Estonian Parental Benefit

The Estonian Parental benefit service is a one click service for parents to apply for the benefit. To apply for the parental benefit, an application must be submitted via the State Portal or at a regional bureau of the Social Insurance Board.

@Photo from Pixabay.

Summary 

To apply for the parental benefit, an application must be submitted via the State Portal or at a regional bureau of the Social Insurance Board. The benefit will start to be paid one day after the period for paying maternity benefit or adoption benefit. Those who do not receive the maternity benefit are paid the parental benefit starting from the birth of the child. The childcare benefit is not paid to parents who receive the parental benefit. Income tax is withheld from the parental benefit.
Citizen can apply for the parental benefit at the Social Insurance Board. The Social Insurance Board officers obtain the data they require from different databases.
The Estonian Parental benefit service is a one click service for parents to apply for the benefit.

Enabling assets or components 

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

Political commitment
Interoperability of the State Information System. Endorsed with the Directive of the Minister of Economic Affairs and Communications 11-0377, 22.12.2011, https://www.mkm.ee/sites/default/files/interoperability-framework_2011.doc
Legal interoperability
Parental Benefit Act. Riigikogu. RT I 2003, 82, 549, https://www.riigiteataja.ee/en/eli/ee/528122016010/consolide/current
----------
Health Insurance Act. Riigikogu. RT I 2002, 62, 377, https://www.riigiteataja.ee/en/eli/529122016002/consolide
----------
Income Tax Act. Riigikogu. RT I 1999, 101, 903, https://www.riigiteataja.ee/en/eli/516012017002/consolide
Socio-cultural influence factors
Parental benefit procedures are supported by Parental Benefit Act and by strategical documents of Ministry of Social Affairs.

All registers must linked by use personal code for citizens.

Secure data exchange layer X-Road (https://www.ria.ee/en/x-road.html) 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 (https://www.ria.ee/en/administration-system-of-the-state-information-system.html ) 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 is 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 ( https://www.ria.ee/en/public-key-infrastructure.html ) 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 (https://www.ria.ee/en/iske-en.html). The goal of implementing ISKE is to ensure a security level sufficient for the data processed in IT systems. The necessary security level is achieved by implementing the standard organisational, infrastructural/physical and technical security measures.

Data guidelines of Estonian Data Protection Inspectorate (http://www.aki.ee/et/juhised) must be followed.

Data handling / data exchange

Type of data sharing

Actual data

Data handler

Architecture

Data architecture
To apply for the parental benefit, an application must be submitted via the State Portal or at a regional bureau of the Social Insurance Board. The benefit will start to be paid one day after the period for paying maternity benefit or adoption benefit. Those who do not receive the maternity benefit are paid the parental benefit starting from the birth of the child. The childcare benefit is not paid to parents who receive the parental benefit. Income tax is withheld from the parental benefit.

Before the child turns 70 days of age, the mother raising the child has the right to the compensation; after that the parents have the right to the benefit by turns. The amount of the benefit is 100% of the average income for one calendar year and the benefit is calculated on the basis of the income in the calendar year prior to the day on which the right to the benefit arose. The maximum amount of the parental benefit is three times the average wage approved by the Government of the Republic. If the income for the previous year was less than the minimum monthly wage level established by the Government, the amount of the parental benefit shall be equal to the minimum monthly wage. If there was no income subject to social tax at all, the amount of the benefit is equal to the rate of the benefit. Those who did not earn income are ensured an income equal to the benefit level (390 euros in 2016).

To apply for the parental benefit, an application must be submitted via the State Portal (https://www.eesti.ee/est/teenused/kodanik/perekond_1/vanemahuvitise_peretoetuste_ja_kogumispensioni_sissemaksete_taotlemine) or at a regional bureau of the Social Insurance Board (https://www.eesti.ee/eng/contacts/valitsusasutused/riigiametid/sotsiaalkindlustusamet )

Linking registers

Resident will log in by using eID and submit Personal Identification Number. Other data will be collected from registers.

Lessons learned 

Enablers

Enabler 1. Legal and organizational interoperability: legislation approved by stakeholders; government solutions pass interoperability assessment process.
Enabler 1. eID and PKI infrastructure needed. Citizen can use for login IDcard, mobileID or digiID
Enabler 2. Secure data exchange layer for confidential and legally binding data needed. In case of Estonia the X-Road is used
Enabler 3. Master data in population registers must described in catalogue RIHA properly.
Enabler 4. The unique personal identification code provide opportunity to merge personal data from different registers.

Barriers

Barrier 1. Owners of registers are fixed by legislation, but it is unclear, who is responsible for development and maintenance of front end service
Barriers 2. Calculation algorithm of benefits and a set of registers needed changes frequently according to political decision

Source: https://scoop4c.eu/cases/estonian-parental-benefit

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

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Estonian Medical Digital Image Bank 

The Estonian Medical Digital Images Bank is a central database that stores almost all of radiological images and films. Every radiologist and physician can have access to their patients` images by using ID cards.

@Photo from Pixabay.

Summary 

The Estonian Medical Digital Images data repository was established in 2005. The Medical Digital Images Bank is integrated with the Estonian Health Information System. This is a central database that stores almost all (90%) radiological images and films (MRT, CT, EKG, X-ray etc). The Images Bank is integrated with the Health Care Providers systems via a secure channel VPN. Every radiologist and physician can have access to their patients` images by using ID cards. Consequently this system gives the possibility to have the overview and dynamics during a longer period of patient history and to compare developments. It also gives the possibility to have a second opinion without making new images (and radiation). Doctors can consult each other without additional research and patient movement. The system is a very good tool for distance consultation in Estonia.

The database has a possibility for each image to have a radiologist`s prescribed answer about findings (nearly 40% have radiologists prescriptions). The same data can also be viewed by the physician or other doctors (via VPN or HIS MISP portal) who have sent the patients to the radiology examination. As the health care providers systems are integrated to the Image Bank, a radiologist has access to the Bank from every secure system and he can give answers about the images. If necessary, you can also ask for a second opinion of the same image. This allows radiologists to give answers about the images even outside of Estonia or a particular medical institution. It allows radiologists to use resources flexibly in smaller hospitals and regions. The Digital Images Repository meets international standards as DICOM and HL7.

Enabling assets or components 

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

Legal interoperability
Health Services Organisation Act, https://www.riigiteataja.ee/en/eli/513032017001/consolide
------------
National Health Information System Regulation, https://www.riigiteataja.ee/akt/106122016011
------------
Personal Data Protection Act, https://www.riigiteataja.ee/akt/12805972?leiaKehtiv
------------
Population Register Act, https://www.riigiteataja.ee/en/eli/523032017001/consolide
------------
Public Information Act, https://www.riigiteataja.ee/en/eli/518012016001/consolide
Socio-cultural influence factors
Legal and organizational interoperability: legislation approved by stakeholders

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

Secure data exchange via VPN

All participants must be implemented three-level IT baseline security system ISKE (https://www.ria.ee/en/iske-en.html). 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 organizational, infrastructural/physical and technical security measures.


Data guidelines of Estonian Data Protection Inspectorate (http://www.aki.ee/et/juhised) must be followed.

