Abstract

This review describes the content of the health data stored in the Estonian nationwide health information system (EHIS), analyses the expectations regarding webbased health data access for citizens and compares similar patient portal services in Europe and in North-America. Also new developments to provide citizens with more attractive patient portals are discussed.  The review concludes with discussion about the functionalities of a new patient portal developed by the Estonian E-Health Foundation. Since the end of 2008 every citizen in Estonia is provided with the opportunity to see his or her medical data via the internet from the Estonian nation-wide health information system (EHIS). As an EHIS service, the patient portal allows secure web-based access to personal health data. However, up to date the citizens` health data stored in the information system depend on the attitude of a particular general practitioner or hospital.

As of late 2012, the health data of more than one million Estonian inhabitants were stored in the EHIS. The health data were accessed, using the ID-card, by almost 50,000 people, accounting for approximately 5% of the citizens with their data included in the system and for 3.6% of the whole population. Even though the number of the users seems relatively low, Estonia is one of the few countries that provides its citizens with secure web-based access to their medical data and, compared to the EU countries where similar services are provided, the percentage of the users in Estonia is several times higher. On the other hand, the proportion of Estonian users is remarkably lower than it is for Kaiser Permanente, a US health insurance company with 9 million members. One of the main reasons for this difference seems to be the fact that patient portals provided by the state are designed predominantly for viewing medical data while organization based portals are offer more services for citizens.

Although in accordance with the Estonian legislation as of 2009, healthcare institutions are expected to submit definite standardized medical data to the EHIS, several physicians and hospitals do not forward required data to the central repository or fulfil this task partly. Therefore, the health data of not all citizens are available through the web-based patient portal, or available data are incomplete. This shortcoming has caused the displeasure of patients on several occasions.