Hidden complexities in information flow between primary and specialty care clinics

Consultations are a critical part of healthcare for many patients; however, they pose macrocognitive challenges at both individual and system levels. Coordination between primary care and specialty clinics is challenging, because information must be shared across clinics, roles, and time. We conducted a study of the consultations process in the U.S. Department of Veterans Affairs. Using interviews, observations, and document review, we identified five limitations in the current documentation of information flow: scheduling is omitted, information transfers appear to be standardized and well understood, all information relevant to consultations appears to be efficiently tracked from beginning to end, CPRS appears to support critical communication about consultations, and follow-up is de-emphasized. We offer a more ecologically oriented, descriptive model of information flow, and highlight common breakdowns in the consultations process.