Data handling / data exchange

Type of data sharing

Actual data

Data handler

Architecture

Lessons learned 

Benefits

- Each attending doctor is able to see whether ordered test results are in, even if the tests were made by another provider
- Reduced number of duplicate tests for the same case
- Makes available the distance consultation without patient movement
- Good cooperation and centralized repository gives a commercial effect (competent, hardware, logistics, services, costs)
- Radiologists in different geographic locations can make comments on radiological images in the central repository or test results in the HIS, using a secure channel (VPN) 

Enablers

• Legal, organizational, technical, social-cultural, fiscal and professional interoperability
• Secure data exchange (ISKE, VPN, encrypted data, access by ID card)
• Organizational and leaders understanding about cooperation benefits (increased handling costs and readiness for integration of medical equipment)
• Used international standards like DICOM and HL7 (because of medical devices)
• All health care providers have a contract with the Digital Images Bank
• Transparent pricing – same price for all counterparts. Every achieving costs

Barriers

All Medical devices don’t have yet the readiness for digital ordination and outcomes
Lack of cooperation and understanding
Lacking of digital ordering services among the health care providers
High development costs (speed, size, security and availability)

Source: https://scoop4c.eu/cases/estonian-medical-digital-image-bank

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

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Estonian Medical Certificate

Every person needs to have a valid medical certificate for the duration of their driving license. When a medical certificate expires, a new medical certificate must be submitted to the Road Administration. Once issued, the certificate is automatically transmitted to the motor registry.

@Photo from Pixabay.

Summary 

Every person needs to have valid medical certificate for the duration of their driving license. Generally the medical certificate issued by the family doctor is valid up to maximum 10 years. When a medical certificate expires or the next medical falls due, a new medical certificate must be submitted to the Road Administration. The validity of a medical certificate can be checked via the e-services to the Road Administration.

Since 1 April 2015 doctors have only been issuing e-medical certificates (only in special cases on paper – for instance in the event of a system malfunction at the doctor’s surgery, whereby the doctor must digitalize it later). In order to obtain an medical certificate, you must fill in a medical declaration online at the National Health Information system regarding your health and then make an appointment with a doctor. Once issued, an e-medical certificate is automatically transmitted to the motor registry. There is no need to come in personally to the Road Administration to submit your medical certificate.

OOP aspect

The e-medical certificate is automatically transmitted to the motor registry. There is no need to come in personally to the Road Administration to submit your medical certificate.

Enabling assets or components 

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

Legal interoperability
Traffic Act, https://www.riigiteataja.ee/en/eli/520102014003/consolide

(§ 101.Medical examination of driver of power-driven vehicle and applicant for right todrive)
--------
National Health Information System Regulation, https://www.riigiteataja.ee/akt/106122016011
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Requirements for Health Certificate, https://www.riigiteataja.ee/akt/121062011008
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Personal Data Protection Act, https://www.riigiteataja.ee/akt/12805972?leiaKehtiv
--------
Public Information Act, https://www.riigiteataja.ee/en/eli/518012016001/consolide
--------
Population Register Act, https://www.riigiteataja.ee/en/eli/523032017001/consolide
Socio-cultural influence factors
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 (https://www.ria.ee/en/x-road.html) 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 (https://www.ria.ee/en/administration-system-of-the-state-informationsystem.html) 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 (https://www.ria.ee/en/public-keyinfrastructure.html) enables secure digital authentication and signing. The infrastructure also allows forwarding data by using an encrypting key pair: a publicencryption 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 XRoad 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 (https://www.ria.ee/en/iske-en.html). 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 (http://www.aki.ee/et/juhised) must followed.

Data handling / data exchange

Type of data sharing

Actual data

Data handler

Government

Architecture

Lessons learned 

Benefits

- Already collected data can be used to develop various new services
- Decrease the number of GP visits
- Makes the certificates reproduced form for long period (for 10 years for drivers licences)
- Certificates are available for the Road Administration as well as Police

Enablers

• Legal, organizational, technical, social-cultural, fiscal and professional interoperability between different sectors (Health care and Road Administration)
• Security and technical
• Clear Responsibilities, rules and technical solutions are made for optimizing the working flow

Barriers

Economical motivation and feasibility
Cooperation between different authorities
Doctors dashboards needs the general modernization for adding new services to their desks

Source: https://scoop4c.eu/cases/estonian-medical-certificate

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

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Estonian Internet voting

The i-voting system allows any citizen to vote at their convenience, no matter how far they are from a polling station. As an added benefit, making the process easy and accessible increased the number of voters.

@Photo from Pixabay.

Summary 

The i-voting system allows any citizen to vote at their convenience, no matter how far they are from a polling station. As an added benefit, making the process easy and accessible increases voter turnout. The idea of having Internet voting in Estonia gained popularity in 2001. Estonia became the first nation to hold legally binding general elections over the Internet for the municipal elections in 2005. The Estonian parliamentary election in 2007 also used internet voting, another world first.

Enabling assets or components 

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

Political commitment
Interoperability of the State Information System. Endorsed with the Directive of the Minister of Economic Affairs and Communications 11-0377, 22.12.2011, https://www.mkm.ee/sites/default/files/interoperability-framework_2011.doc
Legal interoperability
Election Act. Riigikogu. RT I 2002, 57, 355, https://www.riigiteataja.ee/en/eli/ee/514112013015/consolide/current
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Municipal Council Election Act. Riigikogu. RT I 2002, 36, 220, https://www.riigiteataja.ee/en/eli/506112013004/consolide/current
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European Parliament Election Act. Riigikogu. RT I 2003, 4, 22, https://www.riigiteataja.ee/en/eli/ee/529012014001/consolide/current
----------
Referendum Act. Riigikogu. RT I 2002, 30, 176, https://www.riigiteataja.ee/en/eli/514112013007/consolide/current
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Personal Data Protection Act. Riigikogu, RT I 2007, 24, 127, https://www.riigiteataja.ee/en/eli/507032016001/consolide
----------
Public Information Act. Riigikogu, RT I 2000, 92, 597, https://www.riigiteataja.ee/en/eli/507032016001/consolide
----------
The classification system. Vabariigi Valitsus, RT I 2008, 4, 27, https://www.riigiteataja.ee/akt/12910889
----------
The system of address details. Vabariigi Valitsus, RT I 13.10.2015, 2, https://www.riigiteataja.ee/akt/113102015002
----------
The data exchange layer of information system. Vabariigi Valitsus, RT I 27.09.2016,
4, https://www.riigiteataja.ee/akt/127092016004
----------
The administration system of state information system. Vabariigi Valitsus, RT I
29.03.2016, 6, https://www.riigiteataja.ee/akt/129032016006

Socio-cultural influence factors
Population register uses by use personal code for citizens.
PKI or the public key infrastructure ( https://www.ria.ee/en/public-key-infrastructure.html ) 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.

Preconditions
Estonia has a population with high e-readiness, a modern infrastructure, effective governmental IT programs, and wellfunctioning cooperation between the public and private sectors that together are the crucial factors for having successful e-services for a citizen-oriented state. In 2002, the Estonian Parliament created the legislative basis for conducting internet voting. The widespread use of national ID cards was vital for introducing the new voting channel. The ID card, established by the Estonian Government in 2002, is the
new generation’s primary identifi cation document, with dual purpose: besides being a physical document, it also functions as an electronic identity

Benefits

Convenience for voters, particularly those who are traveling outside the country or in areas away from their local polling stations.

Potential to increase voter turnout
Cost savings from fewer paper ballots having to be entered

Median length of the e-voting session was 1:29, 1:21 and 1:36 minutes
in 2013, 2014 and 2015. Saving time for citizens 30 min

Owners of activated e-mail address @eesti.ee will receive electronic voter card by e-mail: decrease of postal expencies

In the case of i-voting, the cumulative time savings in the Estonian parliamentary elections of 2011 were 11,000 working days, which would amount to around 504,000 euros in average wages.

