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92.9% of the population is covered by health insurance. This includes members of health insurance schemes and those with free access to state-provided healthcare services (Our World in Data, n.p.)
Public vs private
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The national PHR
The e-health system in Estonia is called ‘Estonian nationwide Health Information System’ (EHIS). The Ministry of Social Affairs is responsible for it.
EHIS hosts central registers and databases, including those for hospitals, family doctors (general practitioners), pharmacies, school nurses, and medication interactions. It also hosts quality registers (such as cancer, HIV, and tuberculosis). It uses several nationwide registers, including the population and business registers.
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Helmes, a private company, has managed the development of digital systems in Estonia for the past 15 years. The government’s TEHIK (the Estonian Health and Welfare Information Systems Centre) selected Helmes. Helmes has played a key role in advancing the e-health sector, including the implementation of digital prescriptions, hospital information systems, and central patient administration. Their contributions cover other sectors such as government, e-voting, e-justice, and security, to support the overall digital infrastructure of the country (Helmes, n.d.)
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EHIS has three layers: data, data transfer, and application. The data layer stores medical documents and images. The data transfer layer securely moves data over the internet between citizens and healthcare providers over the internet. The application layer delivers services and is in continuous development. It is tailored to the diverse needs of various stakeholders, including citizens, healthcare providers, government authorities, and policymakers.
EHIS is as a federated system: healthcare-related software are independent and interconnected (Metsallik et al., 2018).
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Log in using an ID card or mobile ID.
See and update personal information and add contact details for close relatives.
Access their medical data from healthcare providers.
See referral letters and prescriptions.
Authorise representatives for actions such as collecting e-prescriptions.
Declare intention e.g. organ donation.
Access health insurance data.
Hide sensitive information from doctors and representatives.
Complete a health declaration form prior to an appointment.
See a log of who has saw seen their data.
Challenges and areas for improvement
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Resistance to Change: Healthcare professionals were resistant, particularly in adopting a more standardised language for recording medical information in the e-health portal.
Reluctance to Share Data: Some healthcare professionals were hesitant to share medical data with patients through the portal.
Data Quality: Ensuring consistent and accurate data entry is a continuous challenge.
Semantic Interoperability: Standardising medical terminology to achieve semantic interoperability of medical data is an ongoing effort..
Security and Authentication: Ensuring robust security and electronic patient authentication is critical; blockchain technology has been instrumental in addressing this.
Privacy Concerns: Users are concerned of about potential secondary use of their data.
User Interface Development: ensuring the usability and accessibility of the portal has been challenging and remains a priority.
Digital Skills: A segment of the population lacks sufficient IT skills. To promote inclusivity, patients retain the option to keep accessing their data and services offline.
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