Digital service provision has been the main way of reaching out to clients by private sector at least for 20 years, in some sectors and some countries even longer. In Estonia, online banking was launched 30 years ago, in 1994. By the turn of the century, not visiting any offices to subscribe for telecommunication and other well standardized services was rather a norm than an exception. The online tax board was launched in 1997, which means that virtually anyone under 50 has ever seen the taxman in Estonia.
Of course, in most countries the digital public service space had to compete initially with traditional, appointment-based service model. Partially because the digital services were not offered in a universal way linked to a single government portal and accessible with a universal digital ID. Instead, variety of methods for access and client verification created confusion and held back digital service space development.
Since then, in most countries, consolidation has happened. As people mostly transact online in their everyday life, governments have had to follow the trend, so it has not been possible to force physical appointment-based services anymore. While most governments still do not provide single access point portals for all public service delivery, at least sectoral advances have been made (i.e. digital space for business management, social service provision, and finally, healthcare).
In digital healthcare it is very important that citizens maintain control over who, when and how can see they health information. It is less of a problem in Europe, where governments often take full responsibility for organizing healthcare. The cost of insurance therefore does not depend on health patterns of any individuals, instead they are based on solidarity. In systems where all or part of the insurance cost is carried by citizens directly, there is always the risk of health profile-based prices or in case of high-risk patients, lack of providers willing to deliver the service. It is hard to regulate against these risks, even if most governments try to do so.
Nevertheless, even in solidarity-based health insurance models, people are normally worried about who can see the sensitive data. On the other hand, people understand that centralized healthcare databased reduce the need for repetitive actions by different healthcare providers, saving time for them (and money for government). Therefore, it is the job of a government to provide for necessary safety clauses for citizens, allowing them control over their personal health data.
For example, in Estonia where citizens can donate their DNA sample to the Estonian Genome Bank in exchange of their genetic risk profile, people are free to choose whether or not they share that data with their family practitioner. For the rest of health data, citizens can verify that only their relevant healthcare providers have accessed their medical data and no any other doctor, nurse or hospital has done so. In this way, while complete digital health records for every citizen exists, they know that personal information does not belong neither to their doctor nor the government, but themselves. It has made it easier to accept consolidated healthcare records/systems. After all, if your medical data is stored on paper files, you have far less of a control over who has read it than in case of a digital records, where every reader leaves digital fingerprints (if the system is adequately built, of course).
Finally, based on personal experience, I can testify that fully digital personal health records compared to an alternative where each provider maintains closely guarded patient data (technically, for safety reasons, but very often because of business interest in reality) offer far superior patient experience. The risks related to such systems can be managed by adequate safeguarding and firewalling methods. Since many paper-based systems have long used the data safety arguments in order not to transfer to digital ecosystems, considerable efforts may be needed to convince the patients that digital healthcare records allow, in fact, better data protection and superior level of personal control over sensitive health information.
Final warning – fragmented digital health systems which do not allow patients to transfer all their medical information, including pictures, analysis etc. to the practitioner of their choice, will not deliver neither savings nor patient satisfaction. Therefore, digital healthcare systems must be designed to overcome the fragmented nature of many healthcare provision models! Even if it is in the business interests of hospitals/practitioners not to share the results of whatever tests they have ordered for their patients, the law must be clear that the results of the analysis belong to the patient, not to the hospital and therefore must be fully accessible via digital data systems to other providers if the patient so wishes.
President Kersti Kaljulaid, Fifth President of Estonia (2016-2021)
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