In the 2015 Parliamentary Elections, Internet voting accounted for 30,5 percent of the votes cast. Estonians worldwide cast their votes from 116 different countries.

Data handling / data exchange

Type of data sharing

Actual data

Data handler

Architecture

I-voting is possible only during the 7 days of advance polls – from the 10th day until the 4th day prior to Election Day. This is necessary in order to ensure that there would be time to eliminate double votes by the end of the Election Day.


Central System.
The Central System is also dependent of two other parties:
• Compiler of voter lists (Data generated from The Population Register),
• Compiler of candidate lists (NEC itself).

The components of the Central System:

Vote Forwarding Server (VFS) – authenticates the voter with the means of ID-card, displays the candidates of voter’s constituency to the voter and receives the encrypted and digitally signed e-vote. The e-vote is immediately sent to the Vote Storage Server and the confirmation received from there is then forwarded to the voter. It ends its work after the close of advance polls. Vote Storage Server (VSS) – receives e-votes from the VFS and stores them. After the close of advance polls removes double votes, cancels the votes by ineligible voters and receives and processes e-vote cancellations. Finally it separates inner envelopes from outer envelopes and readies them for the Vote Counting Application.

Vote Counting Application (VCA) – offline component to which encrypted votes are transmitted with the digital signatures removed. The Vote Counting Server uses the private key of the system, tabulates the votes and outputs the results of e-voting.

Linking registers:

Resident will log in by using eID and submit Personal Identification Number. Other data will be collected from registers.


Electronic voter card:
To order an electronic voter card, your @eesti.ee e-mail address must be directed to the e-mail address that you use on a daily basis. Ordering an electronic voter card from eesti.ee portal only takes a few seconds.

The electronic voter card is an alternative to the ordinary voter card that is sent on paper by mail. The electronic voter card is sent to the e-mail address of the voter and it contains information as to where, how and when they can vote.
The electronic voter card merely provides you with the information necessary to participate in voting. It does not need to be shown when voting and it is not a prerequisite for electronic voting.
A voter card is submitted 20 days before elections to all persons with the right to vote and whose data concerning their place of residence has been entered in the Estonian Population Register. Check your data.
No voter card on paper shall be sent if you have ordered the electronic voter card.
The electronic voter card order shall remain valid for all subsequent elections.
If voting in the election also takes place in a foreign state, a voter card shall be sent to a voter residing in a foreign state 60 days before Election Day at the latest if the card has been ordered at the State Portal.

Lessons learned 

Enablers

Enabler 1. Legal and organizational interoperability: legislation approved by stakeholders; government solutions pass interoperability assessment process.
Enabler 2. eID and PKI infrastructure needed. Citizen can use for login IDcard, mobileID or digiID
Enabler 3. The use of open source software solution increases trust to the i-voting system
Enabler 4. Secure data exchange layer for confidential and legally binding data needed. In case of Estonia the X-Road is used.
Enabler 5. Data in Population Register are relevant and up to date
Enabler 6. Master data in population registers must described in catalogue RIHA properly.

Barriers

Barrier 1. Some people (parties) do not trust i-voting
Barrier 2. Trusting Internet transactions by citizens
Barrier 3. Level of computer skills may be higher
Barrier 4. First solution in the world requires sophisticated software and methods for protecting privacy and for achieving high level security

Source: https://scoop4c.eu/cases/estonian-internet-voting

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

Find out more

Estonian electronic tax filing system (E-Tax)

E-Tax is a system, that allows users to do their tax return in less than 5 minutes. Using a secure ID, a taxpayer logs onto the system, reviews their data in pre-filled forms, makes any necessary changes, and approves the document with a digital signature.

@Photo from Pixabay.

Summary 

Using a secure ID, a taxpayer logs onto the system, reviews their data in pre-filled forms, makes any necessary changes, and approves the document with a digital signature. The process typically takes three to five minutes. One-click tax returns are also available, all known data is displayed to the citizen together with the calculated result, then all they have to do is click on the confirmation button; all this takes less than a minute.

Enabling assets or components 

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

Political commitment
Interoperability of the State Information System. Endorsed with the Directive of the Minister of Economic Affairs and Communications 11-0377, 22.12.2011, https://www.mkm.ee/sites/default/files/interoperability-framework_2011.doc
Legal interoperability
Taxation Act. Riigikogu, RT I 2002, 26, 50, https://www.riigiteataja.ee/en/eli/502012017008/consolide
------------
"Tax registry" Establishment and Maintenance of the Register. Riigikogu, RT I,
26.05.2005, 11, https://www.riigiteataja.ee/akt/186654?leiaKehtiv
------------
Personal Data Protection Act. Riigikogu, RT I 2007, 24, 127, https://www.riigiteataja.ee/en/eli/507032016001/consolide
------------
Public Information Act. Riigikogu, RT I 2000, 92, 597, https://www.riigiteataja.ee/en/eli/518012016001/consolide
------------
The classification system. Vabariigi Valitsus, RT I 2008, 4, 27, https://www.riigiteataja.ee/akt/12910889
------------
The system of address details. Vabariigi Valitsus, RT I 13.10.2015, 2, https://www.riigiteataja.ee/akt/113102015002
------------
The data exchange layer of information system. Vabariigi Valitsus, RT I 27.09.2016,
4, https://www.riigiteataja.ee/akt/127092016004
------------
The administration system of state information system. Vabariigi Valitsus, RT I
29.03.2016, 6, https://www.riigiteataja.ee/akt/129032016006
Socio-cultural influence factors
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 (https://www.ria.ee/en/x-road.html) 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 (https://www.ria.ee/en/administration-system-of-the-state-information-system.html ) 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 (https://www.ria.ee/en/public-key-infrastructure.html ) 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 (https://www.ria.ee/en/iske-en.html). 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 (http://www.aki.ee/et/juhised) must followed.

Benefits

Transparent and efficient tax collection.

Citizens save time: no need to go the tax office; no need to submit documents; 95 declaration are submitted online; citizens spend an average 7 minutes for submitting online declaration; one-click declaration available from 2015; no need for traditional post services.

Taxpayers receive refunds in five days

Lover administrative cost for tax board: the number of employees decrees 36,7% (2003-2012); lower expenditure for offices; decrease in the number of tax office visitors.

Higher quality of declarations; reduction of errors

Satisfaction of end users

X-Road services (56) are open for public sector institutions (including local government), for citizens, for business, for self-employed 

Data handling / data exchange

Type of data sharing

Actual data

Data handler

Architecture

Register consists 36 subsystems, 45 services

Lessons learned 

Enablers

Enabler 1. Legal and organizational interoperability: legislation approved by stakeholders; government solutions pass interoperability assessment process.
Enabler 2. Secure data exchange layer for confidential and legally binding data needed. In case of Estonia the X-Road is used
Enabler 3. The unique personal identification code provide opportunity to merge personal data from different registers.
Enabler 4. The unique company commercial registry code provide opportunity to merge business data from different registers.
Enabler 5. Master data in registers must described in catalogue RIHA properly.
Enabler 6. Agreements about semantic interoperability needed: 14 standardised code lists 

Barriers

Barrier 1. Legal interoperability: some paper based requirements
Barrier 2. High development costs
Barrier 3. Organisational interoperability. High number of connected systems requires interoperability agreements between stakeholders.

Source: https://scoop4c.eu/cases/estonian-electronic-tax-filing-system-e-tax

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

Find out more

Estonian Election Information System

Elections Information System is used for tabulating the voting and election results. The register holds information on polling stations and data related to the general election like electoral districts or candidates.

@Photo from Pixabay.

