Estonia’s Ground-Breaking — and Inexpensive — Electronic Health Records System
Estonia is one of the smallest nations in Europe, and its government one of the newest. Yet it’s one of the most advanced nations in terms of technology and e-government.
For example, it’s the only nation where citizens can cast their votes online in every election, even the local ones. Also, 75 percent of its population is connected to the Internet, compared to 61.3 percent penetration for Europe as a whole. Drop the age to 35 and under, and the internet penetration spikes to 100 percent, according to a recent McKinsey Quarterly report.
The article focuses on Estonia’s impressive e-ID and e-government system, which allows both private and public agencies to verify identity, deliver services, and even make loans. The country also boasts an impressive data-access platform — X-Road — that integrates data from across the government and to some private companies.
It’s the kind of electronic infrastructure you’d typically only see in science fiction: Secure, integrated and used for almost every aspect of a citizen’s life.
Given the success of the e-government platform, you can imagine that expectations were high when Estonia decided to build a national Electronic Health Records system (EHR) for its 1.3 million citizens in 2008.
The Estonian eHealth Foundation had a one goal: The central system would register every resident’s medical history from birth until death. That includes every document, from physicians notes to X-rays.
I said it was one goal — I didn’t say it was easy.
I regularly write about integration and on numerous occasions, I’ve covered the efforts in the U.S. to create a nationwide electronic medical system. Physicians, hospitals and other health care organizations in the U.S. are struggling to connect to each other in local settings, much less nationally. One technology expert even called it the “biggest data integration challenge ever undertaken by the IT industry.”
So I feel I can go out on a limb and say, this is a major integration challenge.
How did Estonia solve it?
It used an ESB (enterprise service bus).
Granted, it wasn’t just any ESB. The architecture included an integration server, which included the ESB, a high-performance messaging backbone, a tool for monitoring the performance of the connections and, of course, consultation by a global consulting service.
It’s a robust system, but it has to be, since it is designed to integrate medical records from across the nation, giving doctors access to all past healthcare records, and patients the right to block access if they so choose. As of 2010, the system contained more than 1.6 million medical documents, with 35,000 added each month and 15,000 cases closed each day.
The system made Estonia a global leader when it comes to establishing standards for medical records.
You’d think it would cost a fortune, but that’s the second surprise. With 47 percent of its citizens enrolled, the cost in 2009 to build this system was a mere €7.50 (roughly $10 USD in 2009) per citizen.
Of course, it’s a bit more complicated than that. After all, Estonia was starting from a different place, technologically speaking, than many countries. For instance, in the U.S., this type of integration is complicated by the fact many health care organizations have already invested in proprietary EHR systems, with proprietary data formats and in some cases, locked-down data.
But as so many countries struggle with health care costs and electronic records, it’s nice to know at least one country is getting it right. To learn more about Estonia’s Electronic Health Records system, check out this case study.