REPUBLIC OF ESTONIA
MINISTRY OF SOCIAL AFFAIRS
E-innovation is healthyThinkHealth ,,The Tipping Point" I Bukarest, Romania
19.02.2018
Ain Aaviksoo, MD MPH Deputy Secretary General for E-services and Innovation (CIIO)
Innovation is ...
. . . novel application of new or existing technology, material, product, method or process to gain competitive advantage.
Joseph. A. Schumpeter (1883-1950)
EU2017.EE
Wikipedia
a modest country that
extends beyond
its borders
+population: 1.3 million
+area: 45,339 km2
+currency: Euro
+member of: EU, NATO, WTO, OECD, DIGITAL 5
+ICT sector: 7% of GDP
Europe
estonia overview stories visit enjoy live + wofk rch business stonia
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celebrate our birthday
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E-state
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( Future health and care is '1
! strongly influenced by digital approach ! \ I ' / ----------------------------------------------------------------------------------------------------------------------
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Customisation / Improved
personalisation quality " ,
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Data-driven discovery
New solutions
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coordination
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INCREASED
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✓---------------------------------------------------------------------------------------------------------------------------, /
'
I \ 1 Data-driven approach in healthcare is
valuable source of innovation by
, hitting the triple aim ' /
'--------------------------------------------------------------------------------------------------------------------------- ✓
0 Increased access and safety in healthcare can be achieved through empowered citizens and adequate
data availability at the
point of care
0 Sustainability of health systems will be
supported by valuebased approach.
0 New economic opportunities, jobs
and investment will be created using datadriven health care
innovation.
8
I I
[- Journey of national eHealth services in Estonia -1
'--------------------------------------------------------------------------------------------------------------✓
► Collecting health servicereimbursement invoices
► Deidentified ,,health data lake" for R&Dcross-border ePrescription (2018)
► Drug interaction & adversereaction COSS (2016)
► Services for dentalcare (2015)
► eAmbulance services (2015)
► Medical certificate �services (2014)
► Statistics �services (2013)
► Cross-border Patient Summary
(epSOS 2013)
e
► Health insurance� informationo/ ~2000
► Digital picture Q archiving services
2005
e►
�►
EHR services forphysician and patients - 2008
Digital registrationservices - 2008
► ePrescription Services - 2010
► eConsultation
► Health status summary forSocial Insurance Board
2012services2012
(- Secure exchange of health data - ,,i
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X -ROAD GATEWAY
SERVICE
(2009)
PHARMACIES
AND INDIVIDUAL
DOCTORS
NATIONAL
SUPPORT
APPLICATIONS for
AMBULANCE
SERVICES (2014)
AMBULANCE
SERVICE MOBILE
WORKSTATIONS
4'oNYMIZE,.DATA WAREHOUSE
for ANALYTICS
(2013)
STATISTICS
PORTAL
(2013)
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NATIONAL: MEDICAi: IMAGES
ARCHIVE PACS
(2005 I national 2014)
NATIONAL HEALTH INFORMATION
SYSTEM/ ARCH IVE
{2008 december)
But what does it take to deliver?
11
It takes ...
✓ lots of information from varioussources
✓ powerful information systems toprocess the data
✓ smart people to find the meaningfrom noise or random (thoughsometimes beautiful) patterns
and ...
