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.
Focus | Business |
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Start date | 1 Jan 2012 |
Domain | Health |
Scope | National/Federal |
Country | Estonia |
Nature and status of project | Rolled Out |
Is the OOP case/enabler mandatory? | Opt-in |
Enabling assets or components
Relevant Enablers
Estonian data exchange layer for information systems (X-Road)
Estonian Catalogue of Public Sector Information (RIHA)
Estonian Public Key Infrastructure
Estonian three-level IT baseline security system ISKE
Political commitment
e-Health National Strategy, http://sm.ee/en/e-health
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e-Health National Strategy, https://www.digilugu.ee
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e-Health National Strategy, http://sm.ee/et/eesti-e-tervise-strateegia
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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)
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National Health Information System Regulation, https://www.riigiteataja.ee/akt/106122016011
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Personal Data Protection Act, https://www.riigiteataja.ee/akt/12805972?leiaKehtiv
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Public Information Act, https://www.riigiteataja.ee/en/eli/518012016001/consolide
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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
Stakeholder name | Stakeholder type | Stakeholder role | Kind of data |
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Health care providers | Business | Data consumer | Health data |
Health Information System services – e-consultation (TEHIK) | Government | Database owner | Health data |
Population Register | Government | Data provider | Personal Data |
Business Register | Government | Data provider | Business Data |
Address Data System | Government | Data provider | Address data |
Health Insurance Status Register (Health Insurance Foundation) | Government | Data provider | Health data |
Health care providers Register (Health care Board) | Government | Data consumer | Health data |
Health professionals Register (Health care Board) | Government | Data provider | Semantic assets |
HIS X-Road MISP – Portal for GP | Business | Data consumer | Health data |
State Information Board (X-road, eID, Mobile-ID, ID-card) | Government | Data supervisor | Semantic assets |
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.