The Baltic Exchange

Simple principles that convinced me we need the Estonian model for health data

Estonia introduced electronic prescribing across their entire healthcare system in 2010. After a few months they started to notice some unexpected changes. One was a significant drop in the number of women requesting terminations.

It was a welcome development but it puzzled health experts. It took a study by behavioural scientists to figure it out.

A prescription in Estonia is linked to the citizen’s digital ID. The patient can present their ID at any pharmacy and they will be handed the medication in a plain wrapper. No-one but the doctor, the patient and the dispensing pharmacist knows what it contains.

Estonia has a mixed Catholic and Orthodox heritage. Electronic prescribing allowed women to seek contraception anonymously. Avoiding the risk of embarrassment or stigma changed many lives.

Conversion on the road to Tallinn

I heard about this on a short fact finding trip to Tallinn in 2017. I arrived as a convinced sceptic about digital ID. I returned home three days later as a complete convert.

The Estonian model changed my mind. Everything digital Estonia is built on one foundation. Digital should deliver real benefits. For the economy and society - yes. But most important, visible benefits for every citizen.

So listen to Linnar Viik explain the history (and I highly recommend that you do). And hear him stress the key driver: Digital now gives every citizen back around 2 weeks of their own time. There are a thousand anecdotes like the one above. They add up to concrete, measurable value for everyone.

Six fundamentals

Digital health is just one part of a digital society. Widely considered to be the most advanced in the world. Every element is underpinned by a small but powerful set of principles*:

  • Decentralisation – There’s no central database and every stakeholder, whether a government department, ministry, or business, gets to choose its own system.

  • Interconnectivity – All system elements exchange data securely and work smoothly together. - Integrity – All data exchanges, M2M communications, data at rest, and log ­les are, thanks to KSI blockchain technology, independent and fully accountable.

  • Open platform – Any institution may use the infrastructure and it works as an open source.

  • No legacy – Continuous legal change and organic improvement of the technology and law.

  • Once-only – Data is collected only once by an institution, eliminating duplicated data and bureaucracy.

  • Transparency – Citizens have the right to see their personal information and check how it is used by the government via log ­files.

*Source: e-Estonia Guide

Its easy to nod along with these points. Maybe even believe that we in the UK share some of the same principles. When I look at them, I want to scream with frustration. With the best of intentions, our reality is the exact opposite. COVID has exposed some of the data challenges but there seems little appetite for change.

I will share my thoughts about where we are going wrong and what we can do about it in future posts. I want this to be positive. There is a way to use data to make life better for NHS staff, for patients and for everyone.

Estonia is a tiny country with a terrible history of occupation and oppression. Yet they have shown the way. Let’s be inspired and learn from Estonia.


January 2021 feels as if it has been somehow both frantic and static. Triscribe has been deep in two new projects: one on prescribing safety and another still confidential (more in future posts). We have also been trying to replan our activities. Working to support our NHS customers as they battle the most intense phase of the pandemic.

It seems the end is at least on the horizon if not quite in sight yet. So I have also spent a lot of time thinking about the lessons from this crisis. Every time I circle back round to the structural challenges of using data and technology. My plan is to post a mix of updates about Triscribe projects and ideas for more fundamental change.

I would love to hear from you on either or both of these subjects. Please get in touch and share this post if you think it contributes to the debate.