Note: While I was editing this post, the Government announced a review of the use of health data for research and analysis led by Ben Goldacre. I would urge everyone to contribute to this important piece of work.
The last principle listed in my previous post was transparency. Like the rest, its impossible to argue against. Scratch the surface and the Estonian reality is much more profound.
One story brings this to life. An Estonian police woman was jealous so she used her official computer system to track her boyfriend. The boyfriend spotted this. He asked the police for an explanation. The police woman ended up with a heavy fine and 3 month suspended sentence.
Her boyfriend was able to do this by simply going online and checking who had viewed data linked to his ID. Any citizen can do this at any time. Ann Piperal introduced us to e-Estonia at the start of the trip. She showed us right on screen her latest data.
She used the example of a Doctor’s appointment. She pointed out the name of her family doctor on the screen. But if another medical name had shown up, she would have been entitled to ask why. The health service would have 3 weeks to provide a reasonable explanation.
Transparency works because it involves and engages the citizen. The citizen owns the data remember. Estonia makes it easy for them to manage their assets. Not every citizen does this of course. But every business and government department knows that anyone can at any time.
Transparency, like all the principles, is a noble ideal. Digital Society works because they are not just fine words. Estonia’s digital culture is based on practical and consistent action. Supporting the key principles, they have built a whole infrastructure of laws, systems, habits and incentives.
Mapping all this deserves proper study which I have neither the time nor the skill to do. There are so many elements that make digital Estonia a living reality. Just a handful of other things that struck me:
Distributed means there is no central, government owned database. This builds trust and openness. Estonians talk about blockchain these days but the principle was established long before bitcoin.
The technology that underpins this is called the X-Road. X-Road architecture is clean and simple. It is pervasive, its conceptually robust and it has an ever evolving ecosystem of standards, governance and support.
My favourite thing about X-Road. Everything is open source and freely available. Except the encryption of IDs. That’s delivered by the separate “Trust Services” piece in the image above.
There are no exceptions to the transparency rule - everything is open. No secret service or national security or public interest exceptions.
Linked to this, everything is held to the same, highest standard of security. This cuts two ways. It means even simple, low risk transactions are still safe. Much more important, no-one and nothing is “special”. They don’t need extra rules and barriers for health data because its already totally secure.
Estonia invested in the best possible mobile coverage years ago. Because Estonians love to pick mushrooms in the forest. And a few people get lost in there every year. I love that.
I probably have another 20 ideas in my notes. Just from a three day trip. The point I want to make is that this is real. Its not political policy and posturing. Its not well intentioned people signing pledges. Its not top down PR masquerading as change.
I will talk about the problems we face in a future post. For now I leave you with one thought
Think of X-Road as the 21st century equivalent of the railways. It opens up a whole new social and economic order. With unforeseen and immeasurable benefits.
I spoke to around 15 founders and entrepreneurs while I was there. The whole business culture and ethics are different. Everyone builds trusted software. Trusted software that respects the rights of citizens and applies high standards of care to customer information. Because they know their business will not survive without it.