Merilin Pärli: Handicraft state that does not offer tailored e-solutions

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Merilin Pärli. Source: Ken Mürk/ERR

Estonian IT solutions are like pre-industrial revolution manufacturing where everything was made by hand which took a lot of time and effort. The coronavirus crisis has cast light on the lack of convenient and functional IT solutions in healthcare, and nothing has changed over the past year, ERR journalist Merilin Pärli writes.

Do you remember the fairy tale of the fumbling mouse from whom a cat commissions a coat? The latter makes a mess of the fabric so there is not enough left for a coat and offers to fashion the cat a pair of trousers. After he fails at that, he offers to make a hat but still manages to run out of fabric. Needless to say, the mouse ends up being eaten.

The past year has shown Estonian healthcare IT solutions to be about as effective as the mouse who overestimated his skill as a tailor. This ineptitude and the slow progress it causes have resulted in a lot of suffering and possibly cost lives. Who is responsible? We can see no one stepping forward.

Examples can be found close at hand

The Health Insurance Fund has no overview of how many elderly people are on family doctors' practice lists for deliveries of Pfizer/BioNTech and Moderna vaccines. The work has to be done by hand that takes a lot of time and effort.

Or another example. Family doctors have been forced to call the elderly and people belonging to risk groups posing as vaccination salespeople because the state's digital medical records system has so far not made it possible to register for vaccination. It has sometimes turned out in the course of this process that the person is already vaccinated by someone else, for example, because they are an essential worker.

The family doctor has no access to this information because systems and databases are not compatible. Hours spent calling people for no reason and filling out spreadsheets by hand. More time and effort.

Moving on, the digital registration system ended in a total crash on the first day of testing, meaning that sufficient capacity was not reserved. The digital registration system is throwing up error messages left and right that become traps that snap shut [the system] when one clicks on them.

Children often help their elderly parents with the registration process and say that they cannot understand how anyone can expect people to successfully navigate the system.

"Those who make it through are definitely worth the vaccine," one dutiful son wrote after he managed to lop the heads off all the draconic error messages and register his parents for vaccination. Will those not as digitally savvy risk missing out on the vaccine, risking their lives and good health?

However, that was not the end of it. It turned out by midnight that while the system developed by the Estonian Health and Welfare Information Systems Center (TEHIK) sent people confirmation of a successful registration, no booking was actually made in the Digilugu digital medical records system. One is heartbroken thinking about people who showed up in hopes of being vaccinated only to learn they were not registered.

The next example concerns the Health Insurance Fund's vaccination coverage statistics. We are told how many nursing homes have been vaccinated at weekly COVID-19 situation press conferences. However, when one asks for a county-level overview of nursing home residents and staff who have been vaccinated, one learns the work is being done by hand that requires a lot of time and effort.

The Health Board has said that those vaccinated against the SARS-CoV-2 virus that causes COVID-19 will no longer have to isolate after coming into contact with infected persons. Yet, the board still writes to people and orders them to quarantine following contact. When asked about it, the board says they have no way of making sure the person is vaccinated and that people should send in proof in the form of a Digilugu statement. Sounds absurd, while that is the reality today.

The examples go on and on. Unfortunately, every such spreadsheet-based unit of state administration affects human lives that can expire as a result of half-baked or neglected IT solutions and fail to reach them in time. The state is like lady justice to its citizens – blind. Not only that, the right hand does not know what the left one is doing and there are no eyes to make sure.

State IT solutions form a disjointed clockwork where the transmission is not automatic and needs to be done by hand. The reason is the fact that every agency has procured its own IT solutions without counting on the need to synchronize them with others in the future. While all might have been cool solutions in their time and for their specific purpose, these systems have not been updated nor the need for an integral future system considered.

This has left every agency sitting on top of outdated and error-ridden solutions that are incompatible and forced to exchange data by hand, using spreadsheets or image files.

While we have the eesti.ee state portal meant to bring state services together, an experiment from last week revealed that most people have not forwarded their state email address to the one they actually use that results in official messages getting ost.

Another such example is the Health Insurance Fund's priority vaccination list assembled using diagnosis codes and sent to family doctors. The problem is that the codes are not accompanied by names.

This has caused family doctors to vaccinate healthy people in their forties and fifties who have been treated for certain conditions in the past but are perfectly fine today. People are quick to accept the vaccine because one never knows when the chance will come again.

At the same time, Estonia does not have enough vaccine for elderly people who are waiting eagerly to be immunized. Perhaps we should place more trust in family doctors who know their patients better than the fund's automated system. How about coming up with a functional solution for handling vaccination queues to make sure doctors can spend their time treating people instead of holding negotiations over the phone. If only the databases were compatible and information could move between them…

It is this manual labor requiring time and effort that is keeping us from having rapid and effective necessity-based solutions. The latter requires carefully thought-out IT solutions that make reservations for others like them. It also requires funds for maintenance and development.

That is where the dog lies buried. The need for IT investments has been ignored for years, with every agency left to its own devices. There is no big picture, no one in charge of the whole system. People forced to use the systems we have are in agony. Our once fancy e-state has become a digital backwater, a Chekhovian nobleman whose lands and attitudes merely reflect their former glory.

This has really come to affect the work of agencies and users over the past year. And while these shortcomings came as a shock last spring, the past year has produced little in terms of progress. What we have seen has been so buggy that one is lucky to get a hat out of it instead of a coat.

Instead of the fumbling mouse, our IT system could be the brave little tailor who swatted seven flies in a single blow. That is what smart digital solutions are meant to do – solve problems, not by hand and one after another but take care of seven digital issues in one go.

Who is responsible? I believe it is time someone stepped forward.

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Editor: Marcus Turovski

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