Country Brief: Estonia
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Country Brief: Estonia Authors: P. Doupi, E. Renko, S. Giest, J. Heywood, J. Dumortier October 2010 European Commission, DG Information Society and Media, ICT for Health Unit Estonia About the eHealth Strategies study The eHealth Strategies study analyses policy development and planning, implementation measures as well as progress achieved with respect to national and regional eHealth solutions in EU and EEA Member States, with emphasis on barriers and enablers beyond technology. The focus is on infrastructure elements and selected solutions emphasised in the European eHealth Action Plan of 2004 Disclaimer Neither the European Commission nor any person acting on behalf of the Commission is responsible for the use which might be made of the following information. The views expressed in this report are those of the authors and do not necessarily reflect those of the European Commission. Nothing in this report implies or expresses a warranty of any kind. Acknowledgements This report was prepared by empirica on behalf of the European Commission, DG Information Society & Media. empirica would like to thank Jos Dumortier, Time.lex CVBA for the review of the section on legal issues, and Professor Denis Protti (University of Victoria) for valuable feedback. Reviewer Pille Kink Contact For further information about this Study or eHealth Strategies, please contact: empirica eHealth Strategies European Commission Gesellschaft für c/o empirica GmbH DG Information Society and Kommunikations- und Oxfordstr. 2, 53111 Bonn, Media, ICT for Health Unit Technologieforschung mbH Germany Oxfordstr. 2, 53111 Bonn, Fax: (32-2) 02-296 01 81 Fax: (49-228) 98530-12 Germany [email protected] [email protected] Fax: (49-228) 98530-12 [email protected] Rights restrictions Any reproduction or republication of this report as a whole or in parts without prior authorisation is strictly prohibited. Bonn / Brussels, September 2010 2 Estonia Table of contents 1 Introduction to the report....................................................................................6 1.1 Motivation of the eHStrategies study..........................................................................6 1.2 Survey methodology....................................................................................................7 1.3 Outline...........................................................................................................................8 2 Healthcare system setting..................................................................................9 2.1 Country introduction....................................................................................................9 2.2 Healthcare governance..............................................................................................10 2.3 Recent reforms and priorities of health system/public health.................................11 2.4 ICT use among general practitioners........................................................................12 3 eHealth strategies survey results.....................................................................14 3.1 eHealth policy action..................................................................................................14 3.1.1 Current strategy/roadmap.................................................................................14 3.2 Administrative and organisational structure.............................................................17 3.3 Deployment of eHealth applications..........................................................................18 3.3.1 Patient summary and electronic health record (EHR)........................................19 3.3.2 ePrescription....................................................................................................22 3.3.3 Standards........................................................................................................24 3.3.4 Telemedicine....................................................................................................24 3.4 Technical aspects of implementation........................................................................26 3.4.1 Unique identification of patients........................................................................26 3.4.2 Unique identification of healthcare professionals..............................................26 3.4.3 The role of eCards...........................................................................................27 3.5 Legal and regulatory facilitators................................................................................28 3.5.1 Patient rights....................................................................................................29 3.5.2 Personal data protection act.............................................................................29 3.6 Financing and reimbursement issues.......................................................................30 3.7 Evaluation results/plans/activities.............................................................................32 4 Outlook...............................................................................................................32 5 List of abbreviations..........................................................................................34 6 References.........................................................................................................36 3 Estonia Executive summary Since 2005, the Estonian countrywide eHealth approach includes four pillars: Electronic Health Records (EHR), Digital Registrations, Digital Imaging and Digital Prescriptions. The idea for developing a National Health Information System was introduced by the Estonian Health Project 2015 in 2000 and in 2003 the Department of Health Information and Analysis was established for the practical development of the project’s strategy. In addition to this, the Estonian Information Society Strategy 20131 and its Implementation Plan are directly linked to the Health Strategy. Another important development is the launch of the framework of the 2007-2013 strategy Knowledge- Based Estonia. This document draws upon ICT utilisation roadmaps in six focus areas with one of these areas being healthcare. In January 2009, the National Health Development Plan2 (NPHS) 2009-2020 was presented by the Estonian government and its implementation plan 2009-2012 came into effect. It is a master document integrating many thematic development plans and strategies affecting the health condition of the population into a comprehensive national public health policy document. Thereby, eHealth is one of the issues addressed. In order to consider Estonia’s position regarding eHealth interoperability objectives the following eHealth applications have been examined: patient summaries and electronic health records, ePrescription, standards and telemedicine. In overview Estonia’s situation is as follows: The Estonian Electronic Health Record System (EHR) encompasses the whole country, registers virtually all residents’ medical history from birth to death, and is based on state-developed IT infrastructure. It was launched on 17th December 2008 and since 1st January 2009 all healthcare providers have been obliged to send an agreed number of standardised medical documents, electronic information notes and electronic medical documents to it. The Estonian Ministry of Social Affairs launched a pilot phase of ePrescription services which ran until January 20103. Now, the central ePrescription system has been implemented and enables medical personnel and pharmacies to monitor and manage the issuing of prescriptions. In Estonia, the eHealth Foundation and the Centre for Standardisation are responsible for the use of health informatics standards. In January 2010, Estonia became a Member of the International Health Terminology Standards Development Organisation to enable the use of Snomed CT in connection to digital health records, health research and other applications. In December 2007, the Estonian Telemedicine Association was created as a sub-organisation of the Finnish Society of Telemedicine and eHealth. In general, Estonia has been or is part of several small projects, which are related to the use of telemedical applications. 1 Ministry of Economic Affairs and Communications 2006 2 Läänelaid 2008 3 The pilots were mostly carried out in the area of Tallinn, Tartu and Viljandi. Estonia List of figures Figure 1: Important features of primary healthcare organisation in Estonia........................................11 Figure 2: Estonian policy documents related to eHealth....................................................................17 Figure 3: Division of responsibilities among Estonian eHealth institutions.........................................18 Figure 4: eHealth components of the Estonian health information system.........................................18 Figure 5: Estonian ePrescription system...........................................................................................22 Figure 6: ePrescription progress in Estonia.......................................................................................23 Figure 7: Telemedicine services in Estonia.......................................................................................26 Figure 8: eCards in Estonia..............................................................................................................28 Figure 9: EU Fund Distribution in Estonia.........................................................................................31