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 hospital's 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.