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Estonian doctor-doctor-consultation

The doctor-doctor consultation is a possibility between doctors to share information on a medical case. Generally, a family doctor consults a specialist, who estimates the patient`s situation and decides on the priority of a specialist visit.

@Photo from Pixabay.


This is the doctor-doctor consultation (not the doctor-patient) by using digital form according to specific standards depending on the doctors` area (cardiology, endocrinology, etc). Generally, a GP consults specialised doctors (cardiology, urology, oncology, etc). The GP sends a standardised epicrises and patient values with electronic ordination to a specialist, who estimates the patient`s situation and decides on the priority of a specialist visit (very urgent, urgent, regular or not needed). If it is required to plan an urgent visit to a specialist, a consultation time for the patient will be arranged. Often patients are directed to further evaluation as appropriate. There are also cases where a patient does not need to visit a specialist and the GP can manage himself with specialist recommendations. Eliminating pointless visits saves doctors` time.



Start date1 Jan 2012 
Nature and status of project Rolled Out 
Is the OOP case/enabler mandatory? Opt-in

Enabling assets or components 

Relevant Enablers
Estonian data exchange layer for information systems (X-Road)
Estonian Catalogue of Public Sector Information (RIHA)
Estonian Public Key Infrastructure
Estonian three-level IT baseline security system ISKE

Political commitment
e-Health National Strategy,
e-Health National Strategy,
e-Health National Strategy,
e-Health National Strategy,
Legal interoperability
Health Services Organisation Act,

Especially Chapter 51 HEALTH INFORMATION SYSTEM (adopted on 2008)
National Health Information System Regulation,
Personal Data Protection Act,
Public Information Act,
Population Register Act,
Socio-cultural influence factors
Legal and organizational interoperability: legislation approved by stakeholders

Legal and organizational interoperability: legislation approved by stakeholders

All registers must linked by use commonly accepted keys:
• personal code for citizens,
• code of institution,
• standardised address presentation.

Secure data exchange layer X-Road ( is used for gathering data from different registers. X-Road is a technological and organizational environment enabling a secure Internet-based data exchange between information systems. All registers and Statistics Estonia must be a member of X-Road

Information regarding the X-Road members and the services they provide is available via the Administration System for the State Information System (RIHA). RIHA ( ) serves as a catalogue for the state’s information system. At the same time RIHA is a procedural and administrative environment via which the comprehensive and balanced development of the state’s information system has ensured. RIHA guarantees the transparency of the administration of the state’s information system and helps to plan the state’s information management.

PKI or the public key infrastructure ( ) enables secure digital authentication and signing. The infrastructure also allows forwarding data by using an encrypting key pair: a public encryption key and a private decryption key. In Estonia, this technology is used in relation with electronic identity (ID card, mobile ID, digital ID). All members of X-Road are using Digital seal certificates for signing messages. Citizens and officials are using electronic identity tokens.

All participants must be implemented three-level IT baseline security system ISKE ( The goal of implementing ISKE is to ensure a security level sufficient for the data processed in IT systems. The necessary security level achieved by implementing the standard organisational, infrastructural/physical and technical security measures.

Data guidelines of Estonian Data Protection Inspectorate ( must followed.

Data handling / data exchange

Type of data sharing

Actual data

Data handler

Stakeholder nameStakeholder typeStakeholder roleKind of data

Health care providers

BusinessData consumerHealth data
Health Information System services – e-consultation (TEHIK)GovernmentDatabase ownerHealth data
Population RegisterGovernmentData providerPersonal Data
Business RegisterGovernmentData providerBusiness Data
Address Data SystemGovernmentData providerAddress data
Health Insurance Status Register (Health Insurance Foundation)GovernmentData providerHealth data
Health care providers Register (Health care Board)GovernmentData consumerHealth data
Health professionals Register (Health care Board)GovernmentData providerSemantic assets
HIS X-Road MISP – Portal for GPBusinessData consumerHealth data
State Information Board (X-road, eID, Mobile-ID, ID-card)GovernmentData supervisorSemantic assets


Lessons learned


- A possibility of electronic consultation between a family doctor and a specialist doctor to reduce the number of duplicate visits
- For critical cases gives the possibility to decrease remarkably the waiting time
- According an agreed requirements and analyses by GP it helps to increase the quality and outcomes of the specialist’ visit


• Organizational, technical, fiscal and professional interoperability
• Agreed standards requirements, data models and working flows among GP and specialists (dermatologists, cardiologists, gynaecologists, urologists and other different specialities)
• Prising policy
• Good level technical solution and efficiency

Barriers :

Economical motivation and cooperation between different providers
High standardization cost (medical terminology and international standards adaptation)
Additional costs for required equipment for GP (for example EKG-devices needed to have digital standardized outcome)


Disclaimer: Please note that this article is a result of the SCOOP4C Pilot Project, not an application of a CEF Building Block.

Last updated on  Jul 26, 2019 16:57

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