As a participant in eight different EU projects, Peeter Ross, professor at Tallinn University of Technology, can fairly be described as a veteran of European eHealth research.
Indeed, the first such project – in digitising radiology images – was way back in 2002, before Estonia had formulated its eHealth ambitions. “Although the medical imaging project predated the Electronic Health Records system, it was significant when it came to setting up the records system because it gave insights into what factors to take into account,” Professor Ross says.
It may seem that, when EU projects end, there is nothing tangible to show for them but the knowledge networks that they build are extremely important, Professor Ross believes. “The knowledge that comes from these networks has been a foundation for developing national-level eHealth applications,” he says.
Estonia’s experience demonstrates that there are five essential elements for the successful implementation of national eHealth systems:
- clear governance: the implementing organisation, often the government, must be fully supportive and engaged;
- there has to be legal clarity;
- the physical infrastructure must be in place;
- access rights, stating what and how information will be collected and who has rights to use it, should be clearly defined;
- there must be agreed technical and semantic standards.
“When you look at the range of European projects, you can see that each of these five elements for successful implementation has had some input from EU-funded eHealth research,” says Professor Ross.
In addition to informing the development of eHealth in Estonia, EU research has helped to build trust and confidence in the system, Professor Ross says. “When you take any innovation or disruptive technology, it is really important to have external validation and access to external research.”
Estonia spends a modest – by EU standards – 6% of GDP on healthcare. The evidence is that digitisation enables the country to make the budget go further and, in effect, buy more health. Hospitals have made efficiency gains, individuals are beginning to take more responsibility for their own health and the government has the data to inform public health measures and appropriately direct resources.
Setting the Scene for National-scale Personalised Medicine
All of Estonia’s government services run via a common platform, through which it is possible to link all the databases in a secure and trusted way. Researchers and clinicians can integrate public repositories, including hospital records, pharmacy, health insurance information, causes of death and other disease-specific registries.
Taken in combination, it becomes possible to assess the individual risk of developing disease, based on genetics, environment, comorbidities and age. This can aid public health measures when supporting prevention – for example, sending people who have had one heart attack mobile-phone text messages to encourage them to maintain lifestyle changes.
As a result, Estonia is positioning itself to be one of the first countries in the world to implement personalised medicine on a national scale. It will also support a move to value-based services, in which the performance of the healthcare system is measured not in terms of inputs but of outcomes.
The Estonian Programme for Personalised Medicine envisages that data from all major databases will be integrated, supporting clinical decision-making and treatment. There are plans to develop an eHealth database containing genotypes, eHealth records, prescriptions and so on, relating to 500,000 people by 2022.
Time for More Action
Professor Ross would like to see Estonia use its EU Presidency from July to December this year, bringing greater pragmatism into eHealth in Europe. “The directives are there but we need to inject more action,” he says.
“Each member state has its own concerns about data privacy and security and there have been more discussions about the threat than the benefits,” Professor Ross says. “I hope the Estonian EU Presidency can show the clear benefits of eHealth in, for example, e-prescriptions and several other services.”