Estonia has implemented an advanced digital infrastructure with over 99% of bank transfers and 94% of income tax declarations conducted electronically. Key innovations include the introduction of the e-tax board, e-voting, and mobile ID, which collectively enhance public access to services while ensuring secure digital authentication. The country boasts high levels of public trust in its systems, evidenced by widespread usage of e-services and a significant proportion of medical documents processed digitally.

1. Nationwide e-Estonia mind-set
Erkki Leego IT adviser

2. Estonian E-services
•99% of bank transfers are performed electronically
•94% of income tax declarations made via the e-Tax Board
•24% of votes were cast over the internet on 2011
•62% persons have completed the e- census 2012
•2000: Launch of e-Tax Board
•2000: Launch of m-Parking
•2002 : Introduction of national electronic ID-Card
•2005: i-Voting was introduced
•2007: Introduction of m-ID
•2007: Launch of e-Police system
•2008: Launch of e-Health system
•2010: Launch of e-Prescription
•2012: e-census
•2014: e-residency

3. Estonian information system

4. 06.02.2013
4
Authentication

5. The Estonian ID card
•The ID card is a mandatory ID document for all Estonian residents from the age of 15
•Enables secure digital authentication and signing
•A digital signature has the same legal consequences as a hand-written signature
•Does not have any additional information
–No bank account, no health information etc.
•Active cards: 1 221 948 (08.09.2014)
–Digital signatures: 174 385 946
–Estonian Population 1 286 540 (01.01.2013)
–Estonia has been issuing electronic ID cards from January 1st 2002
–Also Mobile-ID

6. PHARMACIES AND FAMILY DOCTORS 2009
X-Road, ID-card, State IS Service Register
HEALTH CARE BOARD
- Health care providers
- Health professionals
- Dispensing chemists
STATE AGENCY OF MEDICINES
- Coding Centre
- Handlers of medicines
POPULATION REGISTER
PHARMACIS
2010 january
BUSINESS REGISTER
HOSPITALS 2009
FAMILY DOCTORS 2009
SCHOOL NURSES 2010 september
EMERGENCY MEDICAL SERVICE
2011
NATION- WIDE HEALTH INFORMATION EXCHANGE PLATFORM 2008 december
PRESCRIPTION CENTRE 2010 january
PATIENT PORTAL 2009
X-ROAD GATEWAY SERVICE 2009

7. 7
Documents total – 10.8 mio
1.1 mio persons medical data (growth 20% during 2012)
National Patient Portal

9. Genomic information
To be added…

10. Acceptance
•ePrescription covers 94% of issued prescriptions.
•Over 90% of Hospital discharge letters – digital
•Over 97% of stationary case summaries have sent to the central DB
•Ambulatory case summaries sending
–No certain rules for sending ambulatory case summaries!
•1,1 mio person have documents (82% of population)

11. 11
ePrescription (94%)
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jaan.10
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ISSUED
SOLD

12. 12
Retrieval of Medical Documents by Healthcare Professionals
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13. National Digital Health Record DBOnline access to databaseScientistsHealth data. No identification dataPhenotype databasePatient Portal National DHRCancer RegistryCitizen RegistryCauses of Death RegistryParticipantParticipantParticipantParticipantParticipantParticipantParticipantEGCUT databasePersonal health informationAdditional questions. Timeline dataUpdated phenotype dataParticipantData releaseEGCUT IS 2011-2015Primary care physician... Ver. 5.0

14. Tools and enablers of information exchange
•One universal national identification code
–Registries and databases use same code to uniquely identify persons
•National PKI infrastructure
•The Estonian ID card
–Smartcard with two digital certificates
–Mobile-ID – safe digital ID with mobile phone
•National Data Exchange Layer X-Road
•Obligatory national data security framework
•High public acceptance and trust
–No public incidents or misuses (10 years)

15. President Barack Obama 03.09.14 in Tallinn:
•„ … With their digital IDs, Estonians can use their smart phones to get just about anything done online — from their children’s grades to their health records. I should have called the Estonians when we were setting up our health care website“

16. Thank you!
Erkki Leego
IT adviser
Estonian Genome Center, University of Tartu
erkki.leego@ut.ee