Key factors in the success of an electronic patient referral system in the family physician programme: what can we do for the future?

Background
The electronic referral system (e-Referral) is an initial change in the way health care is provided. There are many factors that pre-vent the spread of such technologies in developing countries.

Objectives
Determining the key factors in the success of the electronic referral system in Iran.

Material and methods
This qualitative study was conducted in two phases (semi-structured interview and expert panel). The research participants included 42 people for the interview and 6 local experts, who were selected via the purposive sampling method (stratified sampling) and had at least three years of work experience. Data was collected using in-depth semi-structured interviews which were continued until data saturation. Next, the content analysis method was used to analyse the data. Validity and reliability of the data were determined based on the Guba and Lincoln including acceptability, transfera-bility, reliability and verifiability. Two professors, as qualitative research experts, also verified the credibility of the data through accurate and stepwise control of the research process. Finally, an expert panel meeting was conducted to refine and improve the categorisation of key factors.

Results
The analysis of collected data resulted in the extraction of 6 main themes, 18 subthemes and 47 codes. The main themes included resource man-agement, information technology management, rules and regulations, stakeholder satisfaction and advocacy, domestication and payment mode. Subthemes included management of financial, human, physical and equipment resources, intelligence, security, information exchange speed, information integrity, data access, judicial and insurance laws, health service guidelines, organisational culture, community culture, performance-based payment, etc.

Conclusions
This study offered rich documentation of the implementation of a successful e-Referral system, the availability of which in an information society is essential and will assist managers and policymakers in the successful implementation of the e-Referral system.