Investigating the use of electronic referrals to facilitate the patient referral process in Southern African public hospitals
type: CreativeWork
description: Digital health interventions, particularly electronic referrals (e-referrals) and health information systems, have revolutionised clinical workflows in public hospitals by automating processes. However, the utilisation of e-referrals has yielded mixed outcomes, with varying levels of success in organisational processes. While most healthcare providers (HCPs) in high-income countries have effectively leveraged the benefits of e-referrals, those in low- and middle-income countries have been slower in their adoption and implementation. Consequently, there is a dearth of comprehensive studies documenting the successes and advantages of e-referrals in these contexts. Most studies highlight constraints and challenges related to the significant infrastructural challenges in low- and middle-income countries, ranging from limited internet access, insufficient user involvement, and design limitations within existing health information systems. Consequently, studies conducted in these settings primarily highlight rather than present the potential benefits of e-referrals. In the face of these limitations, HCPs resort to workarounds and improvisations in the form of Shadow Information Technologies (SIT) by using platforms such as WhatsApp to complete their work. Such workarounds, while practical, may not offer the same level of information security as they are neither mandated nor supported by the Information Technology (IT) department. The purpose of this study is to investigate the use of electronic referrals to facilitate the patient referral process in Southern African public hospitals. Employing a multiple case study strategy, the research examined use of e-referrals in two tertiary public hospitals in South Africa's Western Cape Province and Namibia's Khomas region through a comparative study. Additionally, the study explored workaround practices related to mandated health information systems in order to understand their occurrence and effect on referral outcomes. Semi-str…
abstract: Digital health interventions, particularly electronic referrals (e-referrals) and health information systems, have revolutionised clinical workflows in public hospitals by automating processes. However, the utilisation of e-referrals has yielded mixed outcomes, with varying levels of success in organisational processes. While most healthcare providers (HCPs) in high-income countries have effectively leveraged the benefits of e-referrals, those in low- and middle-income countries have been slower in their adoption and implementation. Consequently, there is a dearth of comprehensive studies documenting the successes and advantages of e-referrals in these contexts. Most studies highlight constraints and challenges related to the significant infrastructural challenges in low- and middle-income countries, ranging from limited internet access, insufficient user involvement, and design limitations within existing health information systems. Consequently, studies conducted in these settings primarily highlight rather than present the potential benefits of e-referrals. In the face of these limitations, HCPs resort to workarounds and improvisations in the form of Shadow Information Technologies (SIT) by using platforms such as WhatsApp to complete their work. Such workarounds, while practical, may not offer the same level of information security as they are neither mandated nor supported by the Information Technology (IT) department. The purpose of this study is to investigate the use of electronic referrals to facilitate the patient referral process in Southern African public hospitals. Employing a multiple case study strategy, the research examined use of e-referrals in two tertiary public hospitals in South Africa's Western Cape Province and Namibia's Khomas region through a comparative study. Additionally, the study explored workaround practices related to mandated health information systems in order to understand their occurrence and effect on referral outcomes. Semi-str…
author: Kapepo, Meke
keywords: Information Systems
date published: 2025
date modified: 2026-07-22T22:23:21Z
provider: University of Cape Town
publisher: Networked Digital Library of Theses and Dissertations
type: WebPage
source organization: Department of Information Systems

PropertyValue
property ID: Handle
value: http://hdl.handle.net/11427/41456