Objectives. Provide an introduction to national IT strategies for the health and social sectors, and point out major challenges for the future of eHealth and Telemedicine in Norway. Methods. The information provided in this article is based on reviews of national strategies and plans, and contact with projects and users in the health and social sectors. Conclusion. IT in health and social services has the potential to improve welfare, while simultaneously improving the efficiency of the systems. IT in home-and community-care will provide the users with better services closer to home in the coming years. National strategies and action plans are important, but the funding necessary for the recommended actions must also be provided.

This work describes the use of clinical guidelines in public health care for decision support in a primary care record system. The clinical guidelines were used for decision support in primary care in order to improve the quality of electronic referrals to a hospital. Guidelines were developed by the specialists at the hospital, but the design and the development of the system was done in collaboration with general practitioners working in primary care. This paper sums up the findings from a study six months after the introduction of the decision support system, and is based on interviews with users in primary care. The work processes differed between the practices; General practitioners who wrote the referrals after the patient had left the office did not find the system as useful as the ones who wrote them when the patient was present. The general practitioners were reluctant to use guidelines that resulted in an additional workload in terms of providing the hospital with more information than before, but found the system useful as a support for assuring that they made the right clinical decisions. The guidelines were also seen as useful as a support for refusing to refer the patient to specialized care.

The introduction of electronic referrals in Norway started in 1996, when the first standard for an electronic referral was developed. Subsequent implementations of electronic health record (EHR) systems have been tested by a national testing and approval service. Almost all the Norwegian EHR systems comply with the recommended standards, but the volume of electronic referrals remains low: only 8200 referrals were sent electronically in September 2007. In comparison, 125,000 electronic discharge summaries were sent during the same month. There are four elements that need to be in place before smooth communication can occur between the EHRs of the hospitals and the general practitioners. First, the regional health authorities must have a strategy for electronic cooperation. Second, various technical problems must be solved. Third, certain organizational problems must be addressed. Finally, electronic referrals should be used to support enhanced work processes and joint reception for referrals should be considered at larger hospitals.

The core EHR provides a generic basis that may be used as a pilot for a national patient summary. Examples of a wider use of the core EHR can be: shared individual plans to support continuity of care, summary of the patient's contacts with health providers in different organizations, and core EHR information such as important diagnoses, allergies and contact information. Extensive electronic cooperation and communication requires that all partners adjust their documentation practices to fit with other actors' needs. The implementation effects on future work practices will be followed by researchers.

No abstract