Summary 

Elections Information System is used for tabulating the voting and election results.
The register holds information on polling stations, including data on general advance polling stations and polling stations on Election Day; data on electoral districts, municipalities, voting districts and election authorities; data on candidates (candidate register); data where the electoral district committees and the central election committees submit their results of the elections as they are ready.

Enabling assets or components 

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

Legal interoperability
Riigikogu Election Act, RT I 2002, 57, 355, https://www.riigiteataja.ee/akt/13117287?leiaKehtiv
---------------
Local Government Election Act, RT I 2002, 36, 220, https://www.riigiteataja.ee/akt/13117083?leiaKehtiv
---------------
European Parliament Election Act, RT I 2003, 4, 22, https://www.riigiteataja.ee/akt/13117053?leiaKehtiv
---------------
Referendum Act, RT I 2002, 30, 176, https://www.riigiteataja.ee/akt/13117088?leiaKehtiv
---------------
Candidates nomination and registration procedures for the election of the
Parliament, RT I 2010, 70, 531, https://www.riigiteataja.ee/akt/13360054?leiaKehtiv
---------------
Candidates nomination and registration procedures for the election of the European Parliament, RT I, 16.01.2013, 13, https://www.riigiteataja.ee/akt/13204935?leiaKehtiv
---------------
Statute of Elections Information system, RT I, 02.07.2013, 68, https://www.riigiteataja.ee/akt/102072013068

Data handling / data exchange

Type of data sharing

Actual data

Data handler

Architecture

Data architecture:

Elections Information System is usable for state election department, county electoral managers, electoral commissions and polling stations.

State Electoral Office (government): owner, provider, consumer
Population Register (government): owner, provider
Business Register (government): owner, provider
Citizen (Citizen): owner, provider, consumer
Business (Business): owner, provider


The system is in use during election period.

• Election information system is tailor-made for the Estonian electoral system and environment but open-source solutions are used where applicable (e.g. MySQL).

Linking registers:

Population Register
Commercial register

Source: https://scoop4c.eu/cases/estonian-election-information-system

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

Find out more

Estonian Education Information System (EHIS)

The Estonian Education Information System is a state register, which unites the databases of the education system into one entity. EHIS creates the possibility for everyone to inspect the performance indicators education institutions.

@Photo from Pixabay.

Summary 

The Estonian Education Information System is a state register, which unites the databases of the education system into one entity. EHIS creates the possibility for everyone to inspect the performance indicators of preschool childcare institutions, basic schools, upper secondary schools and vocational educational institutions. EHIS is intended for persons acquiring general, vocational, higher or hobby education, as well as teachers and academic staff working at the same level.

Enabling assets or components 

Relevant Enablers
Estonian data exchange layer for information systems (X-Road)
Estonian Public Key Infrastructure
Estonian Catalogue of Public Sector Information (RIHA)
Estonian Public Key Infrastructure

Legal interoperability
Republic of Estonia Education Act RT 1992, 12, 192, https://www.riigiteataja.ee/en/eli/ee/526082014004/consolide/current
---------
Vocational Educational Institutions Act RT I 1998, 64/65, 1007, https://www.riigiteataja.ee/akt/130122015025?leiaKehtiv
---------
Institutions of Professional Higher Education Act RT I 1998, 61, 980, https://www.riigiteataja.ee/akt/13277158?leiaKehtiv
---------
Private Schools Act RT I 1998, 57, 859, https://www.riigiteataja.ee/akt/13340306?leiaKehtiv
---------
Universities Act RT I 1995, 12, 119, https://www.riigiteataja.ee/akt/13224418?leiaKehtiv
---------
Basic Schools and Upper Secondary Schools Act RTI, 05.07.2010, 41, 240, https://www.riigiteataja.ee/akt/13332410?leiaKehtiv
---------
Study Allowances and Study Loans Act RT I 2003, 58, 387, https://www.riigiteataja.ee/akt/13224397?leiaKehtiv
---------
State Family Benefits Act RT I 2001, 95, 587, https://www.riigiteataja.ee/akt/13190867?leiaKehtiv
---------
Military Service Act RT I, 10.07.2012, 1, https://www.riigiteataja.ee/akt/109032016004?leiaKehtiv
---------
Preschool Child Care Institutions Act RT I 1999, 27, 387, https://www.riigiteataja.ee/akt/13336294?leiaKehtiv
---------
State Pension Insurance Act RT I 2001, 100, 648, https://www.riigiteataja.ee/akt/13335615?leiaKehtiv
---------
EHIS Establishment and Statutes RTI, 12.08.2004, 61, 434, https://www.riigiteataja.ee/akt/119022013004?leiaKehtiv
Socio-cultural influence factors
Data guidelines of Estonian Data Protection Inspectorate (http://www.aki.ee/et/juhised) must be followed.

Data handling / data exchange

Type of data sharing

Actual data

Data handler

Architecture

Data architecture

EHIS consists six interrelated sub-registers:
1) the sub-register of documents certifying education;
2) the sub-register of teachers and teaching staff;
3) the sub-register of pupils, students and resident physicians;
4) the sub-register of educational institutions;
5) the sub-register of curricula and education licences;
6) the sub-register of educational literature.

EHIS is maintained as one-level technological database. To keep the register, automated data analysis is used and the register is being preserved digitally.
Resident will either log in by using an eID or there is a possibility to publically available data without identifying yourself.

Linking registers

Register of Professions
Population Register
Examination Information System
Address Data System
Register of taxable persons
Punishment Records Register

https://www.oecd.org/edu/ceri/Birgit%20Lao-Peetersoo_Introduction%20to%20the%20Estonian%20Education%20Information%20System%20EHIS.pdf

Source:https://scoop4c.eu/cases/estonian-education-information-system-ehis

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

Find out more

Estonian e-Notary

The e-Notary system environment allows notaries to making queries to 16 different registries, i.e. for drawing up and formulating the wording of contracts, forwarding contracts to various registers and monitoring the implementation process of contracts.

@Photo from Pixabay.

Summary 

The e-Notary system is an online environment, which helps notaries in their everyday work and allows electronic communication between notaries and the state. The environment allows notaries to do everything they need in their work. The system also allows making queries to 16 different registries (for example the Marital Property Register, the Official Announcements, the Estonian Central Registry of Securities, the Register of Constructions, the Land Register, the Traffic Registry, the Land Cadastre, the Succession Register, the Population Register, the Registry of Recreational Craft, the Business Register). The system is owned by the Chamber of Notaries and the servers are administrated by the Centre of Registers and Information Systems; the latter also provides user support, trains users and develops the system.

Enabling assets or components 

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

Political commitment
Interoperability of the State Information System, Endorsed with the Directive of the Minister of Economic Affairs and Communications 11-0377, 22.12.2011, https://www.mkm.ee/sites/default/files/interoperability-framework_2011.doc
Legal interoperability
Notaries Act. Riigikogu, RT I 2000, 104, 684, https://www.riigiteataja.ee/en/eli/511032016002/consolide
-----------
Explanatory memorandum to the statute for keeping the e-notary information
system, https://riha.eesti.ee/riha/main?araTopServiceId=application&araThreadServiceId=j3WXs51v&araTransactionId=override
-----------
Notariaadimäärustik. Riigikogu, RT I, 25.09.2015, 5, https://www.riigiteataja.ee/akt/13261784?leiaKehtiv
-----------
Statutes of the electronic information system of notaries (e-notary), https://riha.eesti.ee/riha/main?araTopServiceId=application&araThreadServiceId=a5fJ5rvz&araTransactionId=override
-----------
Public Information Act. Riigikogu, RT I 2000, 92, 597, https://www.riigiteataja.ee/en/eli/518012016001/consolide
-----------
The classification system. Vabariigi Valitsus, RT I 2008, 4, 27, https://www.riigiteataja.ee/akt/12910889
-----------
The data exchange layer of information system. Vabariigi Valitsus, RT I 27.09.2016, 4, https://www.riigiteataja.ee/akt/127092016004
Socio-cultural influence factors
Census procedures supported by census act, by strategic documents of Statistics Estonia.

