title: E-referral Solutions: Successful Experiences, Key Features and Challenges- a Systematic Review.
abstract: BACKGROUND
  around the world health systems constantly face increasing pressures which arise from many factors, such as an ageing population, patients and providers demands for equipment's and services. In order to respond these challenges and reduction of health system's transactional costs, referral solutions are considered as a key factor. This study was carried out to identify referral solutions that have had successes.
  
  
  METHODS
  relevant studies identified using keywords of referrals, consultation, referral system, referral model, referral project, electronic referral, electronic booking, health system, healthcare, health service and medical care. These searches were conducted using PubMed, ProQuest, Google Scholar, Scopus, Emerald, Web of Knowledge, Springer, Science direct, Mosby's index, SID, Medlib and Iran Doc data bases. 4306 initial articles were obtained and refined step by step. Finally, 27 articles met the inclusion criteria.
  
  
  RESULTS
  we identified seventeen e-referral systems developed in UK, Norway, Finland, Netherlands, Denmark, Scotland, New Zealand, Canada, Australia, and U.S. Implemented solutions had variant degrees of successes such as improved access to specialist care, reduced wait times, timeliness and quality of referral communication, accurate health information transfer and integration of health centers and services.
  
  
  CONCLUSIONS
  each one of referral solutions has both positive and changeable aspects that should be addressed according to sociotechnical conditions. These solutions are mainly formed in a small and localized manner.
authors.affiliation: Iranian center of excellence in health management, Tabriz University of Medical Sciences, Tabriz, Iran.
authors.forename: Mansour
authors.initials: M
authors.lastname: Naseriasl
authors.affiliation: Public Health Department, School of Health, Ardabil University of Medical Sciences.
authors.forename: Davoud
authors.initials: D
authors.lastname: Adham
authors.affiliation: Health care Management Department, National Public Health Management Centre (NPMC) of Tabriz University of Medical Sciences, Tabriz, Iran.
authors.forename: Ali
authors.initials: A
authors.lastname: Janati
keywords: consultation; e-booking; e-referral system; health communication; health system; referral