In Estonia, it is mandatory to create a referral digitally and transmit it to the health information system. The referral is used for referring patients to various services. A referral is necessary when a patient is referred from a family doctor to a specialist, as well as from one specialist to another. In addition to the digital referral, paper referrals and solutions provided by healthcare service providers are still used to some extent for documenting referrals.

The digital referral serves as the basis for referring a patient to examinations, procedures, autopsies, outpatient or inpatient healthcare services, as well as for sending samples taken from the patient for examination or analysis, and for transmitting health data for e-consultation.

 

Why is a digital referral necessary?

To support the assessment of a person's treatment needs within a reasonable time frame, which in turn requires:

  • Ensuring that referrals contain important data for directing the patient, especially a clear medical question or hypothesis that justifies the referral.
  • Directing the patient to the appropriate healthcare service.
  • Providing the patient with the opportunity to book appointments for agreed-upon services themselves.
digital referral

To support the initiation of treatment according to the needs, which in turn requires:

  • Transmitting health data to continue treatment-related activities.
  • Ensuring cooperation between healthcare professionals (information and data exchange).
  • Providing healthcare professionals with the ability to monitor referrals (relevant information at the right time).
  • Involving the patient, ensuring the availability and comprehensibility of all data related to them. Patients can see all their referrals and related responses in the national health portal.
  • Ensuring the documentation of the insurance case from the health insurance perspective.

According to the Health Insurance Act, the Health Insurance Fund takes over the payment for the healthcare service only if there is a referral, except when specialist care is provided due to trauma, tuberculosis, eye disease, skin or venereal disease, or when gynecological or psychiatric care is provided, or the specialist decides to keep the patient under the specialist’s supervision or treatment due to their health condition.

A family physician can also consult with a medical specialist through e-consultation

If necessary, the family doctor can also use the e-consultation service. In this case, the family doctor sends a question related to the patient's treatment directly to the specialist through the health information system. The question is reviewed by the specialist, who then consults with the family doctor or invites the patient to a specialist appointment. The family doctor always informs the patient when requesting an e-consultation from the specialist and also asks for the patient's contact phone number, which is noted on the referral. The registration desk must be able to use a query that shows the registrar the existence of the booked referral. 

Requirements for the information systems

  • Information systems must be able to send and retrieve digital referrals from the health information system. The registration desk must be able to use a query that shows the registrar the existence of the booked referral.
  • The service provider's information system must ensure that the creator of the digital referral receives feedback on their workstation that the digital referral was successfully sent to the health information system.
  • When providing e-consultation, the information system must allow the sending of e-consultation response messages to the health information system.
  • The digital referral must always be linked to the response document in the health information system (epicrisis, referral response).
  • If the patient does not show up for the appointment and does not notify the service provider of their no-show, the healthcare provider's information system must release the digital referral and send a notification to the health information system that the patient did not show up for the appointment.

Latest developments

In 2023, the Health Portal was created, which has also made the display of digital referrals and related responses more user-friendly.

Cooperation partners

  • All health care service providers
  • Ministry of Social Affairs
  • Estonian Health Insurance Fund
  • Estonian Association of Family Physicians
  • Estonian Hospitals Association

Funding

The project was funded by the EU Regional Development Fund.  

 

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