... a lot of trust
(from data subjects) 12
Digital Society Recipe of Three
Technology
13
Access and control of health data
becomes crucial
Fundamental principle:
Health data belon s to the erson (data subject)
1 . Access to my data
2. Control of my data use
3. Delegation of my access and control rights
4. Individual monitoring of requests for my data
EU2017.EE
From ,,health data'' to ,,digital health services''
My e-Health r.. Pyccrum
VANANENUDTARKVARA KASUTAMINE ON OHTLIK
Eesti
DIGITAL HEALTH SERVICES
My data Ain Aaviksoo 37406146510
INSURED Family doctor: Katrin Ollikainen
Update _m
Represented persons HANS OSKAR AAVlKSOO 39812310225
HANNA MERILYN AAYlKSOO 49812310237
Time atical data
Dental care documents
Dental status chart
Pass rt ollmmunizabon
Presai •ons
Relerrals Invalid referrals
Valid referrals
NI referrals
Referrals re lated to ana omlmenl
Heallh certificates
Case summaries Out-atient case summaries
In a•ent case summanes
Birll cas anes
Develo men! assessment no,Acabons
nisatio
Growttl notifications
Examination notifica1ions
Counsellin notifications
Referral res onses
Health related information starting from October, you willfind information and matenalsimportant to the patients and !heirfamily members here
Important updates Data is updated about your prescriptions.Possibility is developed to see and prin t ou1 your Passport of Immunization on the ruture
15
---------------------------------------------------------------------------------------------------------, '
/ \
[ Very fast system-wide adoption of I I
l, e-services: the case of ePrescription ----------------------------------------------------------------------------------------------------------
✓
800 000 ,---------,..---------,-------------------80% of electronic prescribing achieved
ePrescriptions within 9 months
400 000
}-- - -1- �\;;;;;;;;;;;-;;;-""""'1A ........ ��� 7�,�-=--_-_-_-_-_-_-_-_-_-_-_-_-_-_-_-_-_-_-_-_-_-_-_-_-_-_-_-_-_-_-_-_-_
200 000 ;-- P /.e rescnpt1ons
dispensed
Jan/10 Mar/10 May/10 Jul/10 Sept/10
E-Prescription in Estonia:
Any doctor can prescribe to
any patient, who can
buy the medicine in any pharmacy
Nov/10 Jan/11 Mar/11 May/11 Jul/11
--------------------------------------------------------------------------------------------------------/ '
[ Public support to Estonian Genome Foundation I
I
I I • • I
l has risen over time ' /-------------------------------------------------------------------------------------------------------�
--In favor of the idea of EGCUT
--cannot comment
--Need more information
---Never heard of EGCUT 70%
-····· Wait-and-see-attitude --Against it -- '
,, 67% ', 61%59% , •
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June,
2001 Sept,
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Feb,
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2004 Sept,
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2005 May,
2007 Apr,
2008 July,
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2011
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2010.08
2010.10
2010.12
2011.02
2011.04
2011.06
2011.08
2011.10
2011.12
2012.02
2012.04
2012.06
2012.08
2012.10
2012.12
2013.02
2013.04
2013.06
2013.08
2013.10
2013.12
2014.02
2014.04
2014.06
2014.08
2014.10
2014.12
2015.02
2015.04
2015.06
2015.08
2015.10
2015.12
2016.02
2016.04
2016.06
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Secure data exchange is built on standard internet
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Number and volume of digital services in Estonia
using secure data exchange layer X-layer is only •
growing ...
2003 2005 2007 2009 2011 2013 2015 Year
1800 Services
1600 • lnst1tubons Data repositories
1400 �� 1200 E � 1000 (I)
::i 800
� <I: 600
400
200
0
2003 2005 2007 2009 2011 2013 2015 Year
�----------------------------------------------------------------------------------------------------------------------,
[' ePrescription with training and public campaign delivered 'j I
!, tangible value for health system and patients '
/ ----------------------------------------------------------------------------------------------------------------------;
• Active ingredient based prescribing doubled within 4 years
• Allows patients to choose medicine with affordable price
Percentage of active ingredient based prescriptions
100% 86%
90%
90% 78%
80% 68%
70%
60%
50% 45%
40%
30%
20%
10%
0%
2010 2011 2012 2013 2014 2015 20
( A precise and learning system with-,1
I I
t,_ constant_clinical/care_ knowledge _creation ________________________ ✓J
care flow
ealth & social service
encounters:
(health, treatment & care
data, molecular data,
seq uenci ng/genotypi ng
ohter individual data)
knowledge flow
..
Pseudonymi
zation ..
..