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 (https://www.ria.ee/en/x-road.html) 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 (https://www.ria.ee/en/administration-system-of-the-state-information-system.html ) 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 (https://www.ria.ee/en/public-key-infrastructure.html ) 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.

Data handling / data exchange

Type of data sharing

Actual data

Data handler

Architecture

Other resources: 17 registers

E-Notary is an everyday tool for notaries that helps them acquire information from different databases for drawing up and formulating the wording of contracts, forward contracts to various registers an monitor the implementation process of contracts. Since the information system offers contract templates and all the necessary data can be requested from different registers with just a few mouse clicks, the preparation of contracts is fast and easy. As a result, the e-Notary system has increased the efficiency of notaries’ work. Last but not least, all clients can securely obtain a legally valid electronic copy of their contracts from the citizen portal free of charge.

The e-Notary programme can only be used by notaries and notary office employees (deputy notaries, lawyers, secretaries, receptionists and archive employees).

External impacts

The e-Notary is useful because it:

• Acquires data about the parties to a transaction and the object of a transaction from other registers;
• Helps the notary to compile notarial deeds;
• Registers notarial acts;
• Helps the notary to digitally sign notarial deeds;
• Helps to calculate notary fees and state fees;
• Compiles invoices for the payment of notary fees and pre-filled payment orders for the payment of state fees;
• Sends data about transactions to other national registers;
• Stores the transaction with the related data in the digital notarial archive;
• Helps notary to register apostilles;
• Compiles notarial statistics

Lessons learned

Enablers

Enabler 1. Secure data exchange layer for confidential and legally binding data needed. In case of Estonia the X-Road is used
Enabler 2. The unique personal identification code provide opportunity to merge personal data from different registers.
Enabler 3. The unique company commercial registry code provide opportunity to merge business data from different registers.
Enabler 4. Master data in registers must described in catalogue RIHA properly.
Enabler 5. Agreements about semantic interoperability needed: 14 standardised code lists

Barriers

Barrier 1. Legal interoperability: some paper based requirements
Barrier 2. High development costs
Barrier 3. Organisational interoperability

Source: https://scoop4c.eu/cases/estonian-e-notary

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

Find out more

Estonian e-File system

The e-File is an online information system which allows parties to legal proceedings and their representatives to electronically submit documents to courts and to observe the progress of the proceedings related to them. 

@Photo from Pixabay.

Summary 

The e-File is an online information system which allows parties to legal proceedings and their representatives to electronically submit documents to courts and to observe the progress of the proceedings related to them. For example, a single parent can apply for alimony without making a trip to the court house.

Enabling assets or components 

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

Legal interoperability
Establishment of the e-file system, RT I, 17.11.2011, 5, https://www.riigiteataja.ee/akt/117112011005?leiaKehtiv
Socio-cultural influence factors
• Data guidelines of Estonian Data Protection Inspectorate (http://www.aki.ee/et/juhised) must be followed.
• Technically, the E-File is a central storage of electronic documents and metadata that is inserted by the users of the information systems of different authorities in justice system. The storage of metadata related to all electronic documents, procedural operations and communication between information systems is the key of the simple electronic information exchange. The information exchange between these information systems and the E-File is based on X-Road, secure data exchange infrastructure established and supported by the state. The use of X-Road ensures complete security of the exchange of data and guarantees that the information is inviolate from the moment of inserting it until the moment when it is stored in E-File.
• Information from the e-File pertaining to oneself can be queried without limitations and free-of-charge. Parents can make free-of-charge queries about their minor children.
• Making a query about someone else requires the forename, surname and persona ID code of that natural person or the name and Business Registry code of that legal person.
• A query made about another person without that person’s authorisation is for a fee (the price of a query from the e-File is 4 euros). Queries can be made one by one; queries for a fee can be paid for via the same environment by using online banking before ordering the query. Queries are replied to within two business days.
• You can authorise another natural person (e.g. a representative of the employer) to query for data. By granting this authorisation in the e-File system, the authorised person can make free-of-charge queries about the principal via the e-File. Such an authorisation allows the employer to get more information about the employee than with a paid query.

Data handling / data exchange

Type of data sharing

Actual data

Data handler

Architecture

Data architecture:

Different online systems communicate with the e-File via the X Road exchange layer ensuring secure data exchange. E-File can only be accessed by using services: there are services for entering information, searching and viewing data. By using web services, each participant in the proceeding process and organization communicating with the e-File, has the freedom to create the most suitable user interface.
From an infrastructure standpoint, the application and database servers are backed up and physically separated, to ensure high availability. E-File uses Oracle databases and it is programmed in C# with . NET framework.

Only the ID card or the Mobile ID can be used for logging into the e-File system. The e-File system grants the procedural parties access to only those cases which are directly related to the person.

Police, prosecution offices, courts, prisons, probation supervision, bailiffs, legal aid system, tax and customs board, state share service centre – all these institutions use the same central information system as their own information systems are connected to E-File.

Steps necessary for using the service
• The legal person joining the RIHA;
• The legal person joining the X-road system;
• The legal person applying for an X-road certificate;
• The legal person ordering the use of the X-road service;
• Interfacing the legal person’s information system with the X-road service.


Linking registers:

Population Register
Address Data System
Register of taxable persons
Criminal Records Database

Lessons learned

• Secure data exchange layer for confidential and legally binding data needed.
• Registers and metadata of registers must properly described.
• Digital Court File is a future development of E-File that has already been initiated. It is part of the fully paper-free court proceeding project started in the end of 2013. While the Court Information System is a system for inserting data, collecting information and conducting the proceedings, Digital Court File will be an everyday tool for judges and court staff that will replace entirely the court file on paper.

Source: https://scoop4c.eu/cases/estonian-e-file-system

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

Find out more

Estonian e-Census

The next 2020 Population and Housing Census will be different. Estonia is now conducting a register-based census. The census data will be compiled from the data of national registers. About 24 national registers will be included, and they involve data on many fields of life.

@Photo from Pixabay.

Summary 

Statistics Estonia conducts a census every ten years. So far, people have had to take an active part in the census: by answering the questions of an enumerator or by filling in an e-census questionnaire. The questionnaire has been pre-filled with data from official registers. The next, 2020 Population and Housing Census will be different. Estonia has set the e-census world record: 67% of the population submitted their data via the Internet In the previous census. Estonia is now taking a step forward and conducting a register-based census. The census data will be compiled from the data of national registers. About 24 national registers will be included, and they involve data on many fields of life.

