EMIF: “Digital Citizen, Digital Patient”

A key aim of the Presidency is to promote Digital Europe. In eHealth the goal will be to highlight how digital technologies can contribute to the sustainability and resilience of healthcare systems. “There is a moral obligation to use eHealth data”, says Ain Aaviksoo, Deputy General Secretary on eServices and Innovation, Ministry of Social Affairs, Estonia.

The European Medical Information Framework (EMIF) meeting in Tallinn takes place a few days before Estonia assumes the EU Presidency for the first time since the country’s accession in May 2004. That makes the EMIF event a fitting moment to showcase the country’s position as number one in Europe in public sector digital services and to reflect on the importance of EU-funded projects in eHealth and big data in helping Estonia achieve its digital vision.

“In Estonia, it is now assumed a natural thing that when a patient moves through the healthcare system and between health and social care, that the data about the individual is available”, says Ain Aaviksoo, Deputy General Secretary on eServices and Innovation, Ministry of Social Affairs, Estonia. The demand for this comes equally from the citizens as the providers, he noted.

That puts Estonia well ahead of the EU as a whole, where the percentage of hospitals exchanging clinical care information about patients electronically with other health care organisations within the same country ranges from 33 per cent to 39 per cent, according to the European Commission’s mid-term review of the Digital Single Market strategy, published on 10 May.

At 1.32 million, the small size of Estonia’s population makes scaling up to a national level easier, but widespread adoption also hangs on trust, both in the governance framework and the technology on which the country has built its eServices.

That enabled Estonia to go from a standing start to 80 per cent coverage in nine months, when it implemented its eprescription service, for example. “If there is an agreement a service is needed, it will get used widely”, Mr Aaviksoo says. Currently, 99 per cent of prescriptions are handled electronically.

To date, the arrival of eHealth services has made the existing delivery model more efficient. Now, under its eHealth strategic plan 2015–2020 Estonia wants to apply the power of digitisation to drive improvements in the organisation of the healthcare system, to put it on a more sustainable footing.

“We want to use eHealth solutions much more to get better productivity”, says Mr Aaviksoo. Experience from some hospitals and primary care centres acting on their own initiative indicates clinicians’ productivity can increase by 30 per cent, for example, through econsultations and the greater ease and flexibility of inputting patient data into the National Health Records system.

At a national level, things remain fragmented, but plans to replicate such improvements across the healthcare system are under discussion, Mr Aaviksoo says.

How EU projects contribute

Estonia does not have the resources to go it alone and EU-funded projects are “hugely important” in achieving its eHealth objectives, says Mr Aaviksoo. “To acquire the knowledge, you either pay for it, or you work with others, incorporating their knowledge and experience. With one or two exceptions, I don’t think there is any country that can scale and get the benefits of big data in health on its own.”

In addition, the technology is advancing rapidly, making it ever more important to have access to external expertise. “We are proud of what Estonia has achieved, but much of the knowledge is elsewhere – we want to be part of the large knowledge pool”, Mr Aaviksoo says.

In return, Estonia is, in effect, a live testing ground. “We are lucky; we can scale. [The country] is a practical example to show what works in what circumstances”, says Mr Aaviksoo. The evidence from Estonia is that eHealth and digital society are seen as desirable. “This is a virtuous circle. If you can prove what you are doing is driving demand from citizens, there are more requests and the funding to develop further.”

The Fifth Freedom

Estonia intends to spotlight its positive practical experience across a spectrum of public sector eservices during its EU Presidency. In eHealth the contribution that digital services can make to promoting sustainability of healthcare systems, in the face of rising costs and increasing demand, will be stressed.

The country will also pursue its mission to have the free movement of data enshrined as the fifth freedom of the EU. That would mean an eprescription issued in Estonia could be filled at any pharmacy in Europe, for example. It would also open the door to the reuse of health data for research.

Mr Aaviksoo believes Estonia has shown in a practical way that individual privacy and access to anonymised data can be in balance, allowing third parties to make secondary use of data. There are use cases from across Europe illustrating the value that can be derived as a result.b

“We would like to make this into a reality: security in healthcare does not mean data are secured from being used, but that data are used securely”, said Mr Aaviksoo. “It is a moral obligation to use healthcare data. So no more pilots – let’s get on with it.”

Ain Aviksoo will be a speaker at the event “EMIF, Digital Citizen, Digital Patient” on 28-29 June in Tallinn, Estonia