PROF. PEETER ROSS, MD, PHDTALLINN UNIVERSITY OF TECHNOLOGY, ESTONIA

EAST TALLINN CENTRAL HOSPITAL, ESTONIA

CONSULTANT OF THE WORLD BANK

REGIONAL HEALTH POLICY DIALOGUE 2018

OCTOBER 09TH, 2018

WASHINGTON D.C., USA

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2000 2003 2008

Planning initiated

Project preparation (2003-2005)

2006

Funding decision by Ministry of Economic

Affairs

Electronic Health Record

Digital Prescription

Digital Registration

Digital Images

eHealth Foundation established

eHealth Projects

(2006-2008)

National EHR System

2010

ePrescription

2015

Digital stamp

Implementation of new

e-services

2001 Electronic transfer of

reimbursement claims

2005 Allreimbursement

claims and prescription data

electronic

2008-2009 Gradual integration of hospital/GP information

systems to the EHR System

1990-2000

Occasional use of

Electronic Medical Records (EMR)

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PHARMACIES AND

FAMILY DOCTORS

2009

X-Road, ID-card, State IS Service Register

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2010 S

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2014

NATION-WIDE

HEALTH

INFORMATION

EXCHANGE PLATFORM

2008 December

PRESCRIPTION

CENTRE

2010 January

PATIENT PORTAL

2009

X-ROAD GATEWAY

SERVICE

2009

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Secure data exchange layer provided by the stateX-Road, ID-card, mobile-ID, State IS Service Register

DRIVING LICENCE

HEALTH CERTIFICATE

APPLICATION

2015 NATION-WIDE

PICTURE

ARCHIVING AND

COMMUNICATION

SYSTEM

2005

SFINX

Drug-drug

Interaction database

2016

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➢ The set of documents is defined b

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-

100,000

200,000

300,000

400,000

500,000

600,000

700,000

800,000

900,000

1,000,000

ISSUED SOLD

-

100,000

200,000

300,000

400,000

500,000

600,000

700,000

800,000

900,000

1,000,000

ISSUED SOLD

*2012 January - August

0

5000

10000

15000

20000

25000

30000

0

2000

4000

6000

8000

10000

12000

14000

16000

18000

Patient Portal users 2015

Men Women

iPatient Portal users 2012

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→

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1. A secure authentication of all users with ID-card or

Mobile ID

2. Digital signing or stamping of all medical documents

3. A maximum accountability (transparency): all actions

will leave an unchangeable (and unremovable) secure

trail, protected by blockchain (hashchain)

4. Coding of personal data: separating of personal data

from medical data

5. Encrypted database that allows to remove the

confidentiality risk from the technical administrators

6. Monitoring of all actions together with the corresponding

counter-measures (both organizational and technical)

Six main principles „6 whales“ of

security of EHR System