{"id":26044,"date":"2026-10-17T01:43:21","date_gmt":"2026-10-16T22:43:21","guid":{"rendered":"https:\/\/trialoog.taltech.ee\/?p=26044"},"modified":"2026-10-19T13:26:09","modified_gmt":"2026-10-19T10:26:09","slug":"estonias-e-health-success-story-needs-better-data-and-greater-involvement-of-doctors","status":"publish","type":"post","link":"https:\/\/trialoog.taltech.ee\/en\/estonias-e-health-success-story-needs-better-data-and-greater-involvement-of-doctors\/","title":{"rendered":"Estonia\u2019s e-health success story needs better data and greater involvement of doctors"},"content":{"rendered":"","protected":false},"excerpt":{"rendered":"

Estonia\u2019s e-health system is an international model, but its next leap forward requires higher-quality health data, greater involvement of doctors and evidence of the real benefits of digital solutions, say three European health informatics experts.<\/p>\n","protected":false},"author":8,"featured_media":25951,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"inline_featured_image":false,"footnotes":""},"categories":[251],"tags":[391,887,265,563,397],"class_list":["post-26044","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-science","tag-artificial-intelligence","tag-e-health","tag-future","tag-health-technology","tag-innovation"],"acf":{"postbuilder":[{"acf_fc_layout":"text","type":"text","text":"Three European leaders in health informatics praise Estonia\u2019s courage and ambition in building a nationwide e-health system, but believe that a technological head start is no longer enough. The next steps should be to demonstrate that digital solutions improve clinical outcomes, structure and harmonise the data layer, and ensure that e-health benefits both patients and healthcare professionals in their everyday lives. These issues will be discussed at the European medical informatics conference MIE 2027<\/a> in Tallinn in April 2027.\r\n\r\nThree international experts visited Estonian HealthTech Week<\/a>, held in Tallinn and Tartu in August. Dipak Kalra, President of the European Institute for Innovation through Health Data (i~HD)<\/a> and Professor of Health Informatics at University College London; Lars Lindsk\u00f6ld, President of the European Federation for Medical Informatics (EFMI); and EFMI Secretary Petter Hurlen spoke to Trialoog about Estonia\u2019s e-health achievements and its next steps.\r\n\r\nKalra considers Estonia\u2019s e-health system remarkable primarily because the country established a nationwide solution early on, bringing together data collected by different healthcare institutions and allowing all healthcare professionals treating a patient to use it in their care. Estonia was also among the first countries to give patients extensive access to their own health data.\r\n\r\nEven more remarkable than the technical solution, Kalra believes, was the willingness of healthcare professionals and institutions to adopt the system and contribute to it.\r\n\r\nLindsk\u00f6ld also stresses that e-health is inherently sociotechnical: trust and the organisation of clinical work are just as important as technology. In his view, Estonia was right to first establish distributed data exchange and then develop common coding and standards based on real clinical cases.\r\n\r\nHurlen likewise believes Estonia\u2019s good reputation is justified. From the outset, Estonia developed health informatics at the national level rather than focusing on a single region or medical specialty, recognising that different parts of the system must work together to treat patients. Such development requires more than a sound vision: Estonia also had the courage to seize the opportunity and put that vision into practice.\r\n\r\nHurlen warns, however, that a good vision and functioning technology alone do not prove that clinical outcomes have improved. The clinical impact of digital solutions should be independently evaluated. \u201cIf someone claims that a technological solution delivers better healthcare, they should also provide evidence,\u201d he said. Hurlen noted that providing such evidence has not been particularly common in health informatics, and Estonia could set an example here.\r\n

\u201cIf someone claims that a technological solution delivers better healthcare, they should also provide evidence.\u201d<\/p><\/blockquote>","image":null,"align":""},{"acf_fc_layout":"image","image":25920},{"acf_fc_layout":"text","type":"text","text":"

