Estonia's e-revolution rolls on: Now it's first in Europe with cross-border e-prescriptions

Finnish digital prescriptions are now valid in neighboring Estonia, thanks to an EU health data initiative.
Written by Kalev Aasmae, Contributor

After a two-hour ferry ride to the capital of southern neighbor Estonia, any Finnish traveler who forgets to bring vital prescription drugs now doesn't need to panic and buy an early ticket home.

They can just head to the nearest pharmacy in the tiny Baltic state's capital of Tallinn and, using their ID-card, obtain the drugs that had been prescribed in Finland.

That's possible thanks to the EU's eHealth Digital Service Infrastructure (eHDSI) initiative, which is designed to provide healthcare professionals secure electronic access to the medical data of EU residents – anytime and anywhere within the EU, respecting the will and rights of the individual.

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The initiative was launched in 2017 and already 23 member states are involved in it. Estonia and Finland are the first countries that have been able to develop and integrate the services and fulfill all the European requirements.

The communication infrastructure is provided jointly by the European Commission and the national healthcare systems. Every participating country offers a secure gateway provided by a designated National Contact Point for eHealth (NCPeH).

In Estonia, the data-exchange platform developed by the European Commission is integrated into Estonian eHealth infrastructure and connects with existing registries, databases, and services. The Estonian NCPeH is the Health and Welfare Information Systems Centre (THIK), which is also responsible for managing the cross-border data exchange.

According to Tõnis Jaagus, head of the Health Division at THIK, the first cross-border digital prescription was actually successfully completed at the end of last year. However, both countries decided to wait until the end of the busy holiday season, so the service was opened for the public in late January.

By the beginning of March, more than 500 cross-border prescriptions have been dispensed, "and the number is growing", Jaagus tells ZDNet.

He explains that the number of e-prescriptions dispensed in Estonia could have been even bigger.

"The reason why it was low at the beginning, was that the Finns need to give additional consent if they want their data to be available abroad, and not everyone knew that," he says.

The service is not reciprocal yet. So Estonians who would like to buy their prescription drugs in Finland have to wait a few more months to have this opportunity.

"Developing the system needs a lot of resources, and because of that Estonia decided firstly to develop the solution as country B, accepting the foreign prescriptions. According to current plans, the Estonians should be able to use their digital prescriptions abroad in Finland, Greece, Cyprus, and Portugal in summer 2019," Jaagus says.

"So far there are 23 countries involved. But because fulfilling all the European requirements, like audit, legislation change, successful testing with the partners, is challenging, it's very difficult to say what is the exact date when all the EU countries will be involved."

The future brings along even more possibilities for data sharing. By the end of the project in 2021, the participating countries could also start sharing patient summaries to improve medical services provided to EU citizens abroad.

Estonia and Finland have been sharing data for years. In 2013, Finland announced it was going to study X-Road, Estonia's internet-based middleware layer for securely exchanging data between government agencies, and build its own system based on that.

The hopes for cooperation and further implementation of X-Road in Europe were high. In the same year, the then-head of Estonia's RIA information authority, Jaan Priisalu, said the main question was which data exchange layer model would be chosen for a pan-European e-service.

"If we get the cross-border e-services between Estonia and Finland to work, the X-Road model has a good chance of being implemented in other European countries as well," he said.

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In 2015, RIA unveiled a new version of X-Road. The new version made cross-border communication possible and the authorities hoped it wouldn't be long before Estonia and Finland, which had been developing its own system, would seamlessly start exchanging data between governmental agencies.

Almost three years later, in February 2018, the technology to share data from Estonian and Finnish national databases was finally completed, but there haven't been any significant results in that area since.

The head of RIA's State Data Exchange Department Joonas Heiter explains that although technologically Estonia and Finland have been ready to share data for over a year now, the necessary legislation hasn't caught up yet.

"We don't have any use cases, but there are lots of startups both in Estonia and Finland, who would be very interested in using these data-exchange solutions. So we're hoping that Estonian and Finnish citizens can use services working via X-Road in the very near future."

So, although in theory, X-Road could have been used to share digital prescriptions and other data between Estonia and Finland and other countries, as Priisalu had hoped, it did not happen, as countries had already opted for the EU data-exchange platform instead.

According to Jaagus, using X-Road was not an option because of different standards.

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