The following is based on the answers to the State of FHIR survey 2023 from Ragne Õitspuu, TEHIK.
Regulation
Estonia has a well-established regulation for health data exchange within the National Health Information System since 2008, articulated through the Tervishoiuteenuste korraldamise seadus (Health Services Organization Act). This legislation does not specifically mention FHIR, but Estonia is currently transitioning from Clinical Document Architecture (CDA) to FHIR. The change in standards is guided by national eHealth roadmap and strategy documents, suggesting a gradual and planned shift with existing regulations expected to persist.
National Standards Development
TEHIK, the Estonian Health and Welfare Information Systems Centre, is the primary national standards organization overseeing most health data exchange standards. A national FHIR data model is under development and partially published on Simplifier.net. There are several FHIR standards for specific use cases evolving from this data model, in line with Estonia’s approach to implementing an information model layer for healthcare data.
FHIR Implementation
The adoption of FHIR is expected to grow substantially, with a strategic transition from CDA to FHIR. This gradual transition will allow both standards to be used concurrently for the foreseeable future, ensuring a smooth adaptation for various stakeholders. Successful FHIR implementations include the Clinical Data Viewer by TEHIK and data exchanges with the European Medicines Agency's Union Product Database, showcasing improved healthcare outcomes and information access.
Estonia is looking forward to implementing new use cases within the National Health Information System, such as medication schemas, laboratory data, and referrals. Despite challenges like a lack of widespread FHIR knowledge, there is optimism for broader implementation, evidenced by regulation, grants, and innovation efforts.
Notable stakeholders in the FHIR adoption process include HL7 Estonia (in application), various vendors like Kodality and Nortal, and organizations such as the State Agency of Medicines, Health Insurance Fund, and the Ministry of Social Affairs.
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[**Health and Welfare Information System Center (TEHIK)**](https://tehik.ee/) is an ICT competence centre which started operation on the 1st of January, 2017 and consolidates the functions of former ICT department of ministry of Social Affairs and Estonia and Estonian eHealth foundation.
TEHIK ensures the operation of ICT services for the Social Insurance Board, Health Board, Labour Inspectorate, Astangu Vocational Rehablitation Centre and Agency of Medicines. Among our clients are also healthcare providers, local goverment, Estonian Health Insurance Fund, Estonian Unemployment Fund, Official Mediators Office and Gender Equality and Equal Treatment Commissioners Agency. For healthcare we develop e-referral, e-lab, e-prescription, Patient Summary, for social system Registry of Social Services and Benefits (STAR) and Registry of Social Protection (SKAIS).
**Our mission is to provide human-based and cross-integrated ICT services.**
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