e-Referrals in Finland

Finland was the first country to implement an e-referral system, introduced in the capital city of Helsinki in 1990. The e-referral project was put in place to allow for a more cost-effective way of treating a bigger number of patients, increase productivity and to improve access to healthcare.

One of the first referral projects was initiated at the Helsinki University hospital in 1991. Two other projects were also well established early: One of them was a system for developed countries. The other was established in the Oulo region in Finland. All these three systems involved e-consultation in addition to referral.  According to the users, the e-referrals saved time and improved the quality of the documentation.

Three different systems established e-referral were examined in Finland. Nonetheless, there appeared to be a number of common features. Whether the purpose is e-transfer or e-consultation, the underlying model of the e-referral process is: the referrer initiates an e-request; the organization managing the process receives it; the organization allocates it for reply; the responder replies to the initiator. Various things can go wrong and the organization managing the e-referral process needs to be able to track requests through the system; this requires various performance metrics. E-referral can be conducted using email, or as messages passed either directly between computer systems or via a Web-link to a server. The experience of the three systems shows that significant changes in work practice are needed to launch an e-referral service successfully. The use of e-referral between primary and secondary care improves access to services and can be shown to be cost-effective.

 First project

Oulu University Hospital has a Web-based multimedia medical record in use. One key element in the creation of regional e-health networks is an electronic referral letter and discharge letter service. In Oulu an XML messaging system is used for an integral part of the medical record. The service has now been extended to primary care centres and hospitals in the Oulu region. Using a secure Web link, primary care physicians have direct remote access to the original hospital’s electronic patient record, including medical images and laboratory results.

e-referral saves time and improves the quality of documentation.

Second project

The regional health information network (RHIN) is comprised of three integrated services between primary, secondary and tertiary care within the county of Uusimaa.

The regional healthcare modules consist of an (1) e-referral network, (2) integrated EHR service between health care professionals and (3) PACS system.

The e-referral between primary and secondary care not only speeds up the transfer, but also offers an option for communication in the form of e-consultation between general practitioners and hospital specialists. By sharing information and knowledge remote e-consultations create a new working environment for integrated delivery of e-services between the health care providers.

Interactive e-consultations enable supervised care leading to the reduction of outpatient visits and more timely appointments. One third of the municipal health centers are connected to the clinics in the Helsinki University Central Hospital by the e-referral system. The link directory service extends the dimensions of networking between organizations by combining legacy systems within regional primary and secondary care. The link directory is an interface to diverse patient information systems, containing links pointing to the actual patient data located in remote information systems. The original data including images can be viewed with a web browser, but data can be accessed only with the patient’s informed consent.

Maryam Ghalandari