Estonia's roadmap to telehealth: identify needs, test and update

What can you tell us about Estonia's approach to telehealth? Telehealth has been widely used for many years and is gaining popularity, particularly during the COVID-19 crisis. Most of these services are used by healthcare professionals, e.g., e-consultations between general practitioners and specialists, while some support patients, e.g., e- booking. Other ones facilitate contact between doctors/nurses and patients, such as via video consultations. How have the foundations of the Estonian healthcare system been designed with digital as an enabler? The Estonian eHealth Strategic Development Plan 2020 [1] sets the eHealth vision until 2025. By 2025, there will be a Network of health services based on well-interoperable e-health solutions. I am happy to see that in the National Health Plan 2020 – 2030, eHealth is seen as an enabler, not a separate mission with its own objectives. Furthermore, the Estonian Health Insurance Fund has been supporting the development of telemedicine services since the beginning of 2020 in order to improve access to healthcare and empower patients to take more responsibility for their health and thus, increase the continuity and quality of treatment. What were the key aspects that needed to be in place to allow Estonia to achieve its lofty goals? First of all, we need to engage end-users (citizens, patients, and healthcare professionals) more actively in this process: identify the needs, test the solutions, revise and update. Secondly, several equally important aspects need to be addressed – digital skills, digital health literacy, access to high-speed Internet, and up-to-date devices. Third, ensure interoperability and cooperation in Estonia and across the border. Last but not least – share your experience and learn from others. How do you think Estonia's access to healthcare differs from other European countries? Is digital facilitating better access? According to the  State of Health in the EU's Country Health Profiles of 2021, self-reported unmet health care needs in Estonia are the highest in the EU and affect individuals across income groups. Waiting times for outpatient specialist care, day surgery and inpatient care are the leading cause of the high level of unmet needs. I am sure digitisation has a role in addressing these issues better, starting with improving digital health literacy and access to (good quality) data and data analytics. What are the main steps in building a telehealth approach to care? Identify the need, look for an existing and tested solution, or test a new solution; if it works and gives you better health outcomes and saves time or resources, make sure it will be accessible, user-friendly, and regularly revised and updated. What conditions must be met for telehealth to become the new standard of care? Demonstrate the result and its user-friendliness. Make it sustainable both from a financial as well as technical point of view. Pilot projects should be a starting point, not the endpoint. Patients need to be part of the process – their opinion is essential in all steps – from developing a solution to analysing patient-reported experience and patient-reported outcomes. However, it is not always easy to describe what the need is. Sometimes, you have to ask what matters most. This question about patient needs is controversial. For example, in this question about unmet needs. Our people may easily complain that they do not have access to outpatient specialist care, but do they actually need specialist care? Often their GP would be the right contact. [1] Estonian eHealth Strategic Development Plan 2020