Going Digital?! – Lessons from Estonia

Health & Well-being delegation

You have probably heard about Estonia’s transformation towards a digital society. Perhaps you have wondered what this means and why Estonia decided to go digital? Perhaps you are wondering if you would like to have a Dutch digital society (or in the country you live in)? The Digital Society consortium went on a Trip to Estonia and here is what we learned (takehome messages can be found below). 

The path to a digital society

In 1992, after the dissolution of the Soviet Union, Estonia had a small budget to build an effective governmental structure and a functioning state. Simultaneously the internet became more well-known and the Estonian government decided to invest in digital technology to provide its services. In 1997 Estonia opened its e-governance centre and today 99% of public services are available as e-services. E-taxes (e.g. electronic tax claims) became available in 2000, followed by internet-voting (i-voting) in 2005. In Estonia’s e-health system, which opened in 2008, patients have access to their own e-health records. This record contains medical case notes, test results, digital prescriptions and X-rays. Since 2014 anyone in the world can apply to become an e-resident in Estonia and open a business with full access to the public e-services.

Our trip in short

In April 2019, 17 delegates from the Digital Society consortium went on a two-day trip to learn from Estonia’s approach to societal digitalization. We visited a diverse range of organizations including the e-Estonia showroom, businesses and universities. On this trip we saw some surprising solutions, exciting business environments and we learned some interesting facts about the country and its digital lifestyle.

The E-Estonia showroom – an introduction to the most digital governmental services

Estonia promotes itself as the most digital society in the world, so the e-Estonia Showroom  was a visit we couldn’t miss out on.  Nearly all public services can be accessed through the main e-portal: a one-stop-shop. Residents and e-residents are able to access almost all governmental services online, at a time and place convenient for the user, without any appointments or waiting lines. Estonian’s don’t go to their city council to change their address or register their new-born child as a new citizen – they go to the government’s online portal. Fun fact: the only three things that Estonian (e-) residents can’t do online are getting married, getting divorced and buying or selling real estate. Our enthusiastic guide told us that these rules exist to protect all citizens. For example, a government official needs to be present during each wedding to attest that no party is forced into this agreement.

Principles of data entry and data access

Data is stored according to the once-only principle: all data can only be entered and stored once. If another service requires the same data, a link to the source is provided. An example: when an institution, such as the government, needs some information from a citizen, such as an address, the citizen only has to provide this once. For every following request for the same piece of information, the database will first be checked. Conveniently, when somebody moves houses, the address only needs to be changed once and other service providers, such as a GP, can request the information from the database.

Transparency of access and data requests. All citizens can access their own e-health record on an integrated e-health platform. In this platform, all medical services are connected: general practitioner, specialist, pharmacy and so on. To our surprise, every medical professional has access to all medical files. This means that technically, not only a patient’s doctor, but also any other doctor could access a patient’s medical records. To prevent unauthorized access a logging system records all views, so that every citizen can see who accessed their file, when, and what they did. Whenever it’s been discovered that someone accessed files unauthorised, legal actions are taken. This logging system applies to all data that are stored in the portal.

Access to the online portal is securely managed with ID cards. Each citizen has an ID-card with a chip and several passwords. The ID card can be connected to a computer. Fun fact: Modern laptops in Estonia have a special slot for the ID-card.

To reduce digital illiteracy, the government has invested a large amount of resources in educating people in digital literacy and using modern technology. From a citizen’s perspective this seems to be a win-win situation: most people go to the online portal which reduces the queue for those who wish to use the face-to-face services (e.g. at the city council).

The interface of Science and Business: Tehnopol

Our second visit was Tehnopol , the science and business campus for innovative tech companies. Tehnopol’s main focus is on IT, healthtech and greentech innovations. In the healthtech domain Tehnopol connects health IT, health start-ups, healthcare providers, pharmaceutical industry, universities and the public sector. Tehnopol is known for their Start-up Incubator which helps technology-based start-ups to develop their business and get investments, using the best mentors from Estonia and Europe. Fun fact: Skype and Transferwise were invented in Estonia.

The seeds of innovation at TalTech: Mektory & Ragnar Nurkse

At the Tallinn University of Technology (TalTech) we had informative interactions with educational (Mektory) and research partners (Ragnar Nurkse).

Mektory is a program that connects Bachelor and Master students as well as children from schools with Businesses through mentoring programs. Mektory actively encourages innovative thinking in young people and gives them space to experiment. New business ideas and prototypes can be developed here and promising ideas are then further developed at Tehnopol.

Thinking about the future of the Estonian society, some researchers at the Ragnar Nurkse Department of Innovation and Governance  at TalTech are building self-driving vehicles. They have demonstrated high-levels of competence and capability to design and develop an autonomous vehicle (AV) shuttle and they are test-driving it on their campus. The University is a good place to learn about the challenges of a digital society from people who are also studying the anthropological effects of self-driving vehicles:  How do people react to courier robots (AV mini cars) that get stuck in the snow? They dug them free and put them back on their path.

Takehome Messages

Many of the online governmental services available in Estonia are already available in the Netherlands, however they are often provided in different portals. For example, in the Netherlands it is possible to pay taxes online, apply for a parking permit, arrange health care insurance or manage student loans, all with the DigiD (i.e. a secure username and password, double protected by sms security codes, that serves as an online ID). Currently, each Dutch service has its own website rather than being connected in one portal. Providing all online public services in one place, just like in Estonia, would offer greater convenience to the public.

Next to the e-portal for public services, Estonia also created an effective marketing campaign that presents Estonia as an innovative hot-spot to the rest of the world. Not surprisingly, Estonia’s flagships are their e-governance portal and their start-up business environment. The small society (approximately 1.2 million citizens) provides a good testing ground for new technologies and innovative ideas.

From a health-care perspective, a system that allows access to everyone’s health profile to all doctors all of the time (e.g. not only in an emergency) is an option that may not be suitable for the Netherlands. A system in which access is controlled by the patient (except in an emergency) may be more appropriate. One could imagine a scenario in which a patient is sent from her GP to a specialist. In order to prepare for the meeting the specialist would send a request to view the patient’s health –profile, which the patient can deny or approve. Transparency and security are key factors that would increase patients’ trust in such a system.

In the end it all comes back to who is leading in the (governmental) decisions that are made: the individual or the society. To achieve a digital society, Estonia seems to have placed the societal perspective above the individual, whereas in the Netherlands the individual and privacy seems to have the upper hand. Each society’s unique balance of privacy and digitalization is determined by public discourse. To make sensible and sustainable progress this discourse need to be ongoing as new technologies and new societal needs arise.

 

The Health & Well-being delegation (Karen Zegers, Anouk Vermeij, Julia Henrich, Annemieke Witteveen, Mieke Schulte and Brigit Klever)