture of the working environment and how business processes are carried out. Thirdly, to design a model eReferral system to project the system’s implications on healthcare costs and utilization of services. Results: by using this eReferral system there was a great reduction of the turnaround time between booking an appointment, diagnosis, treatment and discharge. This led to reduced cost incurred in travelling to go to healthcare facilities to make a booking and seeking treatment. The clinicians were also aware of expected appointments and thus able to prepare in advance. eReferral also enabled acceleration of more urgent care, with clinics having up to 40 percent of referrals expedited. There was significant improvements by Primary care providers reporting that eReferral improved quality of care for their patients with the correct ICT infrastructure. There was improved communication between the different levels of healthcare facilities and this enabled efficient submission and management of referral requests. Contributing factors for this adoption was a user friendly GUI, availability of cheap smartphones and internet access. Conclusion: the use of ICT in managing referral processes is important to ensure an effective and efficient process for service delivery for a comprehensive reform is recommended