Estonia is transitioning from paper-based referrals to digital referrals. This means that referrals to visit medical specialists are no longer issued on paper but are now sent digitally via the health information system. The Ministry of Social Affairs, the Estonian Health Insurance Fund, the Health and Welfare Information Systems Centre, the Estonian Family Physicians Association and the Estonian Hospital Association work closely together to ensure a smooth transition. DIGITAL REFERRAL When do I need a referral?
- A digital referral submitted by a family physician or another medical specialist is required to book an appointment with a medical specialist. The referral is for medical purposes only and contains relevant information for the other physician about the patient’s health condition. A referral is necessary when a family physician refers a patient to another medical specialist or when a medical specialist refers a patient to another medical specialist.
- A referral is required to make an appointment with any medical specialist, except family physicians, gynaecologists, dermatologists, venereologists, ophthalmologists and psychiatrists.
- You must have a referral before you make an appointment with a medical specialist.
- If a patient does not have a referral when making an appointment with a medical specialist, then the patient has to pay for the appointment and any additional services.
- The patient can view any of their digital referrals and the related appointments in the national Patient Portal www.digilugu.ee. All referrals for persons under guardianship and principals are also visible there. A family physician can also consult with a medical specialist through e-consultation.
- If necessary, the family physician may also use the e-consultation service. In this case, the family physician sends a question related to the patient’s treatment to the medical specialist through the health information system. The specialist reviews the problem and provides recommendations for continuing treatment or invites the patient to attend an appointment with a medical specialist, which means the medical specialist will take over the treatment of the patient. The family physician always informs the patient about ordering an e-consultation and asks for the patient’s contact phone number that will be included in the referral.
- The specialist will provide feedback to the family physician within four working days. If the medical specialist decides to invite the patient for an appointment, the patient will be contacted within six working days, depending on the urgency of the medical problem, which is why it is important that the phone number the patient provides is correct and that the patient is reachable by phone during this period.
What will change when paper-based referrals are replaced with digital referrals?
- The doctor will always notify the patient about issuing and submitting the referral to the health information system. If the patient requests, the doctor can provide the patient with a written note.
- Neither a written note nor a printed copy of the referral will replace the digital referral – an appointment to see a medical specialist can only be made on the basis of the digital referral. If a person provides the hospital a paper-based referral when making an appointment, then the hospital is required to check the existence of a digital referral. The receptionist does not have the right to book an appointment without a digital referral.
- If the doctor is unable to issue or submit the referral to the health information system during the appointment, then in agreement with the patient, the doctor can issue or submit the referral to the health information system later but it must be taken into account that the patient can only book an appointment with a digital referral.
- A paper-based referral is issued to a person without an Estonian personal identification code.
What do I need to know about digital referrals?
- A digital referral must be in the health information system before booking an appointment and it is checked when booking an appointment with a specialist.
- We do not issue referrals retrospectively! For example, a family physician is unable to provide a referral to an appointment with a medical specialist that is already in process or has already taken place.
- Digital referrals have a period of validity. This is the time during which it is possible to book an appointment with a referral. The appointment can take place after the period of validity ends, i.e. if the patient has booked an appointment with a valid referral, then on the day of the appointment the referral does not have to be valid anymore.
- Each digital referral allows you to make only one appointment. The health information system does not allow you to make several appointments with different doctors on the basis of one referral. If a patient wants to make a new appointment with the same referral, then the previous booking must be cancelled first.
- If a patient does not come to the appointment or the doctor/service provider cancels the appointment, then the referral is freed and the patient can use it to make a new appointment if the referral is still valid.
After the doctor’s appointment
- At the end of treatment, the medical specialist always provides a summary of the treatment, an epicrisis. In the epicrisis, the doctor writes down recommendations for the patient and, if necessary, guidelines for other healthcare professionals. The epicrisis must always indicate whether the medical specialist will keep observing the patient or if the patient is referred back to the family physician. A family physician can access this information through the health information system if necessary.
- The patient can see the epicrisis written by the doctor in the national Patient Portal www.digilugu.ee.
- If during the appointment with a medical specialist it turns out that the patient requires a referral to another specialist, then that same doctor will issue a new referral. The patient does not have to return to their family physician for a referral.
- If the medical specialist will keep observing the patient, then the medical specialist will book a new appointment for the patient if the appointment schedule has an opening at the required time. A referral is not required in this case. If the patient needs to change the appointment time, a phone number or an e-mail address, etc., is provided to them.
- If the medical specialist will keep observing the patient, but the appointment schedule is not yet open for the required time, then the specialist will issue the patient a so-called recall referral. In this case, the patient does not have to return to the family physician for a referral, but they can be certain that they can book the next appointment with the referral issued by the specialist. It should also be taken into consideration that the next appointment might not be with the same medical specialist.
- If the medical specialist is unable to issue and submit the recall referral to the health information system due to technical problems, then the specialist arranges a recall appointment with the patient in another way and gives the patient an explanation about it. In this case, the medical specialist must enter the information about the recall into the patient’s epicrisis that will be submitted to the health information system.
- If the patient is unsure whether they have been recalled for an appointment, then they should clarify this with the medical specialist before leaving their office.
- If the medical specialist did not make a new appointment, issue a recall referral or indicate a follow-up appointment in the epicrisis, then the specialist has finished the treatment of the patient; for further observations or in case of worsening symptoms, the patient should make an appointment with a family physician.
Thank you for your cooperation! Ministry of Social Affairs and Estonian Health Insurance Fund