Digital e-referrals in Paris: faster semi-urgent access between GPs and hospital teams.

Semi-urgent referrals can fall into a “black hole” when coordination is clunky. At Paris Centre AP-HP, a digital referral system was rolled out across four wards (internal medicine, diabetology, gynaecological surgery, oncology) to streamline GP→hospital communication and speed up decisions.

Over two years (July 2021–July 2023), GPs sent 113 requests through the system. Hospitals met the requested response time in 93% of cases, with a median first response of 6 hours. Requests most often went to internal medicine (74%). After review, hospitals proposed consultation in 40.7% and hospitalisation in 10.6% of cases; overall, two-thirds of final decisions matched the GP’s original request. Exchanges were lean but rich: a median of 4 messages and 1 attachment per case, typically lab/imaging reports.

Satisfaction was high. 100% of GPs and 78% of hospital practitioners rated exchange quality positively; 77% of hospital staff and 100% of care pathway managers felt the system improved patient pathways. Most users found it easy to use and would recommend it. Reported pain points were practical (e.g., attachment limits, ergonomics, lack of notifications), and the system is not designed for emergencies (and is offline on weekends/bank holidays).

Bottom line: a lightweight, secure messaging-style e-referral with clear service levels can accelerate semi-urgent access, improve coordination, and keep clinicians on side—provided operational guardrails (availability, notifications, EHR linkage) continue to mature.

Reference:
Nun A, Tropeano A-I, Flamarion E, Roumy A, Azais H, Dehghani Kelishadi L, et al. Real-life implementation and evaluation of the e-referral system SIPILINK. Int J Med Inform. 2024;191:105605. https://doi.org/10.1016/j.ijmedinf.2024.105605