As of September 2008, a nationwide health information system has been available for citizens and healthcare professionals in Estonia. The information system includes certain data that is supposed to reflect the population's health status, entered into the database either by the healthcare professional or by the patient himself. The content of the centrally stored information is indicated by national legislation. This database is a part of the state information system. There are four e-health projects that make up the Estonian Health Information System (EHIS), led by the Estonian E-Health Foundation and Estonian Health Insurance Fund: Electronic Health Record, Digital Registration, Digital Image, and Digital Prescription.
The creation of a countrywide health information system demands consideration of different significant issues in organisational, legal, ethical, technological and healthcare related areas. These issues were intensively discussed and planned since 2002, when preparation for implementation of the system began. Because of the complexity of a nationwide project, the various components of the EHIS were launched in several timed stages.
To guarantee wide user acceptance of a central medical database, a foundation involving all main stakeholders in healthcare was created. The Estonian E-Health Foundation was established in October 2005 by the Ministry of Social Affairs, three main hospitals (Tartu University Hospital Foundation, North Estonia Medical Centre, and East Tallinn Central Hospital), the Estonian Hospital Association, the Estonian Family Doctors' Association, and the Union of Estonian Emergency Medical Services. To value this decision retrospectively, the involvement of the main players in the field was one of the key aspects in the development and launch of the EHIS.
Parameters for Legal Issues
A lot of effort was put in to the discussions about the compulsory content of the centrally-stored medical data. Another important topic concerning legal issues was the definition of user rights. To find an acceptable solution, a working group for ethics was established. After discussions and debates with medical professionals regarding content, they decided the central database of citizens