Cooperation between family physicians and medical specialists is crucial for providing people with timely, high-quality medical care and advice. To improve this cooperation, an e-consultation service was set up in 2013. This service enables family physicians to quickly and conveniently consult with a specialist to clarify their patient's diagnosis and prescribe treatment. In the beginning years, EHIF funded the e-consultation service only in the specialties of Urology and Endocrinology, but over the years the use of the service has increased among family physicians and several dozen new specialties have been added to the service.
What is e-consultation?
The e-consultation service provides family physicians with an opportunity to consult with medical specialists in order to clarify their patient's health problem, to quickly ask for advice about further treatment, further analyses, and the need for specialised medical care. e-consultation improves the quality of information communicated between family physicians and medical specialist. The service also helps save patients’ time, as now they do not always have to go to see the medical specialist.
A family physician starts an e-consultation by evaluating the patient's health condition and then decides whether the patient needs a medical specialist consultation or not. The patient’s health problem must meet the conditions for referral to an e-consultation. Respective conditions have been agreed on between the Estonian Family Physicians Association and professional associations for each specialty. It is important that any concern could be resolved as quickly as necessary taking account the patient’s health condition. During an e-consultation, the medical specialist evaluates a patient’s health problem and how urgently the patient needs to be seen. Once the patient goes to see the medical specialist, the specialist will already have an overview of his/her health condition.
How does e-consultation function?
As the name of the service suggests, e-consultation is carried out electronically via the Health Information System. All treatment is coordinated by a family physician. The physician prepares a proper digital referral document for medical specialist e-consultation, which describes the patient's complaints and condition in detail, and encloses the results of any analyzes and studies carried out, as well as his/her own thoughts or observations on the patient's health. The family physician then selects respective specialty and medical institution where he/she wants to receive the e-consultation and submits the referral via the Health Information System to the e-consultation provider of his/her choice. The medical specialist views the contents of the referral document and decides whether the patient needs to be seen by a medical specialist or he/she should just follow the family physician’s instructions. The medical specialist prepares a proper response to the referral, and sends it to the family physician via the information system. The response must be made within four working days of the date when the e-consultation referral was submitted to the Health Information System. The patient, too, has an access to the completed referral, the received response and the summary of treatment history.
How much is e-consultation service used?
The use of e-consultation service increased by almost half in 2018 compared to the previous year. Last year, the Health Information System received 21 763 e-consultation referrals for 19 803 patients. While in 2017, in Estonia, 670 family physicians used the e-consultation service, in 2018 the number of service users increased to 882. 402 health care institutions submitted referrals to e-consultations.
While last year family physicians used e-consultation with medical specialists in 17 specialties, this year four more specialties were added to the list. e-consultation is currently available in 21 specialties: urology, endocrinology, lung diseases, rheumatology, ear-nose-throat diseases, pediatrics, neurology, hematology, cardiology, gastroenterology, oncology, orthopedics, allergy-immunology, nephrology, internal medicine, psychiatry, gynecology, skin and sexually transmitted diseases, vascular surgery, pain therapy and rehabilitation.
In 2018, the Health Information System received 21 478 e-consultation responses to referrals. The biggest number of responses were received in neurology, followed by allergology and gastroenterology. Compared to 2017, the number of responses received from these specialties increased by half.
Everyone can view e-consultation information related to their health record in the Patient Portal www.digilugu.ee.