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2022 Transformation track: Reshaping Digital Health Governance | The Estonian use case

EHTEL’s Transformation track is one of EHTEL’s two prime activities in its Imagining 2029 work programme. The track focuses on the organisational and technical challenges experienced by EHTEL members in moving forward with digital health. It provides a forum for members to share their experiences with, and learn from, each other. Key attendees include the European (Member States) competence centres that handle the technical application of health systems and services through information and communication technologies.  


The webinar was chaired by Donna Henderson, EHTEL President. Some 40 people attended, who came mostly from Member States’ ICT-related competence centres. 

Focus: Attendees learned about the experience of the Ministry of Social Affairs of Estonia on assessing the need to adapt its governance approach and initiate  a transformation journey. This work took place with the support of Ernst & Young (EY) and EHTEL. 

ReflectionAttendees were able to consider whether their own organisation’s governance is ready to face the actions needed in the European Commission proposal for a European Health Data Space (EHDS).  


Redesigning Estonian eHealth Governance

Siim Aben, Chief Consultant, EY Consulting 

The presentation gave an overview and introduced the methodology applied by EY, with the support of EHTEL, to redesign the eHealth Governance of Estonia. It focused on the project steps and deliverables, with an emphasis on the ‘as is’ phase – with its ten current challenges. The country drew on work conducted by two leading international organisations, the World Health Organization and the International Telecommunications Union. It concentrated its Health ICT Governance Framework 2.0 on the work of COBIT – an ICT governance approach developed by the international organisation, ISACA. For Estonia, one of the key enduring questions is how to involve stakeholders in this whole process in the most appropriate and efficient way. 


Estonian eHealth: The Governance Transformation Journey  

Taavi Annus , Chief Health Information Officer, Ministry of Social Affairs (MoSA) 

This presentation described the governance journey of Estonia. Many of Estonia’s strengths lie in domains related to digital identity, infrastructure, and security and integrity. The talk filled in attendees on the country’s demographic, administrative, and health and care statistics. It started from the step needed to implement an eGov approach. It continued with the phase involving the deployment of an eHealth infrastructure

eHealth governance needs to be rethought from the perspectives of funding, cooperation, and overall governance. Today, Estonia has landed on the governance needed to share, use and benefit from health data. The ministry recognises that it is “breaking the walls of all the agencies” relevant to health and care. Together, they have agreed on running a virtual planning unit.  

The presentation closed with a set of lessons learned during this whole journey. They include the importance of: change, leadership, “buy-in”, the “big picture”, good information sharing, iteration, and balancing together digital and health. 


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