Overview Of The National Electronic Health Record System Developed By Estonia
Eestlased Eestis 19 May 2010  EWR
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Source: ePractice EU

The idea of an Electronic Health Record (EHR) System for Estonia emerged in 2002. The purpose was to develop a nation-wide framework (database) to facilitate the exchange of digital medical documents and of health information. These were only available in local databases and information systems which were not able to communicate with each other.

In 2005, the Estonian Ministry of Social Affairs launched a new eHealth concept by phasing in four projects, namely: 'Electronic health records', 'Digital images', 'Digital Registration' and 'Digital Prescription'. The result of their implementation is the integrated Electronic Health Record System which was launched on 17 December 2008.

In March 2010, the EHR System contained over 1 million medical documents, including: discharge letters (inpatients and outpatients), referrals, links to digital images and electronic prescriptions (since 1 January 2010).

The Health Services Organisation Act and Associated Acts Amendment Act of 20 December 2007 established an obligation for healthcare providers to forward their patients' medical data to the EHR system as from 1 September 2008. The rules for the use of this data state that only the patient's attending physician or a medical assistant has the right to make enquiries about the patient's data. Conducting such enquiries outside of a treatment process is not allowed.

Of the over 1 000 healthcare providers who are licensed with the Estonian Healthcare Board and who have signed a contract with the Estonian eHealth Foundation - the authorised processor of the system - 309 are currently participating in the actual health data exchange over the system. This may seem like a small number but it is not given the size of the country and the fact that the system's implementation will take time.

The Patient's Portal - launched on 26 October 2009 - enables patients to access their medical data regardless of time and place. The patients can use the Patient's Portal to exercise their right to set the restrictions of access to their health data. When doing so, they will be informed by the system that it is dangerous for their health to provide healthcare services based on insufficient information. In case of an emergency situation, the patients will take full responsibility regarding the possible consequences that may arise from banning access to their data. Since its launch, there have been 13 426 individual visits to the portal and 228 494 patient enquiries have been made (data collected in April 2010).

The EHR System brought innovative results. The most innovative aspect is that the system's implementation does not cause massive re-engineering of the existing in-house information systems and communication infrastructure, which will just be integrated ('linked') by special system modules. The message exchange module (the so-called 'agent centre') enables data exchange and the interoperability of all integrated users and delivers all messages which conform to the standard message type.

By providing the users (medical personnel or patients) with message exchange and administration, the agent centre makes several rights and services possible, thus rendering the system user-friendly.
They include:

* A central security solution
* The administration of rights and users
* The authentication and authorisation of users
* The integration with external information systems (via X-road, the interface for secure data processing)
* Message administration and message-based integration
* User log-in (for example, on the online Patient Portal).

The Estonian eHealth Foundation says that the Estonian EHR System is globally unique in that it encompasses the whole country, registers virtually all the residents' medical history from birth to death and is based on the comprehensive state-developed basic IT infrastructure. It explains that such concept of a nation-wide, integrated EHR system is fully transferable only if all of the following preconditions are fulfilled: first, the existence of a nation-wide secured data-exchange platform; secondly, the application of the highest security standards for system accessibility and users' authentication, signature and encryption; thirdly, the enforcement of the national laws for collection and exchange of personal medical data.

(http://www.egovmonitor.com/nod... )
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