Digitalizing Emergency Referral System and its Evaluation in Northern Thailand

Objectives: Thailand recently implemented an electronic emergency referral system, known as “HIS.SANSAI,” to improve the speed, efficiency, and quality of patient care. This study evaluated the impact of HIS.SANSAI on user experiences and health outcomes. Methods: A multimethod approach was employed, combining data analysis from a cross-sectional survey that quantified users’ preferences and perceptions with an examination of de-identified emergency referral records from 2019 to 2021. Multiple regression analysis assessed whether HIS.SANSAI significantly reduced the duration of medical services, while logistic regression evaluated changes in health outcomes before and after its implementation. Results: The survey results revealed high proficiency in system capabilities. Referring hospitals (sending hospitals) rated the system highest, with a score of 8.00 for “Reducing coordinated time.” Referral hospitals (receiving hospitals) expressed moderate satisfaction, scoring highest (7.03) for “Reducing mistakes in patient information transfer” and lowest (4.27) for “Ease of use when recording.” The effects of HIS.SANSAI were partially supported. Positive outcomes included shorter service times and a 13.16% reduction in severity at emergency room discharge for ischemic stroke patients. However, negative consequences were observed, such as notable treatment delays for acute appendicitis patients. Conclusions: HIS.SANSAI demonstrated robust system capabilities and reduced errors in patient information transfer. Its impact on health outcomes was mixed, with both positive and negative effects. Further evaluation and enhancements are necessary to optimize the system’s overall effectiveness.