Eatablishment of an Electronic Referral System in Golestan Province: Opportunities and Threats

The establishment of a referral system leads to improved relations between general practitioners and specialists, improved service quality, reduced waiting time, and reduced costs. The purpose of this study was to explain the opportunities and threats outside the organization in establishing an electronic referral system in Golestan province.

This qualitative study was conducted using phenomenological analysis in Golestan province in 2019. The participants were 45 managers, experts, family physicians, specialists, and patients selected via purposive sampling. The data were collected using semi-structured interviews and analyzed via content analysis.

After analyzing the interviews, 7 themes and 18 sub-themes were obtained. The most important opportunities available were the existence of upstream documents and laws, the allocation of one percent of value added to cover the costs, the existence of a Nab (Health information software) independent system in the province, and the reduction of out-of-pocket payments. The main threatening factors were the change of officials of the Ministry of Health and the Health Insurance Organization, the patient’s insistence on visiting a specialist, the patient’s failure to see a specialist despite appointments, Poor notification, delays in payments to doctors, and poor communication infrastructure. 

Selecting appropriate strategies by taking advantage of opportunities can facilitate the process of implementing the electronic referral system in Golestan province and modeling it in other provinces. Adopting strategies such as formulating national policies, reforming the outpatient payment system, and reducing out-of-pocket payments can help improve the current situation.