From a paper-based transmission of discharge summaries to electronic communication in health care regions.
OBJECTIVE
In Austria, the general practitioner (GP) is the first point of contact for persons with health problems. Depending on the severity of the person's medical condition, a GP may refer her or him to a secondary care hospital consultant, who reports findings back to the GP in form of a paper-based discharge letter. Researchers report that paper-based communication of medical documents between different health care providers is insufficient in quality, error prone and too slow in many cases. Our aim was to develop and to realise a strategy for a stepwise replacement of the paper-based transmission of medical documents with a distributed, shared medical record.


METHODS
In the first step of a three-steps strategy for development of a consistent, comprehensive and secure regional health care network, an electronic communication of discharge letters and diagnostic results between existing information systems of different health care providers in Tyrol, Austria, has been established: in the form of cryptographically signed S/MIME e-mail messages and, additionally, via a secure web portal system. In two further steps, an extension of the system by a bi-directional communication and by improvements of the web portal system is planned, leading to a comprehensive electronic patient record for shared care.


RESULTS
After realisation of step 1, in October 2004, about 3500 electronic discharge letters were sent out from the Innsbruck University Hospital (IUH), which represents about 8% of the total number of discharge letters of the IUH. In addition, a lot of feedback was received and legal, organisational, financial and methodical difficulties were overcome.


CONCLUSIONS
The stepwise approach to replace paper-based with electronic communication in the first step was helpful, since knowledge has been gained and cooperations were formed. For the realisation of a distributed, shared medical record (steps 2 and 3), it will not be sufficient only to replace paper-based transmission of medical documents with electronic communication technologies, but in the further steps, organisational changes will become necessary. As well, legal ambiguities must be resolved before a distributed medical record for cooperative care, used by several institutions as well as by patients, could be established.
Schabetsberger
Thomas
T
University for Health Sciences, Medical Informatics and Technology (UMIT), Institute for Health Information System, Eduard Wallnöfer-Zentrum 1, A-6060 Hall i.T., Austria. thomas.schabetsberger@umit.at
Ammenwerth
Elske
E
Andreatta
Stefan
S
Gratl
Gordon
G
Haux
Reinhold
R
Lechleitner
Georg
G
Schindelwig
Klaus
K
Stark
Christian
C
Vogl
Raimund
R
Wilhelmy
Immanuel
I
Wozak
Florian
F
D001317:Austria; D035843:Biomedical Research / Q000458:organization & administration; D003195:Computer Communication Networks; D003199:Computer Systems; D003628:Database Management Systems / Q000458:organization & administration*; D003661:Decision Support Techniques; D034742:Electronic Mail; D005568:Forms and Records Control; D033181:Information Dissemination / Q000379:methods; D016247:Information Storage and Retrieval / Q000379:methods*; D008491:Medical Informatics Applications; D008498:Medical Record Linkage / Q000379:methods; D016347:Medical Records Systems, Computerized / Q000458:organization & administration*; D010351:Patient Discharge; D012041:Regional Medical Programs / Q000458:organization & administration*; D012042:Registries; D017216:Telemedicine / Q000379:methods / Q000458:organization & administration*