Jarmo Reponen

Organizational aspects of e-referrals

summary Three different, well established systems for e-referral were examined. They ranged from a system in a single country handling a large number of cases (60,000 per year) to a global system covering many countries which handled fewer cases (150 per year). 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 studied 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.

Extending a multimedia medical record to a regional service with electronic referral and discharge letters.

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 hospitals electronic patient record, including medical images and laboratory results. According to the users, e-referral saves time and improves the quality of documentation. On the other hand, workflow development is still immature. Our experience suggests that the implementation of e-referrals is a process which requires careful handling, in relation to the technology as well as organizational changes and communication.

A portable diagnostic workstation based on a Webpad: implementation and evaluation

A wireless hand-held Webpad device was used to review a sample set of cranial computerized tomography (CT) studies to assess its diagnostic capabilities and its feasibility as a portable diagnostic workstation for radiology. The data-set consisted of 30 head CT studies of emergency cases. Two neuroradiologists and a senior radiologist participated in the evaluation of the portable workstation. They used a Web-based viewer that we developed, which provided all the major functionalities required for radiological image review. The reported radiological findings and diagnoses were compared with a gold standard, comprising a set of diagnoses previously formulated by a consensus panel of radiologists who had reviewed the original studies. The diagnoses made using the Webpad were correct (no major discrepancies) in 82 out of 90 interpretations (91%), which is comparable to the accuracy reported in image review with a conventional radiological workstation. The average total working time per diagnosis was 5 min 25 s (range 2–12 min). The simplicity of use of the system and its low cost make it suitable for distributing radiological studies within hospital facilities.

Radiology as a part of a comprehensive telemedicine and eHealth network in Northern Finland

Oulu University Hospital is the northernmost tertiary hospital in Finland and its responsibility area is the largest in the country, covering nearly half of the Finnish territory, also including the arctic regions. Because of vast distances and a sparse population, Oulu has been a forerunner in developing telemedicine and eHealth services in the country. The development started in 1990 and has resulted in the establishment of teleradiology and televideoconferencing services, distance education and a multimedia medical record with remote access capabilities. Wireless technology has been a special focus area, as has the development of an efficient communication between primary care and secondary care. This review highlights some of the key success elements.