Enabling assets or components 

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

Political commitment
Interoperability of the State Information System. Endorsed with the Directive of the Minister of Economic Affairs and Communications 11-0377, 22.12.2011, https://www.mkm.ee/sites/default/files/interoperability-framework_2011.doc
---------
European Statistics Code of Practice. Adopted by the European Statistical System Committee. 28th September 2011, http://ec.europa.eu/eurostat/web/quality/european-statistics-code-of-practice
----------
Principles and Recommendations for Population and Housing Censuses,Revision 2.
Statistical Papers Series M, No. 67/Rev.2, ST/ESA/STAT/SER.M/67/Rev.2. United.
United Nations (2008).Nations Department of Economic and Social Affairs
(UNDESA), Statistics Division
----------
Rahandusministri käskkiri 6.03.2015.Statistikaameti strateegia 2015-2020

Decree of the Minister of Finance
Legal interoperability
REGULATION (EC) No 223/2009 OF THE EUROPEAN PARLIAMENT AND OF THE
COUNCIL of 11 March 2009 on European statistics, http://eur-lex.europa.eu/eli/reg/2009/223/oj
---------
REGULATION (EC) No 763/2008 OF THE EUROPEAN PARLIAMENT AND OF THE
COUNCIL of 9 July 2008 on population and housing censuses, http://eur-lex.europa.eu/eli/reg/2008/763/oj
---------
COMMISSION REGULATION (EC) No 1201/2009 of 30 November 2009 implementing Regulation (EC) No 763/2008 of the European Parliament and of the Council on population and housing censuses as regards the technical specifications of the topics and of their breakd, http://eur-lex.europa.eu/eli/reg/2009/1201/oj
---------
Commission Regulation (EU) No 1151/2010 of 8 December 2010 implementing
Regulation (EC) No 763/2008 of the European Parliament and of the Council on
population and housing censuses, as regards the modalities and structure of the
quality reports and the te, http://eur-lex.europa.eu/eli/reg/2010/1151/oj
---------
Official Statistics Act. Riigikogu, RT I 2010, 41, 241, https://www.riigiteataja.ee/en/eli/506012015002/consolide
---------
Personal Data Protection Act.Riigikogu, RT I 2007, 24, 127, https://www.riigiteataja.ee/en/eli/507032016001/consolide
---------
Public Information Act. Riigikogu, RT I 2000, 92, 597, https://www.riigiteataja.ee/en/eli/518012016001/consolide
---------
The classification system. Vabariigi Valitsus, RT I 2008, 4, 27, https://www.riigiteataja.ee/akt/12910889
---------
The data exchange layer of information system. Vabariigi Valitsus, RT I 27.09.2016,
4, https://www.riigiteataja.ee/akt/127092016004
---------
The administration system of state information system. Vabariigi Valitsus, RT I
29.03.2016, 6, https://www.riigiteataja.ee/akt/129032016006
---------
The system of address details. Vabariigi Valitsus, RT I 13.10.2015, 2, https://www.riigiteataja.ee/akt/113102015002
Socio-cultural influence factors
Census procedures supported by census act, by strategical documents of Statistics Estonia.

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 (https://www.ria.ee/en/x-road.html) 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 (https://www.ria.ee/en/administration-system-of-the-state-information-system.html ) 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 (https://www.ria.ee/en/public-key-infrastructure.html ) 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 (https://www.ria.ee/en/iske-en.html). 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.

The address data system (ADS) (http://www.maaamet.ee/index.php?lang_id=1&page_id=471&no_cache=1485415080) must implemented in all parties. ADS is a framework of administrative, technical and legal measures which ensures unambiguous identification of address objects in their location and in different databases, and common organisation of the establishment of location addresses and processing of address data.

Data guidelines of Estonian Data Protection Inspectorate (http://www.aki.ee/et/juhised) must followed.

Benefits

Save manual work. Compared to conventional censuses, a register-based census saves the state an average of 25 x 1,300,000 minutes, or 541,667 hours, or 67,708 working days, or 280 full-time staff years.

Save time. A register-based census enables receiving results faster than a conventional census, as it reduces the number of human errors made by enumerated persons, which would have to be corrected during the data validation period in a conventional census. If the same national databases are regularly used for censuses, it is possible to use standardised software for the validation and analysis of census data.

Lower cost. A register-based census has lower costs, because it eliminates the need for census interviews which is the most labour- and cost-intensive stage of conventional
censuses.
Better quality. The quality of a register-based census depends on the quality of data. High data quality should be an important objective for each national database.

Data handling / data exchange

Type of data sharing

Actual data

Data handler

Register of Employment (TÖR). (Ministry of Finance)

Architecture

Data exchange principles

For a successful register-based census, Statistics Estonia requires information from 20 national databases. Data acquisition (loading register data into Statistics Estonia’s information system) is automatic. Data acquisition will take place in two ways:
• Primary acquisition: the transmission of the required part of a register;
• Acquisition of updates: the transmission of changes made in the register.

Methods:
• Registers and Statistics Estonia exchange data over the secure data exchange layer X-Road (legally binding data, confidential data).
• Data has transferred by using file transfer protocols (non-critical data).
• Data files has transferred by using e-mail (non-critical data).

Requirements:
• ALL registers and metadata of registers must described in catalogue RIHA.
• Data has transferred by using secure X-Road services according to the agreement between Statistics Estonia and registers. Both "pull" and "push" methods has allowed.
• Data are presented in XML-format and described by XMLSchema (.xsd format)
• Updates should include the time; updates must be able to get since the last updates.
• All addresses must have taken from ADS-system.
• All physical persons must have identified by PIN code, or with codes of business register
• Data of registers must aligned to the results of the quality assessment of Statistics Estonia.
• Registers must include all necessary characteristics, must be complete and accurate.
• Registers must ensure the integrity of data.

Lessons learned

Enablers:

Enabler 1. Legal and organizational interoperability: legislation approved by stakeholders; government solutions pass interoperability assessment process.
Enabler 2. Secure data exchange layer for confidential and legally binding data needed. In case of Estonia the X-Road is used
Enabler 3. The unique personal identification code provide opportunity to merge personal data from different registers.
Enabler 4. The unique company commercial registry code provide opportunity to merge business data from different registers.
Enabler 5. The unique address data provide opportunity to merge address data from different registers.
Enabler 6. Master data in registers must described in catalogue RIHA properly.

Barriers :

Barrier 1. Quality of data needs to be improved. It should establish clearer quality requirements.
Barrier 2. The systematic logic controls of data must applied.
Barrier 3. Registers legislation must contain provisions to allow their data reuse by Statistics Estonia.
Barrier 4. Data of registers can processed by Statistics Estonia exclusively for the purpose of Census. The data allowing a person to be identified shall be substituted by a code. Decoding and the possibility to decode is permitted only for the needs of additional scientific research or official statistics.

Source: https://scoop4c.eu/cases/estonian-e-census

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

Find out more

Estonian e-Ambulance and time-critical health data

In an emergency, it is very helpful to have quick background information for patient review, especially as the patient is often unconscious. When a person is identified, time-critical data, like information about allergies, can be quickly served from a central database.

@Photo from Pixabay.

Summary 

In emergency situations (ambulance or emergency service) it is very helpful to have quick background information for patient review, especially as the patient is often unconscious. When a person is identified (personal ID–code is identified), time-critical data (allergies, past acute submissions and visits, the main diagnoses, major surgeries, medications, etc) can be quickly served from a central database. The time–critical data include allergies, last visits, the main diagnoses, major surgeries, medications, etc. The speed and quality of this service depends on the integrated solutions of the specific health care providers system.

