In Estonia, it is mandatory to compile a referral digitally and transmit it to the health information system, which is the basis for sending a patient for an examination, outpatient or inpatient health care service, or for conducting an e-consultation between health care professionals.
Why is digital referral needed?
- A digital referral is required to book an appointment with a medical specialist. A referral is necessary when a family physician refers a patient to another medical specialist or when a medical specialist refers a patient to another medical specialist.
- It is impossible to lose a digital referral – a patient can see all their referrals in the national Patient Portal digilugu.ee.
- A referral is issued to the patient only based medical indications. The referral must include the medical problem or hypothesis about the patient’s health condition reasoning the necessity of referring the patient to another medical specialist.
A family physician can also consult with a medical specialist through e-consultation
If necessary, the family physician may also use the e-consultation service. In this case, the family physician sends a question related to the patient’s treatment to the medical specialist through the health information system. The specialist reviews the problem and provides recommendations for continuing treatment or invites the patient to attend an appointment with a medical specialist. The family physician always informs the patient about ordering an e-consultation and asks for the patient’s contact phone number that will be included in the referral. It must be possible to use an inquiry at the e-booking system that indicates to the registrar that the booked referral is available.
Requirements for the information systems
- Information systems must be able to send and request digital referrals from the health information system. It must be possible to use an inquiry at the e-booking system that indicates to the registrar that the booked referral is available.
- The information of the service provider must ensure that the compiler of the digital referral would get the feedback on their desktop about the successful sending of the referral to the health information system.
- In case of e-consultation service, the information system must enable to send replies to the health information system.
- A digital referral must always be linked to an answer document in the health information system (epicrisis, answer to a referral).
- If the patient fails to show up to the appointment and do not notify the service provider of such failure, the information system of the health service provider must release the digital referral and send a notification to the health information system about such failure.
In 2021, the digitisation of nursing and hospital treatment referrals will be completed. The goal of the project is to start using digital referrals instead of paper referrals, in the framework of which a response document – nursing epicrisis – will be created.
The result is the upgrading of the existing data exchange service in the health information system through the creation of new types of digital referrals and the feedback messages and documents provided in response to them.
- All health care service providers
- Ministry of Social Affairs
- Estonian Health Insurance Fund
- Estonian Association of Family Physicians
- Estonian Hospitals Association
- 2019 – the technical standardisation of documents has been completed
- 2019 – developmental guidelines are available for developers and health care service providers
- 2020 – the developments of the central system, the monitoring module, the doctor's portal, and the patient portal have been completed
- 2020 – ongoing developments and implementations of information systems
- 2021 – digitalisation of nursing and hospital treatment referrals
The project is funded by the EU Regional Development Fund.