What the U.S. Medical System Can Learn From Estonia

Americans waste time and money filling out paperwork and repeating tests in the doctor’s office. A small Baltic nation has found a better way.

People compete during a snow-kayak downhill race near Otepää, Estonia, in 2013.
Ints Kalnins / Reuters

The scene: a doctor’s office. You: frustrated, on your lunch break from work, just wanting to get in and get out. It’s probably not your first visit to that provider. It might not even be your second or third. And yet there you are, filling out byzantine papers attached to a clipboard, promising to pay if your insurance doesn’t, providing your Social Security number for the kajillionth time, and trying to remember your insurance group number, which is not the same as the ID number.

“Every time I go to the doctor, I spend the first half hour filling out pages of information. Why isn’t that traveling with me?” asked a cancer survivor in the audience of a recent talk by Eric Topol, the chair of innovative medicine at Scripps Research, at Aspen Ideas: Health, co-hosted by the Aspen Institute and The Atlantic.

“It’s so real that you have to fill out the same forms all the time,” Topol responded. The American medical system is atrocious at keeping track of the stuff it does. According to Topol, 10 percent of all scans in the United States are repeated unnecessarily simply because patients can’t get hold of their past records and scans. It amounts to billions of wasted dollars.

Instead of this current system, Topol recommended that the United States take a page from Estonia, the Baltic nation where health records are digitized and travel with the patient. “You wouldn’t be filling out all these forms, because you could send your data” to the doctor, Topol said.

Under the e-Estonia project, much of the data behind Estonians’ lives, from doctor appointments to taxes, have migrated from dead trees to the cloud. Almost all people in Estonia have an electronic ID card that contains their entire health record. Doctors can see one another’s notes, as well as past scans and X-rays a person has had. “In an emergency situation, a doctor can use a patient’s ID code to read time-critical information, such as blood type, allergies, recent treatments, on-going medication or pregnancy,” the e-Estonia site explains. Patients own their health information; they can access it at any time. The health data are kept secure through blockchain technology, which takes note each time something in the record is changed. Even the country’s ambulances get downloads of the health data of the people they are rushing off to help.

The disparity between the United States and Estonia when it comes to electronic health records came to the attention of former Estonian President Toomas Hendrik Ilves during a trip to Northern California. “If you have to prove that you live where you live or get your child to be registered for school, you have to come in with a paper copy of your electricity bill,” Ives told Public Radio International’s The World in 2017. “The reality of your sort of life dealing with bureaucracy, it is not touched by the digital revolution.”