Enabling assets or components 

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

Political commitment
e-Health National Strategy
* http://sm.ee/en/e-health
* https://www.digilugu.ee/
* http://sm.ee/et/eesti-e-tervise-strateegia
* http://tehik.ee/
Legal interoperability
Health Services Organisation Act, https://www.riigiteataja.ee/en/eli/513032017001/consolide

Especially Chapter 51 HEALTH INFORMATION SYSTEM (adopted on 2008)
---------
National Health Information System Regulation, https://www.riigiteataja.ee/akt/106122016011
---------
Personal Data Protection Act, https://www.riigiteataja.ee/akt/12805972?leiaKehtiv
---------
Public Information Act, https://www.riigiteataja.ee/en/eli/518012016001/consolide
---------
Population Register Act, https://www.riigiteataja.ee/en/eli/523032017001/consolide
Socio-cultural influence factors
Legal and organizational interoperability: legislation approved by stakeholders

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

Secure data exchange layer X-Road (https://www.ria.ee/en/x-road.html) 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 (https://www.ria.ee/en/administration-system-of-the-state-information-system.html ) 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 (https://www.ria.ee/en/public-key-infrastructure.html ) 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 (https://www.ria.ee/en/iske-en.html). 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 (http://www.aki.ee/et/juhised) must followed.

Data handling / data exchange

Type of data sharing

Actual data

Data handler

Architecture

Lessons learned

Benefits:

- A brief general overview of patient’s critical data is available without any tests in emergency situations incl. in emergency medical care via mobile desks to the Ambulance and Emergency care
- Collected data can be used already in the Ambulance care on the way to patient when the ID code is detected via the rescue desk (112)
- Patient historical and current data could reuse directly to the Ambulance record and to send to the hospital if needed

Enablers:

• Legal, organizational, technical, social-cultural, fiscal and professional interoperability
• The HIS architecture enables the fast collection and reusing the data (special agents collecting over the all cases the critical data)
• Wireless secure access to the data from anywhere, technical solutions
• Good cooperation with Rescue Administration, Police and the ministries of Interior and Communication and Economy
• Optimized working flow and data reusing

Barriers :

Technical equipment and secure wireless connection for mobile desks outside the hospitals (in the Ambulance car on anywhere where the patient is)
High development costs (standards, hardware, software, training)
Feasibility

Source: https://scoop4c.eu/cases/estonian-e-ambulance-and-time-critical-health-data

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

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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.

Summary 

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.

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, http://sm.ee/en/e-health
---------
e-Health National Strategy, https://www.digilugu.ee
---------
e-Health National Strategy, http://sm.ee/et/eesti-e-tervise-strateegia
---------
e-Health National Strategy, http://tehik.ee/
Legal interoperability
Health Services Organisation Act, https://www.riigiteataja.ee/en/eli/513032017001/consolide

Especially Chapter 51 HEALTH INFORMATION SYSTEM (adopted on 2008)
---------
National Health Information System Regulation, https://www.riigiteataja.ee/akt/106122016011
---------
Personal Data Protection Act, https://www.riigiteataja.ee/akt/12805972?leiaKehtiv
---------
Public Information Act, https://www.riigiteataja.ee/en/eli/518012016001/consolide
---------
Population Register Act, https://www.riigiteataja.ee/en/eli/523032017001/consolide
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 (https://www.ria.ee/en/x-road.html) 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 (https://www.ria.ee/en/administration-system-of-the-state-information-system.html ) 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 (https://www.ria.ee/en/public-key-infrastructure.html ) 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 (https://www.ria.ee/en/iske-en.html). 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 (http://www.aki.ee/et/juhised) must followed.

Data handling / data exchange

Type of data sharing

Actual data

Data handler

Architecture

Lessons learned

Benefits:

- 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

Enablers:

• 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)

Source: https://scoop4c.eu/cases/estonian-doctor-doctor-consultation

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

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Estonian Digital Prescription

The Prescription Centre is a centralised database with necessary services that provides access for doctors and pharmacies. The main goal of the Centre is to provide access to all prescriptions issued in Estonia so that the medicine can be bought from any pharmacy in Estonia.

@Photo from Pixabay.

Summary 

The Digital Prescription Centre In Estonia has been working since 2010. The Prescription Centre is a centralised database with the necessary services that provides access for doctors and pharmacies. The Prescription Centre is linked to the Health Information System (EHR), Estonian Insurance Fund and different Health Care Providers via the X-road. All digital prescriptions are collected in the Central Prescription Centre in Estonia. The main goal of the Centre is to provide access to all prescriptions issued in Estonia so that medicine can be bought from any pharmacy in Estonia. A doctor prescribes the medicine in their infosystem for a patient (everybody in Estonia has their personal ID-code) and sends to the Prescription Centre via the X-road. When a person goes to the pharmacy, a pharmacist detects the person's identity card and sells the medicine. In case there is a preferential rate for the medicine, the person pays only the preferential price and the pharmacy will receive the remaining amount of the full price from the Estonian Insurance Fund on the basis of automatically generated reports. There is also a securely working solution available when buying medications for family members.

The Prescription Information Centre displays the data to each patient's EHR Portal where all prescriptions can be seen by the persons themselves. Doctors can see the data on whether the patient has purchased the medicine. It is very important for doctors to see all current prescriptions of the patient to be able to evaluate dangerous interactions.

Enabling assets or components 

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

Legal interoperability
Medicinal Products Act, https://www.riigiteataja.ee/en/eli/516052016002/consolide
--------
Health ServicesOrganisationAct, https://www.riigiteataja.ee/en/eli/513032017001/consolide
--------
Personal Data Protection Act, https://www.riigiteataja.ee/akt/12805972?leiaKehtiv
--------
Public Information Act, https://www.riigiteataja.ee/en/eli/518012016001/consolide
--------
Population Register Act, https://www.riigiteataja.ee/en/eli/523032017001/consolide
Socio-cultural influence factors
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 (https://www.ria.ee/en/x-road.html) 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 (https://www.ria.ee/en/administration-system-of-the-state-information-system.html ) 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 (https://www.ria.ee/en/public-key-infrastructure.html ) 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 (https://www.ria.ee/en/iske-en.html). 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 (http://www.aki.ee/et/juhised) must followed.

Data handling / data exchange

Type of data sharing

Actual data

Data handler

Architecture

Lessons learned

Benefits:

• A patient can buy a prescription medicine from any pharmacy in Estonia
• Persons can buy prescription medicines for their relatives as well
• Each attending doctor is able to see whether a patient has bought the prescribed medicine of not
• For patients` is important to meet the right level of reimbursement, get an E-consultation or second opinion
• Log data available for every prescription
• For doctors` is important to prescribe the right level of reimbursement, give an E-consultation
• For doctors is available the possibility the detection of medicines over- or misuse, access the full medicines history
• A physical visit to the doctor is not required for issuing a recurrent prescription for chronic patients, as the attending doctor can simply renew the digital prescription
• Each attending doctor is able to see which prescriptions (both historical and current) a patient has from other doctors in order to assess pharmaceutical interactions (DP, DHR)
• For Pharmacists’ :Less data to enter into system, Easier invoicing, Less illegible paper prescriptions
• For State is available the good statistics and an efficient tool for policy changes
• Various public agencies can order aggregate and anonymised statistics
• Scientists can conduct research based on different linked databases, subject to a permission of the ethics committee 

Enablers:

• Legal, organizational, technical, social-cultural, fiscal and professional interoperability
• Secure data exchange layer for confidential and legally binding data needed. In case of Estonia the X-Road is used, The use of X-Road ensures complete security of the exchange of data
• The unique personal identification code provide opportunity to merge personal data from different registers.
• The unique company commercial registry code provide opportunity to merge business data from different registers.
• eID and PKI infrastructure needed. Citizen, Doctors, Pharmacists and nurses can use for login IDcard, mobileID or digiID
• Prescription Centre meets very high security requirements for trust reasons (Baseline security system ISKE)
• Master data in registers must described in catalogue RIHA properly
• All e-health classificators are regulated by government act and published at publishing center https://pub.e-tervis.ee/ and identified by OID register
• The Data security guidelines of Estonian Data Protection Inspectorate (http://www.aki.ee/et/juhised) must be followed by all counterparts. 

