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Where is Estonian e-health headed?

Priit Tohver, adviser for e-services and innovation at the Ministry of Social Affairs, looks at the current state and possibilities of e-health solutions.

“In the future visiting your doctor will mean that a screen with your family doctor will appear while you’re having breakfast. Sensors on your body have detected that your blood cholesterol levels are a bit high and your doctor suggests replacing fried eggs with granola instead.” This is roughly how the future of e-health was depicted all around Europe about ten years ago. What are we dreaming of right now and how do we get there?

If we move past the worrying image of a human doctor who should be keeping an eye on their patients every morning, ten years ago this vision seemed really cool. Knowing how these solutions should actually work, was also pleasantly unimportant. The fun ended the moment I passed through the security gates at the “super ministry” to start my job at the Ministry of Social Affairs. As it turns out, my family doctor still doesn’t know what I have for breakfast, and it was now my job to figure out the best way to let him know.

The National Audit Office of Estonia said in their 2014 report that the e-health tiger has not been leaping lately. Other tigers had gone to consult in Finland in the meantime and had discovered that their health data remained in Estonia still, regardless of X-road interoperability. Others (and myself included) had been too busy learning new languages and had fallen behind in the conversation. What are eHDSI and DICOM and is SNOMED still with HL7 dwarves?

Estonia has many smart e-health solutions

Fortunately there have been smart people steering our e-health towards calm waters. We have a lot to be proud of, even on an international level, like a fully functional e-prescription, smart support for discovering the co-effects of medicine, e-ambulance and a developing e-consultation service. Even a digital registration that works across the country is now working and more and more hospitals are connecting to it. Cross-border e-prescription now reaches across the Baltic Sea.

We are capable of creating a health system that supports the person – let’s call him Mart (or Mari) – and their whole life cycle. If Mart so wishes, we are capable of gathering data that describes his journey through the medical system, but also his environment, lifestyle, genome and more. Integrating these data, we can create a full picture of his current health situation and plan preventative actions if need be.

We also have the technology for all this

If Mart would like to move to another country for a change, his health data can also be shared with his new doctors. If Mart falls ill, we can determine if the problem requires a doctor’s attention or can be solved more easily, maybe even with the help of an automated system. This way we can also ensure that once Mart really needs a doctor, the doctor will have time for him.

More importantly, we can bring medical help to Mart’s doorstep through long-distance solutions, which is crucial if Mart is not mobile for some reason. If Mart should have a chronic disease – and around half the people will have one – we could monitor his health situation from his home already now. Mart in turn could download a mobile app integrated to the health system that reminds him when to take his medication, what to eat and which exercises he should be doing.

If we put all the Marts and Maris of our country together, we could learn from our master data which treatments are actually effective, which hospitals give the best care, which problems our people have and even how genes affect diseases and treatments. For example, Mari could discover that even though she carries the BRCA gene mutation, her risk of getting breast cancer is lower because her lesser known gene regulators will block the mutation. We know this based on other women who carry the same genes and didn’t have cancer.

We need international cooperation more than ever

It’s already a tangible reality if only we could put the pieces of e-health together as one whole. Future health is not an unattainable dream, however, I could never say that it will be easy to get there. Figuratively, we have the components to build a ship for Mart or Mari to sail to the e-health paradise. Unfortunately we and everyone else lacks a ship building master to put the components together so that the ship wouldn’t sink.

This is why we’ve created an association with other European Union countries called eHAction – European Union e-health joint action. It has e-health experts from 30 countries and it is focused on mobile health, telemedicine, big data analysis, artificial intelligence and cross-border health services. Of course, the challenges lie with privacy and data security. In three years we hope to get this far that every country will at least have an IKEA-style guide to build the ship mentioned above. Estonia will win from user-centric and effective e-solutions in any case.

This article was originally posted in Estonian on the Ministry of Social Affairs blog.

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