Electronic Referrals in Health Care a Review Vigdis Heimly The - - PowerPoint PPT Presentation

01-09-09 Vigdis Heimly, NTNU

Electronic Referrals in Health Care a Review

Vigdis Heimly

The Norwegian University of Science and Technology, IDI,

Vigdis Heimly, NTNU

01-09-09 Vigdis Heimly, NTNU

Health Care in Norway

• Public health system
• Hospitals are owned by the government and
• rganized under 4 regional health authorites

(RHAs)

• Municipalites have responsibility for primary

care: GPs, nursing homes, homecare

• Patent has one GP as primary contact

Vigdis Heimly, NTNU

01-09-09 Vigdis Heimly, NTNU

Electronic referrals

Vigdis Heimly, NTNU

01-09-09 Vigdis Heimly, NTNU

Status for one month in 2007

• 8200 electronic referrals

sent

– 6300 of these within RHA

North Norway

• 125 000 discharge

summaries were sent in

Vigdis Heimly, NTNU

01-09-09 Vigdis Heimly, NTNU

History of electronic referrals in Norway

• First natonal standards in 1996
• Natonal requirement specifcaton for

communicaton modules in 2002

• EHR-vendor are provided with funding for

implementaton of the modules

• Ministry of health has instructed the RHAs

to facilitate receival of electronic referals

Vigdis Heimly, NTNU

01-09-09 Vigdis Heimly, NTNU

Why are volumes low?

• Norwegian study in 2008 indicated that

most challenges were not technical, but

• rganizatonal
• Some technical issues did stll need to be

sorted out

Vigdis Heimly, NTNU

01-09-09 Vigdis Heimly, NTNU

Organizatonal challenges

• Specialists did not see enough benefts by

introducing the system compared with the costs. (Lang waitngtme for patents, no real competton for patents)

• Specialist were reluctant to new systems that

could bypass the outpatent clinic

• Senders and receivers did not have a common

understanding of how the technical (XML) standard should be used

Vigdis Heimly, NTNU

01-09-09 Vigdis Heimly, NTNU

GP’s requirements

• Not peer to peer systems where GP flls out

informaton in a system at the hospital based

• n the hospitals’ requirements
• One interface from EHR-system
• Seamless transfer of informaton to hospital

Vigdis Heimly, NTNU

01-09-09 Vigdis Heimly, NTNU

Is this a problem for Norway in partcular? Which lessons can be learnt from other countries?

Vigdis Heimly, NTNU

01-09-09 Vigdis Heimly, NTNU

Criteria for review

• Documentaton available in English
• Research papers
• Natonal projects and projects from

countries with public health care system

• Not pilots

– Pilots are ofen successful

Vigdis Heimly, NTNU

01-09-09 Vigdis Heimly, NTNU

The review process

• Initated search for research papers
• Hard to fnd documentaton
• Referral projects regarded as implementaton

projects, not neccessarily followed by researchers

• Few reviews done, mostly Telemedicine in

general

• Project documentaton is ofen lacking or not

Vigdis Heimly, NTNU

01-09-09 Vigdis Heimly, NTNU

Benefts

• Evaluaton of the Peijas system in Finland
• Hasmans study
• Danish study of quantfable costs

Vigdis Heimly, NTNU

01-09-09 Vigdis Heimly, NTNU

Optmistc start

• Finnish projects in Helsinki and Oulu

– Electronic referral and consultaton – Conclusion from early stages: Promising

• Early projects in Denmark and Norway

– Messaging, EDIFACT later XML – Pilots were promising, but infrastructure for full

difusion was lacking. Few EHR-systems in hospitals

Vigdis Heimly, NTNU

01-09-09 Vigdis Heimly, NTNU

Difcult contnuaton

• Norwegian booking project

– Initated by government to facilitate free hospital

choice

– The system was not integrated with EHR-systems

at the GP’s ofce or in the hospital

– GP’s were to a limited degree involved in the

planning

– Specialists did not want GPs to prioritze ”their”

patents

Vigdis Heimly, NTNU

01-09-09 Vigdis Heimly, NTNU

Zorg Domain, Netherlands

• System intends to create a common domain

for GPs and specialists

• Includes referrals and discharge leters
• Use of clinical guidelines and clinical

trajectories

• The distributon of tasks between specialists

and GP can be changed because of the system

• Specialists were reluctant to use it

Vigdis Heimly, NTNU

01-09-09 Vigdis Heimly, NTNU

Choose and book, NHS

• Controversial system
• Long difusion tme, but the number of users

have increased signifcantly

• Costly
• Was not suited for the clinician’s and patent’s

needs in the frst version

Vigdis Heimly, NTNU

01-09-09 Vigdis Heimly, NTNU

Choose and book

Vigdis Heimly, NTNU

01-09-09 Vigdis Heimly, NTNU

Denmark

• Refost-Referral hotel

in 2008

– GPs deposit referrals in

hotel

– Patent pics up referral

from hotel and chooses specialist

– Promising

Vigdis Heimly, NTNU

01-09-09 Vigdis Heimly, NTNU

Conclusions

• There is not one best soluton, difers with
• rganizaton of health system and from

country to country

• Difusion of electronic referrals is

complicated because collaboraton from many actors is needed

• What’s in it for me? Who has to take the

Vigdis Heimly, NTNU