Barriers:

Economical motivation is needed for stakeholders
High development costs (harmonizing the work flow processes and data models among different health care providers, implementing the international standards and indicators )
High standardization cost (medical terminology and international standards adaptation)
Organisational interoperability – different health care rules in the states
Global and local market policy barriers

Source: https://scoop4c.eu/cases/estonian-digital-prescription

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

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Estonian Consumer Service Environment Data System

The Consumer Service Environmental Information System is a system, where public servants deal with the acomplaints from consumers and the scheduled inspection operations. Consumers can submit complaints through the system and access the archive of their statements.

@Photo from Pixabay.

Summary 

The Consumer Service Environmental Information System is a system, where public servants deal with the acomplaints from consumers and the scheduled inspection operations. Consumers can submit complaints through the system and access the archive of their statements.

Enabling assets or components 

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

Legal interoperability
Consumer Protection Act1, RT I 2004, 13, 86, https://www.riigiteataja.ee/akt/131122013007
---------
Statute of the Estonian Consumer Protection Board , RT I, 12.02.2014, 19, https://www.riigiteataja.ee/akt/112022014019

Data handling / data exchange

Type of data sharing

Actual data

Data handler

Architecture

The data entered in the database consists of complaints and appeals from consumers and also relevant operations for resolving complaints, as well as the procedural steps in connection with the administrative and misdemeanour proceedings. Also, people can watch their appeals' archive. Consumers can submit appeals and complaints anonymously or using an ID card.
The database has been integrated with the commercial register; the Population Register; Address Data System; Criminal Records Register and Register of Economic Activities.
The Consumer Service Environmental Information System also acts as a document register, which allows to avoid duplication of data entered into different systems. Data about completed submissions, decisions and procedures are kept in the archives, which are public.

Source: https://scoop4c.eu/index.php/cases/estonian-consumer-service-environment-data-system

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

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Estonian Central Health Information System and Patient Portal

The Central Health Information System EHR is a patient-oriented system where patient summaries about every case are collected. Data are visible to all clinicians who treat patients and patients can see their own data and see who have accessed their data.

@Photo from Pixabay.

Summary 

The Central Health Information System (so called Personal Digital History www.digilugu.ee – as EHR service) started in Estonia in 2008. The central system is a patient-oriented system (based on the personal ID–code). In the EHR central system, epicrises about every case (short overview about visits, anamnesis, diagnoses, treatment, examinations and recommendations) have been collected, which are visible to all clinicians who treat patients. The doctors` access to the central database is allowed only via the personal ID-card for security reasons. All accesses will be logged and are allowed only to licensed health care providers. In addition to this database all the collected epicrises are linked to the Medical Images Bank, the Prescription Centre and health care providers systems via the X - road.
The Estonian EHR has a specific service portal for patients – the Patient Portal. Every person has access to the portal via her/his ID-card and can have a look at his/her personal data. A patient can also look up information about his/her children (up to 18 years) or others if specifically permitted. There are several services possible for a patient:
• to see their own data from various service providers in one place
• make declarations (allow donation, distribution of the rights for the family to open or to close the data, data closure for doctors) all over Estonia
• look at their treatment bills, prescriptions, and the loggings (who has accessed their data)

Enabling assets or components 

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

Political commitment
* http://sm.ee/en/e-health
* https://www.digilugu.ee/login;jsessionid=E4977B1746FACDA24D4D56596C953C46
* http://sm.ee/et/eesti-e-tervise-strateegia
* http://tehik.ee/
Legal interoperability
Health Services Organisation Act, https://www.riigiteataja.ee/en/eli/513032017001/consolide

Especially Chapter 51 HEALTH INFORMATION SYSTEM (adopted on 2008)
--------
National Health Information System Regulation, https://www.riigiteataja.ee/akt/106122016011
--------
Personal Data Protection Act, https://www.riigiteataja.ee/akt/12805972?leiaKehtiv
--------
Public Information Act, https://www.riigiteataja.ee/en/eli/518012016001/consolide
--------
Population Register Act, https://www.riigiteataja.ee/en/eli/523032017001/consolide
Socio-cultural influence factors
Legal and organizational interoperability: legislation approved by stakeholders

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

Secure data exchange layer X-Road (https://www.ria.ee/en/x-road.html) 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 (https://www.ria.ee/en/administration-system-of-the-state-information-system.html ) 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 (https://www.ria.ee/en/public-key-infrastructure.html ) 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 (https://www.ria.ee/en/iske-en.html). 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 (http://www.aki.ee/et/juhised) must followed.

Data handling / data exchange

Data handler

Architecture

Data: citizens
Medical documents: Health care providers (hospitals, doctors, etc)
National registry (National Health Information System):
Processor: Health and Welfare Information Systems Centre (former Estonian eHealth Foundation)

Benefits:

- Each family doctor is able to view the data on patients in their practice list to see which specialist doctors they have visited or whether they have been hospitalised or received emergency care (irrespective of geographic location)
- Each attending doctor is able to see which prescriptions (both historical and current) a patient has from other doctors in order to assess pharmaceutical interactions
- Each attending doctor is able to see a patient’s tests or visits associated with the same case (this is particularly important in case of chronic diagnoses or chronic patients, as well as patients under monitoring)
- Each attending doctor is able to see whether ordered test results are in, even if the tests were made by another provider
- Reduced number of duplicate tests for the same case
- A brief general overview of patient’s critical data is available without any tests in emergency situations
- Collected data can be used to develop various new services
- Persons can view their prescriptions, summary reports, test results (except images) and the details of their children, and they can also see who else has viewed their data in the systems; they can make their data accessible or inaccessible, issue expressions of will (regarding organ donations, powers of attorney) and order electronic medical certificates
- For the patient is available to ask a second opinion
- Various public agencies can order aggregate and anonymised statistics
- Scientists can conduct research based on different linked databases, subject to a permission of the ethics committee 

Enablers:

• Legal, organizational, technical, social-cultural, fiscal and professional interoperability (see conclusions for detailed description)
• Secure data exchange layer for confidential and legally binding data needed. In case of Estonia the X-Road is used, The use of X-Road ensures complete security of the exchange of data
• The unique personal identification code provides opportunity to merge personal data from different registers.
• The unique company commercial registry code provides opportunity to merge business data from different registers.
• eID and PKI infrastructure needed. Citizen, Doctors and nurses can use for login IDcard, mobileID or digiID
• Central eHealth system meets very high security requirements for trust reasons (Baseline security system ISKE)
• All e-health classificatories are regulated by government act and published at publishing center https://pub.e-tervis.ee/ and identified by OID register
• All health care providers have a contract with the TEHIK (former E-health Foundation, processor of the HIS)
• The Data security guidelines of Estonian Data Protection Inspectorate (http://www.aki.ee/et/juhised) must be followed by all counterparts.
• Harmonized and agreed working flows, standard, classificatory and data models among the health professionals 

Barriers:

Motivation is needed for stakeholders
High development costs (health care providers infosystem development - hardware and software, implementation and training, harmonizing the work flow processes and data models among different health care providers, implementing the international standards and indicators )
High standardization cost (medical terminology and international standards adaptation. Example SNOMED and others)
Organisational interoperability
Changing paradigms between global market, entrepreneurs, patient awareness, technological possibilities and insurance market – lack of clear vision (where to invest)

Source: https://scoop4c.eu/index.php/cases/estonian-central-health-information-system-and-patient-portal

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

Find out more