Nortal: taking Estonia’s digital healthcare success to the global market

One of the giants of Estonia’s tech scene, Nortal has been a key player in the development of the country’s digital healthcare ecosystem for the last 15 years. The company is now leveraging this experience abroad, implementing large-scale projects in Europe and the Middle East.

Sometimes size truly can be an advantage. When it comes to delivering complex systems for running hospitals or medical records databases for entire countries, it helps to have a large pool of in-house talent and experience to draw upon. In Nortal’s case, the size factor isn’t only about numbers of experts. It’s about the broad range of areas they cover.

“Nortal’s edge is that we’re much more than just a healthcare tech company. It’s even fair to say that we’re much more than a tech company,” explains Taavi Einaste, the group’s head of digital healthcare. While Nortal does indeed have a strong track record in the connected healthcare field, it also has solid experience in several other areas, from eGovernment and optimizing heavy industry to ease of doing business, providing strategy and change management services as well as technological solutions.

“That gives us an extremely wide portfolio that includes data-exchange standards, electronic ID expertise, big data analytics, data protection – the fundamentals that modern medical systems are built on,” said Einaste. “We even have experts in GDPR compliance, for example, so we can integrate that feature into our designs from the beginning.”

This breadth of knowledge has continued to prove useful ever since Nortal’s first foray into the healthcare field in 2003. It was then that Nortal began building a comprehensive, web-based hospital information system for Tartu University Hospital, an organization that remains a Nortal client to this day.

More recently, Nortal created a centralized national health record (NHR) system for Lithuania. The system serves as the foundation for the country’s entire healthcare ecosystem and allowed the later addition of an electronic prescription element that has gained widespread popularity.

In the United Arab Emirates, Nortal is partnering with the Abu Dhabi-based IT company inHealth to provide expertise and solutions in the area of electronic health records, electronic prescription and healthcare analytics.

Electronic ID and other handy tools

“Our experience has shown us that every country, and every hospital, has its own way of doing things, which is why recreating systems in new environments is notoriously tricky,” Einaste notes. “That said, there are certain key components that need to be in place to make electronic healthcare systems run seamlessly.”
Chief among those, he says, is a secure, easy-to-use digital identity – an area in which Nortal excels.

“Often the reason these systems stumble and fail to deliver is a faulty set-up for managing users’ digital identities and permissions,” Einaste explained. “The lack of a reliable and flexible identity in the digital environment slows down the introduction of interactive solutions and services, and even limits access within healthcare organizations.”

Systems created by Nortal not only overcome this roadblock but do so with maximum simplicity at the user end, typically incorporating the latest in mobile-ID and smart-ID authentication. This way, a patient can easily assign access rights to a specialist, for example, and allow doctors to share information that’s vital to making the best treatment decisions.

Other areas of Nortal’s larger portfolio that come in extremely handy in the digital healthcare field are big data analytics – the kind that can be used to track health trends and treatment effectiveness – and the prosaic but critical realm of data exchange platforms.

Lately, compliance with the General Data Protection Regulation (GDPR) has become a major topic of concern in healthcare. The EU’s new data protection requirements reach far beyond patient data, touching on everything from communications to human resources. Nortal’s experience with GDPR solutions runs deep – the company has implemented top-to-bottom compliance programs for large corporations and even developed its own data discovery tool for handling data mapping. Applying its GDPR expertise from the business world at large, Nortal is able to design its digital healthcare systems with privacy at its core.

The patient-centric approach

As beneficial as digital healthcare systems are for providers, Einaste points out that ultimately it’s the patients who matter most in the equation. For this reason, putting the patients’ needs first is fundamental to the systems designed by Nortal.
“It sounds like a platitude, but it’s hard to overstate how much this ‘patient-centric’ orientation boosts the level of real impact these systems have on health outcomes,” he said.

“Before we built the NHR system in Lithuania, health records there were mostly stashed away in individual hospitals and clinics and often kept on paper. If you had a medical issue when you happened to be in another city, the doctors treating you would have a hard time getting your information, which could impede treatment,” said Einaste. “Even more frustrating, patients had to jump through hoops to get access to their own medical records.”

Now the situation couldn’t be more different. Not only can vital medical records be instantly retrieved and securely shared among health professionals, patients themselves have full access and control over who views those records.

“Our systems let patients use their mobile phones to grant doctors access to records on-the-fly, which is important when time is a factor. This is another example of maximizing ease of use for the patient,” Einaste said.

He notes that, on a more global scale, giving patients ownership of their records through NHR or EMR systems could mark the beginning of a larger shift in the relationship between doctor and patient, leading patients to take a far more active role in their own health maintenance and treatment.

This increased level of patient involvement may be further increased by the growing popularity of connected wearable tech, a trend that Nortal is watching closely. From off-the-shelf activity trackers to specialized telemedicine monitors, these can feed data directly into existing electronic medical records to generate a more holistic picture of a patient’s health.

Nortal developed the data-exchange standard for connecting wearables to the NHR in Estonia. Further work will have to be done before wearables actually become a standard part of the nation’s health data landscape, but the foundation has been established.

“This is a perfect example of how we’re constantly looking ahead, designing not just for what’s available now, but also for what’s heading our direction,” Einaste said. “This is how Nortal is contributing to healthcare.”

The blockchain and healthcare

In 2016, the Estonian government was looking for new ways to secure the health records of its 1.3 million residents. It turned to blockchain technology.

The distributed ledger technology has proved its potential in applications where data integrity is critical. For this reason, the Estonian E-Health Foundation made the blockchain central to a development project aimed at safeguarding patient records.

Crucially, it’s not the health records themselves that are blockchained but the log files that record access or change to those records. The blockchain creates an immutable audit trail that can be monitored, ensuring that life-critical data hasn’t been improperly altered.

The project is still a work in progress, but other nations that use electronic health records could soon follow suit. Nortal is looking into practical ways to use this Estonian experience in other innovative and cutting edge markets.