Stories from Estonia’s Health Information System: Why Is Estonia Moving to Event-Based Data Exchange?

Stories from Estonia’s Health Information System: Why Is Estonia Moving to Event-Based Data Exchange?

We are launching a new series of articles, Stories from Estonia’s Health Information System, in which we explain the services and data exchange solutions we are developing, why they are needed, and what they will change for healthcare professionals, healthcare organisations and people.

In the first article, we look at why Estonia’s Health Information System is gradually moving from document-based data exchange to event-based data exchange.

The right information can change a treatment decision

In its 2025 audit, Ensuring the correctness, accuracy and timeliness of health data, the National Audit Office of Estonia described a case that demonstrates the importance of ensuring that healthcare professionals have access to up-to-date information.

A patient who was undergoing cancer treatment was brought to an emergency department with an ischaemic stroke. The patient’s medical record did not indicate whether the cancer was at an early stage or was metastatic. The emergency department team assumed a poor prognosis and decided not to administer thrombolysis.

When the physician responsible for the patient’s cancer treatment learned about the situation, they clarified that the cancer was at an early stage and that thrombolysis had been clinically indicated. The patient ultimately recovered. Nevertheless, the case demonstrates that the information needed to make the treatment decision was not available at the right time.

This is not an isolated problem

Direct treatment errors caused by poor documentation are rare, but the audit describes the missing and late data behind this case occurring repeatedly. In the first three months of 2025 alone, more than 152,000 treatment summaries were submitted late to the Health Information System. Some documents were not submitted until several months after the episode of care had ended.

According to data from the National Institute for Health Development, one fifth of healthcare providers did not submit a single document to the Health Information System in 2024.

Incomplete health data also affect decisions outside direct patient care. The Estonian Unemployment Insurance Fund had to make one request for missing health data for every 2.4 work ability assessment applications. For a person, this may mean waiting longer for a decision that affects their income, access to support and ability to manage everyday life.

From documents to events

Some of these problems are related to working practices and documentation. No IT development can solve them on its own.

However, the current structure of the Health Information System also plays a role. At present, much health data is transferred to the central system in the form of completed documents. Important information may therefore arrive only once an episode of care has ended and a discharge summary has been compiled.

With event-based data exchange, agreed datasets are transferred to the Health Information System during the care pathway, as soon as a relevant event occurs. The information no longer needs to wait for a complete summary document to be produced.

The aim is to ensure that healthcare professionals receive the information needed for decision-making at the right time, in an up-to-date and usable form.

Data exchange alone is not enough

Event-based data exchange does not in itself guarantee better care.

The data must be of high quality and structured in a clear and understandable way. They must also reach the healthcare professional’s information system in a form that allows relevant information to be identified and used quickly.

For this reason, we develop new data flows in line with clinical workflows. For each service, we need to consider who needs the information, when they need it and how it should be presented in the tools they use.

The transition will happen step by step

The transition to event-based data exchange is a multi-year process. We are addressing services and data flows gradually.

For each service, we:

• agree on the necessary dataset together with stakeholders;
• develop the central solution;
• publish the technical information needed for integration;
• give healthcare organisations time to develop and connect their systems;
• test the solution together with its future users.

The move towards event-based and standardised data exchange is also supported by the European Health Data Space Regulation, or EHDS. Its requirements will apply in stages. The first major obligations concerning the cross-border exchange of health data will apply from 2029.

What comes next?

Our aim is to ensure that healthcare professionals have access to up-to-date, high-quality and understandable information when making decisions.

In future articles, we will also introduce other services and developments related to Estonia’s Health Information System.

Author: Karin Rääsk
Business Architect at the Health and Welfare Information Systems Centre (TEHIK)