Final Report: Impact evaluation of the Estonian Electronic Health Record System – an overview of DIGIMPACT project

The Estonian nationwide Electronic Health Record System (EHR) was launched in 2008. In the same year a project called “The Development of a Methodology for Assessing the Influences of the Electronic Healthcare Message Exchange System in Estonia” (DIGIMPACT) was initiated by the Estonian eHealth Foundation to develop an evaluation framework measuring the potential impact of the nationwide EHR.

The framework should enable improved decision-making process, and increase information, motivation and trust of all health system stakeholders for using ICT solutions. The main focus of the project was aimed at developing the methodology for evaluation. The project chose an approach called PENG-model and its initial quantitative validation was performed using non-insulin dependent diabetes as a model disease. Important asset of PENG-model is that it enables one to evaluate not only the immediate financial gains and costs, but also evaluate the impact of intangible benefits.

During the DIGIMPACT project a benefit mapping was carried out by the group of different stakeholders of the disease treatment process. This resulted in a comprehensive benefit-tree along main stakeholder groups - patients, health care service providers and the society. The tree enables to describe the logical path of all benefits that can evolve after a successful implementation of a nationwide health information exchange platform. The tree also leads to measurable units for each benefit, which enables to quantify the result.

Wide range of benefits and costs associated with implementation of the EHR were analyzed. As an example, an improved communication between health workers and patient/relatives was further divided into separate benefits for patient/ relatives and for the professionals. For patient/ relatives improved communication capabilities enables better self-management of the diseases as they are better informed. For the professionals it will result in better treatment decisions as they are also better informed. As to costs, both direct and indirect costs were included in the model calculations.

The study has revealed so far that such large scale health information exchange platforms have large potential for enabling the improvement and change that is needed in healthcare sector. By capturing the full potential of the nationwide EHR system it is possible to decrease the level of bureaucracy, increase the quality and efficiency of health care, and create a patient-centric health care system.

The project was financed from the European Social Fund (EU Structural Fund period 2007-2013). The project partners were the Ministry of Social Affairs of Estonia and the Estonian Health Insurance Fund. The research and development work on the project was carried out by the PRAXIS Centre for Policy Studies, the Institute of Clinical Medicine of Tallinn University of Technology and the Estonian eHealth Foundation.

Full document text with appendixes available here:
DIGIMPACT Final Report

DIGIMPACT Final Report Appendix 1

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DIGIMPACT Final Report Appendix 2

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