Digitised data is not yet readily usable data<\/strong><\/h4>\r\nKalra sees Estonia\u2019s population-wide health dataset as a strength: it brings together data from family doctors, hospitals and other healthcare institutions, and includes genomic data for some people.\r\n\r\nIn his view, a dataset linking information from different care settings is already highly valuable. Its value would increase further if data were consistently structured and coded, and systems\u2019 semantic interoperability improved. Estonia\u2019s dataset is too small to study rare diseases, for example, making it necessary to bring together data from several countries.\r\n\r\nLindsk\u00f6ld is also convinced that the next step is to move beyond merely digitised health records towards fully structured and harmonised data. Tools for this include FHIR, which helps different health information systems exchange data; openEHR, which enables health data to be stored using a common structure; and the OMOP data model, which harmonises health data from different sources and makes it comparable. For him, the semantic layer is decisive: it ensures that data means the same thing in different systems.\r\n\r\nWithout harmonisation, Lindsk\u00f6ld argues, AI cannot be used safely in patient care, nor can health data be reused within the European Health Data Space in accordance with FAIR principles.\r\n\r\nHurlen points to another danger. Replacing doctors\u2019 descriptions in professional language with codes for the sake of secondary data use may cause some meaning to be lost. Such coding has been attempted for decades, he said, but a safe and effective method has yet to be found.\r\n\r\n[caption id=\"attachment_25923\" align=\"alignright\" width=\"313\"]\"EFMI<\/a> EFMI Secretary Petter Hurlen stresses that the benefits of e-health solutions must be demonstrated scientifically and that technology must support doctors\u2019 work rather than make it more complicated. Photo: private collection[\/caption]\r\n\r\nHurlen also considers retrospective studies based on previously collected data important, but points out that medical research is predominantly prospective. In his view, discussions of big data tend to overlook some of what medicine has already learned about the possibilities and limitations of analysing epidemiological data.\r\n\r\nHurlen is also concerned that entering ever more data into registries forces doctors to spend time coding at the expense of patient care. Estonia could look for ways to improve data availability for secondary use without undermining communication between doctors. One possibility he raises is whether AI could help reconcile these two needs.","image":null,"align":""},{"acf_fc_layout":"image","image":""},{"acf_fc_layout":"text","type":"text","text":"

Doctors and patients must benefit from the system<\/strong><\/h4>\r\nKalra could not assess how much doctors currently benefit from Estonia\u2019s e-health system, citing a lack of data. He did, however, describe what the system could achieve.\r\n\r\nIt should allow healthcare professionals to access information about a patient quickly and conveniently, even when it is not held in their own institution\u2019s electronic health record, without overwhelming users with excessive information. It should also enable care teams to analyse the quality of their work and identify shortcomings that could be addressed.\r\n\r\nFor patients, an important improvement would be not having to repeat their medical history whenever they see a new doctor or other healthcare professional.\r\n\r\nSecondly, Kalra believes that simply allowing people to view their health data is not enough. They should be able to use it in apps and other digital tools to monitor changes in their health, receive personalised reminders and find relevant health information. Making the system useful to patients is his priority.\r\n\r\nAll three experts emphasise the central role of healthcare professionals in designing systems. Kalra said their participation cannot be meaningful if the system being developed serves someone else\u2019s interests. The first task is to establish what value it creates for healthcare professionals themselves. They must then be involved throughout the development lifecycle, with compensation for their time paid to them or their employer.\r\n\r\n\u201cCo-design is a methodology, not merely a courtesy,\u201d Lindsk\u00f6ld said. Alongside technical requirements, developers must consider healthcare professionals\u2019 cognitive workload and actual workflows. Healthcare professionals always reason within a particular context, whereas machines follow rules. If system design ignores that difference, a solution may not work in a hospital\u2019s everyday practice.\r\n\r\nHurlen believes doctors must be involved in development in a way that gives them real influence over the outcome. Simply asking them to explain current working practices to developers is insufficient.\r\n\r\nHe stresses that technology can have both intended effects and unintended side effects. Serious side effects may outweigh potential benefits. \u201cWe treat patients, not data,\u201d he summarised.\r\n

\u201cWe treat patients, not data.\u201d<\/p><\/blockquote>","image":null,"align":""},{"acf_fc_layout":"image","image":25945},{"acf_fc_layout":"text","type":"text","text":"

