Digital discussions

Looking West: Estonian IT firms consider the digitisation of US (and Canadian) healthcare

Digital Discussion e-Health North America

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Can Estonian-style digital society really be transposed to a large, federated country like the US?

The answer is apparently yes, or at least Estonian firms welcome the dialogue and want to try. Estonian companies have an extensive background in digitisation efforts at home and abroad. Since the dawn of this century, they have worked hand in glove with the public sector to construct one of the world’s most advanced digital societies. The collaboration has yielded services as diverse as i-Voting and e-Residency. In healthcare, Estonia has gained a reputation for its versatile e-Health solutions, ranging from secure digitised electronic health records to e-prescription services. Now companies in the sector are looking to help US partners make a similar transition.

Eager to partner

Nortal, a digital transformation company headquartered in Tallinn, has been expanding into international markets, particularly throughout Europe, the Middle East, and the US.

In terms of e-Health solutions, it has worked with partners to craft e-services based on secure data exchange, electronic ID, analytics, and privacy. The company has undertaken e-health projects in Estonia, Finland, Germany, and Lithuania. While it has had a US office in Seattle since 2017, it hasn’t yet pursued healthcare-related projects in the North American market, but according to Taavi Einaste, head of digital healthcare at the company, that is likely to change.

“Nortal went to the US market in 2017 and our US presence has grown to more than 200 people, serving Fortune 500 companies mostly,” says Einaste. The company is also eager to serve the adjacent Canadian market and Einaste says Nortal has conducted exploratory workshops with Canadian public sector health authorities recently. “We have provided them with a crash course on Estonian digital health infrastructure and tried to map it to what they were doing,” he says.

A unique moment

The ongoing COVID-19 pandemic has the potential to open doors for Estonian IT companies. As mass vaccination efforts make it possible to reopen public places and restore international travel, authorities are faced with the challenge of managing vaccination certificates or health passports.

“At this unique moment, there is a readiness to change and start making use of health data in digital form at a larger scale,” notes Ain Aaviksoo, CMO of Guardtime Health. Founded in Estonia, Guardtime is now a multinational firm headquartered in Lausanne, Switzerland. Its solutions are based on its KSI blockchain technology, which allows the firm to build zero-trust systems that provide a verifiable mathematical proof of correct operations.

Last year the firm worked to develop VaccineGuard, a vaccination certificate platform that enables management of vaccination campaigns as well as distribution of vaccines. The platform could find use in the US market too, Aaviksoo points out.

“We support coordination of different entities and coordination of vaccine flow through the health system and through the supply chain for higher efficiency and higher quality vaccine management,” says Aaviksoo. “This epidemiological situation will go on for at least the next few years if not forever,” he says. “There needs to be a system which helps to maintain this cross-boundary health information exchange in a privacy-preserving and secure manner.”

Building backbone

Tallinn-based Cybernetica sees the potential for its solutions to make inroads in the US market. Kevin Tammearu, head of business development at the company, notes that its unified exchange platform or UXP can facilitate “user-friendly healthcare services” through interoperability.

“UXP enables seamless data exchange across a trusted ecosystem, including institutions, care teams, and patients,” notes Tammearu. “Time-critical data can also be used securely, increasing overall transparency around medical data,” he says.

Having such a secure data exchange is widely seen as the backbone to any digital transformation, adds Tammearu. “In healthcare, it’s the foundation for integrated health services, leading to a fully interoperable ecosystem and creating new business models.

Like Cybernetica, Helmes, another Estonian IT firm, has decades worth of experience in building that backbone. The company is responsible for Estonia’s e-prescription service, unveiled over a decade ago, now used by most citizens. It also has specialised in developing hospital information systems. That knowledge could be transferred to other countries, even larger, federated ones like the US. “Our main focus is on business efficiency,” says Meelis Lang, vice president of engineering and innovation at Helmes. “Hospitals and clinics tend to have complex software systems with legacy silos causing a lot of wasted work time,” Lang says. “Our expertise is in creating smart service flows that help hospitals to work considerably more efficiently even if they have an info system in place, to begin with.”


Compared to Helmes and Cybernetica, the Estonian firms Certific and Viveo Health are relative newcomers. Certific CEO Liis Narusk has been leading the firm since last year. Certific’s core offering is a digital platform to certify remote COVID-19 testing. The company’s application manages an individual’s data relating to tests and health certificates issued by a doctor or medical testing provider. Certific is already on the market in the UK offering at-home PCR test verification. Narusk says the firm’s origins stem from the ongoing COVID-19 pandemic.

“It’s easy to go into a lockdown, but how do you get out of it?” she says. “We knew there needed to be a new infrastructure emerging that would enable people to be social again.” Narusk says that Certific would like to be part of this “brave new world opening up” where technology platforms like its own support some return to normalcy.

Viveo Health is not quite as young as Certific, but still at just two years old qualifies as a startup. The company has endeavored to create a global digital health platform, bundling virtual visits, offline clinics, and private insurance into a single offering under the banner of digital health for a billion people. Its platform has experienced rapid uptake in markets like India, where it experiences triple-digit weekly growth.

“Whenever you need a doctor, you just call Viveo and we pretty much act like a concierge service for companies taking care of everything for their employees’ health,” says Gomti Shankar, chief revenue officer at the Tallinn-based company. “You don’t need to file for claims, keep invoices, or make upfront payments.”

Given its acceptance in India, Viveo Health is also keen to break into the US market, Shankar notes, where it seeks both investors and partnerships. “It’s the sheer size of the US,” says Shankar. “The digital health ecosystem in the US is the largest in the world, telemedicine has been there for years,” she says. She also notes that US investors are less conservative than their European counterparts. “In the US you have investors who invest in an idea, a belief,” she says. “All of those things make the US very attractive.”



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