The exporting of our knowledge and products would result in the emergence of new ideas and additional resources for local developments. While Webmedia is trying to sell a complete solution, GenNet Lab is of the opinion that the provision of consultancy services and the exporting of module-based solutions would have more perspective.

The IT companies that have been actively developing health care information systems in Estonia for years now feel strong enough to offer their services to foreign markets as well. However, as different as their target countries are, their products and sales strategies are also varied.

Ain Aaviksoo, a medical doctor who now works as head of the Praxis Centre for Policy Studies, is mediating the co-operation between hospitals and the IT-sector as an independent expert and is currently consulting Webmedia, the largest IT development company in Estonia. According to him, the most likely product to have export potential is none other than the most modern information system developed by Tartu University Hospital and Webmedia.

“The system used by Tartu University Hospital has been developed to a point but, to be honest, it’s still a long way from utilising all the possibilities available,” Aaviksoo says. “The development process will undoubtedly continue. It’s important for an export product to offer more functions than an Estonia hospital would use.”

Andre Krull, the head of Webmedia’s eHealth project says that once the product development process has been completed, the company is hoping to sell the product license to at least ten health care establishments outside of Estonia within a period of three years.

At present, the system developed for Tartu University Hospital is almost complete and it is being developed in a manner that would allow it to be easily adapted to new circumstances. “The aim of our product development is to make it possible to administer the system dynamically so that we would not have to make extensive changes each time a new user is added,” Krull explains.

Webmedia sees the developing European markets, the well-developed Middle East region, and Western Europe as its target markets. “We’re planning to sell the first product licences in 2011, which, however, doesn’t mean that no customised solutions based on the modules of eHealth will not already be sold this year,” Krull says, assessing the situation and adding that promising negotiations are already being held with potential customers from Qatar, Lithuania, and the United Kingdom.

“We’re selling a service offered through a network based on modern technology,” Aaviksoo says. “There are no geographical limitations, all that we need to ensure is that the system would be available in a language the user can understand and that it would meet the technical requirements of the health care system of the target country.”

Webmedia is currently trying to find a common language with a total of ten organisations from both Estonia and abroad. This means that the company is vigorously trying to spread its reach here also, in Estonia, giving reason to believe that there is a chance of the company becoming a monopoly and, as such, an inflexible partner.

“In the USA market, which has a population of 300 million people, there are only five to seven large and important service providers operating in this field. It would probably be difficult to expect good results from a large number of service providers in Estonia as well,” Aaviksoo believes, adding that it would be reasonable and unavoidable in every respect if an excellent and top quality product would be introduced to the Estonian market as a result of the mobilisation.

Aaviksoo does not think it possible that a complete solution would be created by only using the funds available in Estonia. However, should local developers be able to compete on the global market as well, it would be conceivable for the market to be shared by more than one company. Krull is also of the opinion that, when it comes to the reasonable use of resources, it would be wise to use only one such hospital information system in Estonia, which would help hospitals to considerably reduce their costs. However, he does not believe in the rise of a monopoly.

“All the companies developing information systems for hospitals are independent organisations fighting for their place under the sun,” he says. “Given the current level of investments Estonian hospitals are making into IT, the financially most reasonable thing for the developers would be to focus on the development of specialised software products, since it is absolutely impossible to cover all the costs related to the creation of a modern hospital information system by using only the resources received from the turnover of Estonian hospitals.”

Märt Haamer, a member of the management board of GenNet Lab, the company responsible for the creation of the largest hospital information system in Estonia, does not approve of the software developing process being managed by one single company and, in fact, does not believe in the rise of a monopoly.

“I believe that Webmedia’s reign over the market would contradict the principles of Estonian entrepreneurship. Estonia’s success lies in following a model of small business enterprise in which companies would operate within their market niche, doing business innovatively and flexibly,” Haamer says and gives an example from Finland where, during the period of an IT boom, it was decided that only one single system would be used but where development in the field now tends to linger.

In addition, Haamer believes that the reason Estonia’s e-health system has become relatively successful in such a short period of time lies in the fact that the currently used broader system in which many hospitals have developed their individual solutions has not been destroyed. On the contrary, developers have been focusing on the establishment of standards, which would enable for connecting the solutions created so far with one another.
“Health care is such a broad sphere of life that no company operating in the sector would be able to cover it entirely,” Haamer says, referring to the USA where, next to the big players, there are also a number of smaller developers in the field, adding that it would be impossible to implement all the aspects of the American experience in Estonia.

According to Haamer, the situation would have been much more complicated for the state if it would have held negotiations for the creation of the e-health system with only one service provider. “The reason the development we see today has been progressing so rapidly is that small companies are competing with each other by coming up with new solutions. It is vital that we continue to follow this model in the future as well in order to ensure the success of Estonian businesses and the country’s export capabilities,” he says.

“Today, we need to pay very close attention and observe which of the components used by our competitors tend to work better than our own. On the basis of this knowledge, we need to co-operate with one another and take the next step together without trying to eat each other,” Haamer says. Following this principle, GenNet Lab has already successfully joined several customised solutions developed by Estonian and foreign developers via its information system called ESTER.

Haamer believes the following of such a module-based approach to be important in export as well, saying that a fully complete information system cannot be sold since when there are already differences between the processes of each individual hospital, the obstacles encountered due to the differences between countries are even graver. Thus, he thinks that the right thing for us to sell would be consultation services based on experience and standardised modules (for such spheres as hospital check-in facilities, in-patient medicine, emergency medicine, etc.) that could be easily connected to different systems.

Unlike Webmedia, GenNet Lab is currently focused only on targeting the markets close by. Among the most interesting projects, the company is currently engaged in is the integration of an automated voice recorder solution with ESTER in co-operation with a company from Finland.
Tartu University Hospital has been using the eHL system developed by Webmedia since the beginning of 2008. In the 17 hospitals belonging to the hospital group, the system has more than 2,500 users.

The hospital information system ESTER developed by GenNet Lab is used by a total of 20 hospitals all over Estonia, the first of which joined the system in 2000. ESTER is used by approximately 6,500 health care employees.

Development Requires Money

However, IT development requires money and there are significantly larger sums of it available on the foreign markets. While in Estonia approximately one per cent of the hospitals’ total budget is invested in health care information systems, at least twice as much would be needed to keep up with the current pace of development. In comparison, the hospitals and health care systems in charge of leading this sphere of life invest four times as much in it as others.

“It might be true that it would be very difficult to create an internationally successful product by using only the money available in Estonia,” Aaviksoo says. “And if Estonia would have a product that could succeed on the global market Estonia would, all in all, benefit from it.”
With the export potential of their product primarily in mind, Webmedia has applied for financial support from Enterprise Estonia, which it has been granted. In order to enable the company to develop Tartu University Hospital’s information system known as eHL under the name of eHealth in the future, the company has been given 12 million kroons.