National Audit Office of Estonia (RK)

Activities of the state in implementing the e-health system - Do the state, doctors and patients benefit from ehealth? Read full summary in English

2015 report

Estonia’s population is aging and the share of elderly people is increasing, as fewer children are being born and people are living longer. This creates a constantly growing need for health and social services and patients are also becoming more and more demanding about the volume and quality of the services provided. The more extensive and systematic implementation of e-health solutions helps make the health system more efficient, improves people’s health via more effective prevention, raises the awareness of patients and also contributes to the more reasonable use of health resources. E-health solutions also save patients time.
The purpose of the audit was to assess whether the objectives set to e-Health – higher quality of the health service and more efficient organisation of health care – have been achieved. The four main e-health projects were reviewed in the audit: Electronic Health Record, Digital Prescription, Digital Registration and Digital Image. The problems encountered in the development and implementation of e-health and the reasons for these problems were also studied.

In the report page 3-4, 39

- The Ministry of Social Affairs, whose duty should be to represent the interests of the state, has been more of an onlooker in the management of e-health. The Minister of Social Affairs does appoint four members of the supervisory board of the Estonian e-Health Foundation (EHF), but they have also failed to represent the state’s interests adequately.

- The outcome of this is that despite the state’s desire to implement e-Health Information Systems on a broader scale, for example, Digital Registration was completed in 2008 but it has still not been implemented due to opposition from health service providers.

- Only one IS of four subsystems of e-health worked properly. Digital Prescription is the only sub-system of e-health that is actively used. The use of the Electronic Health Record and image reference has been modest and Digital Registration has not taken off in the five years since its completion.

- The creation and implementation of e-health has cost considerably more than planned (about 15 million instead of 2,8 million euros) and it is unknown how much more money it will still require.

In the report page 4

- E-health does not help to save health insurance money or use the working time of doctors more reasonably.

- E-health is largely a database and offers very few e-services that would make the present work organisation of health service providers more efficient and the use of health insurance money more reasonable. One of the first services provided via e-health is e-consulting, family doctors can only use it to refer patients to specialists in two specialities and this option has found very little use to date.

In the report: part The risks of developing e-health were known, but never managed (page 39-44)

- Although the implementers of the project were well aware of the risks, they failed to manage them and therefore didn’t achieve the objectives of the project. The schedule of the projects was one of the reasons why such a situation occurred. Namely, the e-health projects were financed with the funds of the 2003-2007 programme period of the European Union and they could only be used during a certain period of time. All of the four main e-health projects should have been completed by the end of 2007.

- This means that the schedule was extremely unreasonable despite the preliminary work done before the establishment of the e-health system and before the actual launch of the e-health project (conditionally from 14 November 2005 when the Estonian e-Health Foundation was established). The persons involved in the e-health project who were interviewed in the course of several audits were of the opinion that the decision-makers knew from the start that the schedule was far too optimistic.

The risk cases visible on this page are collected and described by the e-Government Subgroup of the EUROSAI IT Working Group in contact with author Supreme Audit Institutions (SAI). In the same way, analytical assumptions and headings are chosen by the Subgroup. We encourage you to read the original texts by SAIs - to be found in the linked files.