What is the hypothetical “patient journey” for a citizen diagnosed with diabetes in Estonia, Finland and Slovenia and how can they use eHealth services in their countries? ESPON project eHealth has some interesting findings

Estonia

While Estonia has basic infrastructure and generic set of eHealth services in place, there is no evidence of condition-specific eHealth tools for healthcare professionals and patients, including digital solutions aimed at people with diabetes.

Regarding identification and verification of diabetes, people can find Type 2 diabetes self-assessment tests to find out if they are at risk from websites like kliinik.ee and diabeet.ee.

In the care-focused healthcare system, there is not yet the prevention programmes to identify the risk group (using AI and machine learning-based algorithms) and prescribe interventions like weight management (supported by the trackers and apps) to reduce the risk of getting ill. 

In the diagnosis, treatment and monitoring stages, the main responsibility in the healthcare system relies at the primary care level, while general practitioners are equipped with the eConsultation possibility, which allows them to consult with the specialist doctors.

However, a study commissioned by the MoSA and the Estonian Diabetes Association in 2016 found out, that at doctor’s appointment considerable time goes for the activities, which could be done by the patient in advance (e.g. lifestyle audit, self-assessment of diabetes management) and/or could be solved by using digital solutions (e.g. automated summaries from the patient’s diabetes and nutrition e-diaries).

People living with diabetes are free to use different apps and connected devices available in the global market to manage their condition, though there are no solutions adopted or developed particularly for the Estonian market.

Even when 63% of people in Estonia would expect their doctor to prescribe them also digital tools, doctors are usually not aware of or do not trust the digital solutions and therefore do not recommend these to their patients.

Finland

In Finland, it is possible for a patient to use eHealth entirely from first identification of diabetes symptoms all the way through diagnosis and treatment. The system presents a comprehensive approach to how eHealth can be applied throughout the stages of treatment.

Before the actual patient journey begins, people can use a web-based self-test to identify their personal risk of getting diabetes. Once diabetes has been diagnosed, there are several support services available. These start with a helpline and peer support telephone services, social media groups, web-based and e-mail courses aimed at recently diagnosed patients.

One of the most developed eHealth platforms in Finland is the Virtual Hospital. It was launched in 2018 and it covers several diseases, one of which is diabetes. The Diabetes House at the Virtual Hospital offers a wide range of services including eAppointments, ordering self-monitoring devices and materials, etc. Most of these services are available via eHealth applications, and the ones that require traditional appointments, examinations or treatments are integrated through the eHealth platform. Furthermore, the Diabetes House offers a wide range of support materials and services for self-monitoring and management of diabetes.

The concept of the Virtual Hospital offers a shared platform where new and more extensive eHealth services and applications can be developed. Further development of the platform facilitates better and more extensive integration across healthcare units, which is currently not as seamless as it could be.

Replacing or complementing traditional healthcare services with eHealth services and applications often require significant changes in day-to-day practices, both among healthcare units and professionals as well as patients. However, the economic potential is high, as can be illustrated e.g. by the weight management support services for diabetes patients: the cost of delivering these services via the Virtual Hospital platform is only one third compared to traditional ways of delivering the same services.

Slovenia

From the point of view of eHealth services, diabetes patients in Slovenia do not represent a special case and they use all regular eServices available to patients (unlike Finland, where specific solutions are in place).

eHealth system in Slovenia has been designed at the national level as a horizontal, integral system covering the entire health care system in the country. Citizens, regardless of the entry point, i.e. at the local community GP centre, specialist clinic or hospital, have access to the same set of integrated services and, via platform zVem, also to the same set of electronic medical documents.

The most frequently used integrated services are the eReferrals/eAppointments and the CRPD, when fully used, provide via zVem key documents and information to stakeholders in a patient pathway across the national health care system.

A weak point of the system is the numerous internal hospital information systems, many of which are not yet fully integrated with the national interoperability backbone and therefore not yet sending all relevant medical documents to the CRPD.