The European Health Data Space divides expert opinion<\/strong><\/h4>\r\nKalra sees no major risks in integrating the standards of the European Health Data Space (EHDS), and the data exchange intended for patient care, with Estonia\u2019s digital system. In his view, this would bring relatively modest but nevertheless valuable changes.\r\n\r\nEstonia could test high-quality, standardised data exchange primarily with patients, but also between healthcare professionals. Since health records are already shared in Estonia, the main added value could lie in giving patient summaries a consistent, standard structure everywhere.\r\n\r\nKalra sees greater challenges in secondary use of health data, for example in academic and industry research. Estonian datasets could become so sought-after that their use expands faster than efforts to engage and inform the public. People must be told what their data is used for, how it is protected and what benefits are expected.\r\n\r\n[caption id=\"attachment_25928\" align=\"alignleft\" width=\"312\"]\"University<\/a> University College London Professor of Health Informatics Dipak Kalra regards Estonia\u2019s e-health system as an international success story, but stresses that health data must be more usable and digital solutions must deliver real benefits to patients and doctors. Photo: private collection[\/caption]\r\n\r\n\u201cThe public must be involved before and during the expansion of data reuse,\u201d Kalra stressed. Trust rests on transparency. People must know when identifiable data is being used, when data is anonymised or pseudonymised, and when aggregate analyses are conducted using larger datasets.\r\n\r\nIt must also be clear for which purposes data may be used and who decides, which security and governance measures are mandatory, who provides oversight and how potential errors are corrected. Patient organisations and the public must also have opportunities to provide feedback.\r\n\r\nKalra also cautions against using the expression \u201cmy data\u201d too loosely, because data ownership is a complex issue.\r\n\r\nHurlen was more critical of the EHDS. In his view, it is a top-down process with little or no involvement of doctors and patients.\r\n\r\nDoctors do not know which problems the EHDS solves for them, what improvements in clinical outcomes are expected or what its consequences for healthcare professionals might be, he said.\r\n\r\nHurlen also warns that expanding secondary data use must not impair communication between doctors or increase their coding workload at the expense of patient care.\r\n

\u201cThe public must be involved before and during the expansion of data reuse.\u201d<\/p><\/blockquote>","image":null,"align":""},{"acf_fc_layout":"image","image":""},{"acf_fc_layout":"text","type":"text","text":"

AI needs the same rigorous evaluation as other medical technology<\/strong><\/h4>\r\nHurlen cited radiology as a model for evaluating AI. When a new imaging method is introduced, assessments include sensitivity and specificity: how well it detects a lesion that is actually present and how well it avoids false findings.\r\n\r\nAI-based clinical decision support tools should be assessed in the same way, Hurlen believes. Doctors should know how likely an AI recommendation is to align with current approaches to care, as reflected in resources such as UpToDate and the Cochrane Library. The final decision must nevertheless remain with the care team.\r\n\r\nHurlen believes Estonia could be among the first countries where healthcare professionals use AI to develop the systems they need themselves. Estonia\u2019s existing infrastructure and highly qualified healthcare professionals provide a strong foundation, he said, potentially enabling better systems at substantially lower cost than conventional development methods.\r\n\r\nKalra remained cautious about assessing AI\u2019s current maturity. An assessment made today could be outdated in just six months, he said.\r\n\r\nKalra offered two recommendations to Estonia\u2019s government and hospital leaders. First, they should value learning from health data and treat spending on data and data technology as an investment rather than an avoidable expense. Secondly, they should accelerate the adoption of digital health tools that help patients take a more active role in maintaining and managing their health. Kalra believes this could also help ease healthcare workforce and capacity pressures.\r\n\r\nThe European medical informatics conference Medical Informatics Europe 2027<\/a> will take place in Tallinn on 26\u201330 April 2027. It is organised by the Estonian Medical Informatics Association (EstMIA)<\/a> in cooperation with EFMI, TalTech, the University of Tartu, Estonian hospitals, medical and health informatics companies, and public authorities.<\/em>","image":null,"align":""}],"related_authors":[{"author":1476,"position":"Editor-in-Chief of Trialoog"}]},"yoast_head":"\nEstonia\u2019s e-health success story needs better data and greater involvement of doctors - Trialoog<\/title>\n<meta name=\"description\" content=\"Estonia\u2019s e-health system is an international model, but its next leap forward requires higher-quality health data, greater involvement of doctors and evidence of the real benefits of digital solutions, say three European health informatics experts.\" \/>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/trialoog.taltech.ee\/en\/estonias-e-health-success-story-needs-better-data-and-greater-involvement-of-doctors\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Estonia\u2019s e-health success story needs better data and greater involvement of doctors - 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