Electronic hospitals, virtual doctors

Surely, many of you already know about the existence of Google Health. For those who are not in the subject: the system is designed for convenient interaction between doctors, patients and pharmacy workers. It would seem a good product, but there is one nuance. Since Google’s health system and all the data it collects is located on servers owned by a private company (from the USA), no state in Europe will use the application in full. Perhaps small private clinics use it, but this will never happen at the state level. Countries should not and do not like to depend on anyone.

Today I will talk about a new e-health system that has been developed and is being successfully implemented in Estonia. So, we present to your attention the project of the Foundation Eesti E-tervis and the Estonian Health Insurance Fund (an analogue of the Ministry of Health) - Digilugu.


The Digilugu system ( Russian language: Electronic medical history ) consists of four main blocks: a history of diseases, a digital registry, a digital snapshot, a digital prescription. Let's go through each of the blocks:
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Digital registry.

They say the theater begins with a hanger, similarly, for most people, the clinic starts with the registry.

Medicine in Estonia is arranged in a somewhat strange way: the majority of doctors do not work at a polyclinic or hospital — they are PFL (entrepreneurs are natural persons). Some doctors combine and create a commercial enterprise. Further, all these enterprises rent offices and premises from the polyclinic. Salaries and all expenses of businessmen-doctors themselves pay. When you come to the registry, you not only make an appointment with the doctor, but also receive a bill for the services of the doctor. When you come to an appointment with a specialist, you give him an invoice, he complements it (usually the nurses do it) and, if you have insurance, the invoice is sent to the Hospital Cashier, who pays for it from the state. of the budget.

A fairly large part of the Estonian population lives in the countryside, so it turned out that the residents of the volosts who came to the hospital admission did not receive a number, because they simply did not get it. Since the level of internetization of rural areas in Estonia reaches 96%, the ability to make an appointment with a doctor via the Internet will make life easier for rural people.

Until now, almost every large hospital in Estonia had its own patient registration system ( Tallinn Central Hospital [EST] , South Estonian Hospital [EST] , University of Tartu Clinic [EST] , North-Estonian Regional Hospital [EST] - electronic patient registration systems ). The state (represented by the EHIF) decided to integrate all registration systems and make them more secure. That is, in order to register with a doctor, now you need to use an ID-card. Fortunately, almost all Estonian residents have such a “thing”.

Video: Digital Registry [EST - RUS]

Digital snapshot

No, no, no one scans the finished film shots to email them to your doctor. Your shot immediately "gets" into the computer. By the way, the system is arranged so simply that even pensioners working in X-ray rooms are easily managed with it. In some cases, several pictures are taken from which the program can simulate a 3D image.

Finished images can also be viewed through the Digilugu Internet portal (both a doctor and a patient, as well as several doctors can watch pictures), you can even leave comments.

The system of “Digital Images” is also interesting because the specialist doctor who sent you for an x-ray transmits only your personal code and the answer to the question “What to shoot?”. You come to the X-ray room and just give the employee your ID card. A person working in an x-ray room does not have access to your medical history - he simply “uploads pictures to the hosting”. Anonymous x-ray is cool :-) Of course, the pictures laid out in Digilugu are connected with the history of a particular person’s disease.

Video: how it works and looks [RUS-EST] .

Digital recipe

Since January 1 of this year, the introduction of the third unit of the Digilugu system, the Digital Recipe, has begun in Estonia. Contracts with pharmacies have been signed, a system of information exchange between doctors and pharmacies has been introduced (the so-called Center for Prescriptions - Retseptide Keskus). Now doctors write you a prescription in the electronic system Digilugu, then the prescription is sent to a database to which pharmacies have access.

When you come to the pharmacy, you will be asked for an ID card. The pharmacist will ask you which of the prescribed medicines you wish to redeem, you will pay for the medication, and take them with you. At the same time, information on the purchase of medication will be transferred to your medical history The pharmacist cannot view medical records, diagnoses, or pictures.

Medical history

Here we come to the main block of the whole system Digilugu. Your case history collects all information about current diseases. For each disease and related information (pictures, prescriptions, records of doctors, etc.), a separate directory is created. In addition, the system contains information about vaccinations of a person, his chronic diseases, blood type, etc. Thus, a completely systematized “map” was created (remember such thick paper out of paper :-) for monitoring human health.

In Estonia, there are no district doctors, pediatricians and “doctors for adults”. A network, the so-called "family clinics". It is understood that every resident of Estonia has his own “family” doctor, who has been observing his whole life. The powers of the "family" doctor are severely limited - it is not a substitute for medical specialists. The family doctor also plays the role of a social worker, helping the patient’s family, if necessary. Usually assistance is expressed in the direction of a sanatorium or state social services. Having access to a complete patient record, the family doctor can successfully collaborate with specialist doctors, the patient and his family. Of course, do not forget about the "human factor". This is me to the fact that not all "family" doctors are as good as provided by the Digilugu system ...

Data access

The most important thing is that no one except the attending doctors has access to your medical history. That is, the hospital director will not be able to enjoy reading your medical history, unless he turns out to be your doctor. The system keeps a log of all accesses to the history of the disease and to each of its parts separately. The patient has the ability to read logs of access to his account.

It is possible to restrict access to data. For example, if you do not want a specialist doctor to know that you have AIDS, you can “close” this information for him. Do not block access to any information for the family doctor.

You can add “trustees” to the system. Trustees can view your disease information from your account. For example, you can allow your parents or relatives to view their information. You can limit, or vice versa, expand the circle of persons who will know your current diagnosis.

For a snack

In fact, the capabilities of the e-health system are enormous. Here you can find your information (and useful information) of chronic patients and donors, parents of children with disabilities and pensioners. You can even bequeath your organs to close people or decide what to do with your body after death.

The “obscuration” program of the Estonian health system provides for the training of doctors in the use of the system. If you want to get acquainted with educational materials, you can do it here [RUS] .

How does all this work from a technical point of view? In general, I am not a master in technical matters. But I have this picture:



Answers to additional questions will be in the comments. Thanks for attention.