Telemedicine in managing demand for secondary-care services.

The sustained growth in demand for hospital services has inspired new ways of managing the demands for secondary care. In Finland, teleconsultations have been used alongside an electronic referral system for hospital outpatient clinics for the management of primary-care patients by specialists. Direct outpatient costs of the internal medicine department of a district general hospital with an electronic referral system and using teleconsultations were compared with those of a similar department at another hospital using a paper referral system. The former were at least 20% lower. Almost every paper referral in the conventional system (over 95%) led to an outpatient visit, whereas only one-third of the teleconsultations resulted in actual outpatient visits. Thus virtual integration of secondary and primary care with an electronic referral system as part of an electronic medical record reduced both the costs of hospital outpatient care and the demand for it.