During the project the research focused on what kind of health monitoring solutions Estonia uses, at which phase the implementation of those systems is, and how the general socio-economic context and national policies and initiatives have helped. During the study 10 interviews were conducted with different parties and the implementing entities, and the survey also highlighted the main barriers which hinder the implementation of innovative and cost-effective tele-medicine solutions.

It was a sub study of the European Commission’s wider study of the care system and health monitoring systems called “Strategic Intelligence Monitor on Pesonal Health Systems“. This study is focused more on the role of ICT in promoting integrated care and what the current situation with tele-health and tele-care is like.

On the national level, the focus is set on public health in general. So far, the combination of long-term care and ICT has been slightly out of focus. This study analyses three case studies that use technology – 1) the VIRTU project – uses personal integrated assistance using videoconferencing solution; 2) Dreaming project – uses services which allow extending the independent life of the elderly by providing equal level of safety such as in an elderly home and offers a way to stay in touch with loved ones. Technology-based services include monitoring and alarm handling services and elderly-friendly videoconferencing; 3) ELIKO project – uses a tele-care system prototype intended for different medical applications such as supervision of the elderly, mobile tele-medicine aimed towards fast data collection on the chronically ill or pregnant women, and also rehabilition, including post-op rehabilitation.

The study finds that there are many drivers and barriers for the implementation of tele-health and tele-care patient monitoring services.


  • International initiatives and projects
  • Estonian ICT-friendly environment and thrive towards innovation
  • Enthusiasts who have initiated the adoptions of such technologies in the sector
  • Pilot-projects as learning material for future projects


  • Low integration of health and social care systems
  • Small market and a relative lack of financing from the state
  • Central goverment has no active role in supporting the development of suitable technology
  • Underdeveloped health technology assessment practices
  • Lack of co-operation between municipalities (in case of social-care)
  • Low integration of ICT developments and social care systems
  • Varying internet speed in local areas
  • Low interest in tele-health and tele-care technologies by medical personnel
  • No incentives for hospitals to implement home-monitoring
  • Limited IT-skills of Estonian medical personnel on average
  • Difficult to find financially capable Estonian investors

Ideally the future development of tele-health and tele-care services is initiated through significant change in the national (EHIF) reimbursement policy. What is also needed: raising awareness among doctors and medical institutions (key stakeholders to the EHIF and the Ministry of Social Affairs), among patients (influencing their physicians), and among the business people (the innovation creation side).

The Estonian society is quite ICT-friendly with a will to evolve, making Estonia a potential future tele-care champion. A nation-wide electronic health record base system also provides necessary precondition for moving on to tele-care and tele-health practices. The hindering factors are that the Estonian society is increasingly aging which reduces the tax-base and increases the number of people suffering from aging-related and chronic diseases. The economic factors are also no the most favouring. However, the conclusion of the study is that, at least in the care provision service, is that there is a potential new direction which may help Estonia meet those challenges.