e-Referral Service in Norway

The introduction of electronic referrals in Norway started in 1996, when the first standard for an electronic referral was developed. Subsequent implementations of electronic health record (EHR) systems have been tested by a national testing and approval service.

Almost all the Norwegian EHR systems comply with the recommended standards, but the volume of electronic referrals remains low: only 8200 referrals were sent electronically in September 2007. In comparison, 125,000 electronic discharge summaries were sent during the same month.

There are four elements that need to be in place before smooth communication can occur between the EHRs of the hospitals and the general practitioners.

First, the regional health authorities must have a strategy for electronic cooperation.

Second, various technical problems must be solved.

Third, certain organizational problems must be addressed.

Finally, electronic referrals should be used to support enhanced work processes and joint reception for referrals should be considered at larger hospitals.

Some Norwegian hospitals provide solutions for standardized referrals, and all the general practitioners EHR-systems are prepared for sending electronic referrals. Less that 25% of the referrals were sent electronically in January 2009. The basis for electronic referrals has been EDI-messages based on XML.

A national electronic booking project was established in 2002. The idea was that general practitioners in cooperation with the patient should book appointments at any Norwegian hospital. The use of the system has been very limited.

In parallel with the deployment of traditional EDI-messages, web-based solutions are planned at AHUS hospital, UNN in Tromsø, Bærum hospital and St. Olavs hospital.

These projects have a basis in the Norwegian messaging standards but represent a migration towards new solutions. The project at UNN is called the One-STOP project. The objective of the One-STOP project is to study if standardized electronic referrals based on guidelines combined with electronic booking can decrease waiting time for out-patient surgery.

The project at AHUS is a web-based referral solution linked to work with new national guidelines from the Directorate of Health. The project is intended to be deployed within the whole South-East regional health authority, which is the largest of the four regional health authorities in Norway.

The project is linked to other projects at Bærum hospital and St. Olavs in hospital in Trondheim. The project in Trondheim has a focus on development of recommendations for referrals within different specialities. The intention is to combine the referral solution with the EHRsystems, decision support and clinical guidelines.