Care decision support
algorithms & engine
Anonymized ._·data warehouse
-:(500 000 i.g�_csons) ',;;,�-'
....-(
for R&D -�:-.�1-'. ·.; '. '.·:;, ._--•.r.
Europe has defined Digital Single Market as its
core strategic goal and digital health is one of it's
cornerstones •••• •
• • • • • ••
European Commission > Strategy > Digital Single Market >
Digital Single Market
DSM blog post 3 MAY 2017
The European Digital Health Revolution
"Europe has embarked on a journey towards a seamless
digital health revolution which brings together eHealth,
mHealth and even wearable health. As a citizen of the
European Union, I'm looking forward to it!" 23
✓---------------------------------------------------------------------------------------------------------,
/ \
[ Most of Europeans want to and can use I
I
[ digital health services if offered ' I
'---------------------------------------------------------------------------------------------------------✓
/,- --, / '
,// 76% Europeans have ',\ access to fast internet
79% are using internet ( of which 70% are using it every day or al most
\ every day) ' ' ' /
, __________________________________________ ,
I I I I I I I I I I I I I I I I I
I I I I I I I I I
I
/ /
---------------------------------------/ '/ '
I \ I \
52% European citizens want access to their health data
' / ' /
----------------------------------------
,-------------------------------------, / ' / '
I \ I \ '
70% ARE willing to share
their data with others (incl
63% with their doctor)
23% ARE NOT willing to
\ share their health data \ I
', / --------------------------------------
✓
24
EU General Data Protection Regulation facilitates better
use of personal data
••• • • • • • • •••
European Commission Building a European Area of Justice
Euro pron Comm1a.a1on > J11abcc > O•t.i protection > reform
Q HOME
-
- ALL TOPICS
DATA PROTECTION
[ Search
Reform of the Clata protection
legal framework
Reform of EU data protection rules
The new Regulation will also guarantee
free and easy access to your personal
data, making it easier for you to see
what personal information is held
about you by companies and public
authorities, and make it easier for
you to transfer your personal data
between service providers - the so
called principle of 'data portability'.
Privacy means that personal data should not be secured from being used, but to be used securely
25
/- -, I \
[ Main strategic e-health projects in Estonia I I
! (in varying implementation phase) l \ I
'--------------------------------------------------------------------------------------------------------------------✓
1. Comprehensive patient care pathway ,,logistics'' managagement (referral letter+ e-consultation + appointment booking) - 2018
2. Full cycle care continuity for chronic conditions - 2019
3. National quality assessment service for outcome based health system - 2020
4. Innovative integration of health and social care at the regional/community level - 2020
5. Clinical decision support systems for adaptive care pathways (including personalisedmedicine implementation) - 2018
6. Integration and sharing of personal medical data with 3rd party (non-medical) data
services (including personal health record) - 2018
7. National data-as-a-service framework (1-stop-shop) for secondary use of health data
for R&D&I - 2018/2019
27
ex connected, health Competence areas
Estonian Healthfech Cluster
• digita I ID
• e-ambulance
• e-prescription
• e-dermatology
• innovating hospital workflows
• true continuum of care for the most critical and expensive medicalconditions
• data management, trust and security services for health registers,biobanks and clinical trials
connectedhealth.ee
28
ex connected'- health Companies with export portfolio
Estonian Healthfech Cluster
,. ... NORTAL Helmes
ORNet � CelsiusHealthcare
••• • •
• •
C OGNU S E_ ,. ... - -- - .. . .. .
CilureTEC
LabToWeUness
connectedhealth.ee
tfl'•, ,�� ,surgery,�':t>,:-
MediKeep
T eleHealth.ee BOOKING & VIDEO PLATFORM
dermtest
• CYBERNETICAE·GOV£RHMEHT MARINE TECHNOLOGIES SECURITY TECHNOLOGIES
Guardtime's KSI® is a blockchain platform
desig1ed for e11terorise solutiO"S witb
sect..riry, sc.ale a10 performance bJilt iri.
guardtime�
IUPIITECH
[!II medi5CFb
29
