Illustration: © Marlena Baron

Estonian health care

COVID-19 pandemic revealed several weaknesses in public health and the health systems in general, at the same time accelerating change towards a next normal in healthcare.

From mid-March in 2020, due to the COVID-19 outbreak, Estonian Health Insurance Fund (EHIF) started financing remote consultations as an alternative to regular doctor-patient meetings. Within a 2,5-month period more than 30% of the outpatient appointments were made via remote consultations [1]. Altogether 213,800 remote consultations were carried out, amounting to more than five million euros worth of services reimbursed by EHIF. Most of the consultations were carried out over the phone. The majority of them were specialist consultations, more specifically in the field of psychiatry and gynecology. EHIF continued to fund remote consultations after the emergency situation and from 1st of September, 2020, has added remote consultations to the list of health services, for which the insurance fund will pay in accordance to the established terms. When during the emergency situation, the range of services carried out was rather wide, then now EHIF only finances appointments held at doctor’s recall, meaning it must be a repeated visit. Even under normal circumstances, the need and suitability for a remote consultation for a specific patient should be assessed by the healthcare professional. The patient has the right to refuse remote consulting and can choose a regular appointment instead.

In late August, last year, the Ministry of Social Affairs and the Health and Welfare Information Systems Centre launched the official COVID-19 contact-tracing app HOIA. It was created in collaboration with 12 Estonian companies – Cybernetica, Fujitsu Estonia, Guardtime, Icefire, Iglu, Mobi Lab, Mooncascade, Velvet, FOB Solutions, Heisi IT OÜ, Bytelogics and ASA Quality Services OÜ [2]. The app notifies the person if he/she has been in close contact with an infected person and makes it also possible inform others if they have become ill. The app is optional and its aim is to limit the spread of coronavirus.

Estonia also started cooperation with the World Health Organization (WHO) to build a trusted COVID-19 Vaccination Certification Infrastructure, accelerating recovery from the global pandemic. The platform will be based on KSI Blockchain, an EU-EIDAS certified trust service and X-ROAD, Estonia’s data sharing platform [3].

Germany’s perspective

In the past two years, digitization has become a much stronger focus of healthcare policy in Germany. The legal framework has made a significant progress with several laws contributed to strengthening eHealth in Germany: An Appointment Service and Healthcare Act (Terminservice- und Versorgungsgesetz, TSVG) came into force in May 2019 followed by the Digital Healthcare Act (Digitale-Versorgung-Gesetz, DVG) in December 2019. In 2020 the Patient Data Protection Act (Patientendaten-Schutz-Gesetz, PDSG) as well as the Hospital Future Act (Krankenhauszukunftsgesetz, KHZG) were adopted, whereas the next legal measure to modernizing nursing care is already planned by the mid of 2021.

These laws had and will have an impact on all key areas of healthcare: telematics infrastructure and electronic patient records, telemedicine, digital health applications as well as interoperability and usability of aggregate patient data. Germany has taken on a pioneering role internationally with the introduction of reimbursed digital health applications (“DiGA”).

Corona pandemic has also shown its impact on digitization as the previous abstract benefit of using digital health applications is becoming more concrete. Telemedicine is considered an example of a breakthrough in the inpatient as well as in the outpatient sector particularly in these times of pandemic. Even in spring 2020 the percentage of physicians in private practice offering video consultations was 52% and another 10% were planning the introduction. According to the survey of over 2,000 physicians this value had increased from 2% at the end of 2017 [4].

Furthermore, additional funding of EUR 4.3 billion has been made available for the digitization of the hospital sector, which these institutions can access for telemedicine projects, networking as well as [5].

However, what is still lacking is an overall eHealth-strategy including a coordinated implementation plan. In comparison to international pioneers there is still a need to catch up in some areas with regard to implementation of health innovations, but the course is set.

This article was written by Helen Staak and Marlena Baron.

Sources:

[1] Eesti Haigekassa (2020) Kaugvastuvõtte jätkatakse ka peale eriolukorda. Online available at: https://www.haigekassa.ee/en/partner/medical-institutions/development-telemedicine

[2] Wright, H. (2020) Estonia launches coronavirus exposure notification app ‘HOIA’. Online available at: https://news.err.ee/1125119/feature-estonia-launches-coronavirus-exposure-notification-app-hoia

[3] Whyte, A., Wright, H. (2020) Estonia to sign digital health cooperation deal with WHO. Online available at: https://news.err.ee/1142077/estonia-to-sign-digital-health-cooperation-deal-with-who

[4] Stiftung Gesundheit (2020) Ärzte im Zukunftsmarkt Gesundheit 2020. Online available at: https://www.stiftung-gesundheit.de/pdf/studien/aerzte-im-zukunftsmarkt-gesundheit_2020.pdf

[5] Bundesministerium für Gesundheit (2020) Krankenhauszukunftsgesetz für die Digitalisierung von Krankenhäusern. Online available at: https://www.bundesgesundheitsministerium.de/krankenhauszukunftsgesetz.html