The idea of e-Health and electronic health record was to develop a nationwide framework (database) to facilitate the exchange of digital medical documents and diffuse health information available so far only in local databases and information systems that were not able to communicate with each other. Implementation of E-Health enables modernizing Estonian health system offering more efficient healthcare solutions and opportunities for population and challenging the Government in the management of the functioning as e-country. The e-Health includes four projects, from which the most widely used is the digital prescription service.
During the last decade, Estonia became well known as a country with advanced e-services, not only in the business sector (especially banking), but also in e-Government services (electronic tax board, state commercial, car and shipping registers, e-voting, e-school, e-ticket etc.). The state has already established and maintains a nationwide technical infrastructure called the X-road platform. X-road is a platform independent standard interface for secure data processing, connection of all Estonian public sector databases and information exchange. The use of other IT-solutions such as digital signatures and ID-card authentication is comprehensively regulated by national law. These developments are the basis of implementing sectoral policies such as creating a countrywide electronic health record.
The idea of e-Health and electronic health record already emerged in 2002. The purpose was to develop a nationwide framework (database) to facilitate the exchange of digital medical documents and diffuse health information available so far only in local databases and information systems that were not able to communicate with each other. In 2005, as the recipient of the structural aid, the Estonian Ministry of Social Affairs launched a new e-health concept by phasing in four projects:
1) Electronic Health Record,
2) Digital Images,
3) Digital Registration and
4) Digital Prescription (e-health projects).
The result of implementing e-health projects is the Electronic Health Record that was launched on December 17th 2008.
The main goals for starting the e-health projects were the following:
• decreasing the level of bureaucracy in the doctors work process;
• increasing the efficiency of the health care system;
• making the time-critical information accessible for the attending physician;
• developing health care services that are more patient friendly and have higher quality.
The most innovative technological aspect is that implementation of the Electronic Health Record does not cause massive re-engineering of the existing in-house information systems and communication infrastructure, which will just be integrated ("linked") by special system modules. The message exchange module (the so-called agent centre) enables data exchange and interoperability of all integrated users and delivers all messages, which conform to the standard message type.
Providing the users (medical personnel or patients) with message exchange and administration, the agent centre makes possible several rights and services, which make the system user-friendly:
• central security solution;
• administration of rights and users;
• authentication and authorisation of users;
• integration with external information systems (via X-road);
• message administration and message-based integration;
• log-in (for example, for the online Patient Portal).
Barriers and Drivers
There are two main barriers in wider use of e-Health services: technical and mental barriers. There are 1.16m ID-cards issued in Estonia, which makes it about 90% of the population. Hence, many people, specially elderly people and children, use the ID-card only as identification. Today, more and more people have started to use the ID-card also as a basis for purchasing the medicines from the pharmacies as the physicians are widely useing the digital prescription platform. Within this platform the patient only needs to go to the nearest pharmacy and the medicine will be sold on the basis of ID-card. At the same time, on the statistics of the Estonian Health Insurance Fund 84% of the prescriptions are issued electronically, which shows the readiness to use the electronic solutions. But not only the ID-card is needed for the digital prescription or other e-Health services - the pharmacies, hospitals and medical centres need relevant hardware and software to use the platform. Today the platform is used in every medical insitution and 95% of the pharmacies are ready to process the digital prescriptions.
The main drivers are the wish to save time, get more convenient services and comfort.
The idea of e-Health includes hidden advantages like savings in energy, transport and communication costs, as well as time use. This leaves people time and resources for other activities like working, managing familiy issues or practicing hobbies, which may work as a small catalyst for domestic demand.
Socially, the speed of the healthcare services has been improved, the volume of doctors paperwork has decreased and the communication between the patients and medical centers are made easier. This has enabled also the medical centres and hospitals to optimize their processes and reorganise their work. The objective is to icrease the quality of the medical treatments through the increasing time left the physitians for treatment. The patients do not have to call the overloaded registrations lines at the medical centres, they can regsitrate online. For prescription there is no need to visit the doctor, the prescription is waiting around the corner on the nearest pharmacy. This has made the life easier not only for medical personnel, but also patients and employers.
Savings in energy and transport costs serve the maintaining the level of overall energy use and decreasing the CO2 emissions. At the same time the exact environmental impact is not known as the time dealing with the health issues can be replaced with activities, which can be environmentally intensive.