The decision support of the Estonian Health Insurance Fund

Since May 2020, family physicians and nurses can use the decision support system of clinical decisions that enables to receive patient-based recommendations to their desktop and helps reach quality decisions faster. The clinical decision support system is the first one of its kind in Estonia, as it gathers and analyses people’s data, e.g., the diagnoses of the last five years, prescribed medicines, analyses, blood pressure measurements, lifestyle indicators and genetic risk scores.

How it works

With different algorithms, patient’s health data will be analysed, and the corresponding notifications will be displayed to the family physician. The goal of the decision support is to provide accurate information in a timely manner, in the right context and format, in order to help the health care worker to follow proper treatment guidelines. Based on the above, the decision support service must offer the doctor support for deciding the treatment and the monitoring of the treatment of a concrete patient who has registered to the appointment.

otsustustugi

The decision support works without interfering with the doctor’s work, meaning that the queries of decision support are activated to a certain event the doctor initiates in their software, and alerts shall be displayed on the desktop automatically.

There are three different types of principles and methodologies of decision support:

  1. During prevention, it is important to know the genetic peculiarities of the patient, and to notice and analyse early symptoms.
  2. In diagnosing illnesses, health care decision support is used for finding and specifying the right diagnosis.
  3. In the stage of treatment, decision support has a major role in choosing suitable procedures, medicines and medicine doses for the person in question.

A wholesome system

As databases are managed by different authorities, important health data that is sent to decision support should be gathered and analysed thoroughly. The structure of health care decision support unifies the components of the Estonian health system and the information systems of different health care service providers into a wholesome system.  

Data from health information system

Healthcare decision support uses patient data from the health information system. The precondition for using data is the existence of structured data. The health information system is a database that includes the health data of all Estonian people.

Reuse of data

This is the first solution in Estonia that uses health data secondarily and, as a result of data analysis, forwards notifications about a specific patient to a doctor.

The availability of fast health information is particularly valuable for patients with multiple chronic diseases and multiple medications the effects and interactions of which need to be taken into account. This is the extension that enables to do knowledge-based treatment decisions and avoid treatment mistakes. In the future, genetic risk scores and lifestyle indicators will be added to the system. In addition, decision support takes into account both Estonian and international treatment guidelines. Decision support has been integrated into the software used by family physicians and is available in their desktops.  

Latest developments

The service covers 1.3 million patients. 786 family physicians and 1636 family nurses use the service. The solution is able to support 130,000 queries in a day. Many other countries are interested in implementing a similar system.  

Added value

  • Raises the quality of treatment
  • Ensures better and comprehensive treatment for patients
  • Saves time for doctors

Other contributors

  • Estonian Health Insurance Fund
  • Ministry of Social Affairs
  • Estonian Family Medicine Association (40+ doctors participated in the development and testing of the solution)

The health care decision support system was named the best state digital service in 2020.