From January to March, all visitors to the Estonian Patient Portal digilugu.ee were asked to answer questions about the purpose of their visit and about how positive or negative their user experience has been. The survey, part of the international research project NORDeHEALTH, was devised to establish what people’s main motivations are for accessing their health data, what kind of new features they are expecting to see, and how they rate the overall security and privacy of the portal. The same questions are being posed to people in Finland, Sweden, and Norway.

Interest is higher among women

The 2104 responses showed that people in Estonia use the Patient Portal extensively and frequently, so much so that it has become a habit to them. For example, nearly half of the respondents had looked at their health data online at least twice in the previous 12 months, and nearly a quarter have accessed the data at least ten times. Nearly a quarter of the respondents had viewed their health data over 20 times.

The most frequent viewers of health data in the Patient Portal are women and people aged 15–44. The lower a user rates their health, the more frequently they examine their health data in the portal.

Purposes differ between younger and older users

Hedvig Soone, project manager of NORDeHEALTH, added that people mostly access their health data in the Patient Portal in order to gain a better understanding of their health issues, to check and follow treatment guidelines, to prepare for an appointment or hospitalisation, or just out of curiosity.

 ‘Curiosity is a more common driver for young people aged 15–34 and those who rate their health status as good. As people get older and their health deteriorates, their needs become more practical and serious: they increasingly view their health data to get a better overview of things,’ noted Soone.

Two thirds of the respondents have had highly positive experiences with using the Patient Portal, while negative experiences were reported by one fifth of the respondents. Highly positive experiences were mentioned more commonly by those who took the survey in Russian and among people aged 45+. The most frequently cited positive examples included the overall convenience of using the environment and the possibility to access one’s test results and treatment data. The prompt receipt of COVID test results and the certificate creation function were also named as positive experiences.

Highly educated people were more critical

More than half of the respondents said that the Patient Portal meets their needs and nearly half affirmed that the portal is easy to use. The perceived ease of use and relevance to user needs of the Patient Portal increases with the age of the users. In addition, these aspects are rated higher by the Russian-speaking populace and those with secondary education. Respondents who have completed higher education, however, are less satisfied.

Complaints about the difficulty of finding the necessary information and using the system were more common among those who rated their health as poor. This means that users who visit the Patient Portal more frequently and whose needs with regard to the portal are more serious and practical (rather than driven by simple curiosity or interest in data) may experience difficulties in their operations.

All in all, it can be said that the more highly educated a person is, the greater their demands are regarding the portal. For example, respondents aged 35–44 and respondents with higher education were more likely to report a highly negative experience, as were those who rated their health as poor. The most commonly cited negative aspects were the overall difficulty of use, inconvenience, and slowness of the Patient Portal, as well as the difficulty of finding the necessary information or performing an operation.

The security of digilugu.ee is considered high

One very positive finding was that Estonians have a high level of trust in the security and privacy of digilugu.ee. ‘Privacy concerns were only expressed in regard to the copying of one’s health data from the portal to other applications (e.g., Google Health, Apple Health).’ Confidence in the security and privacy of the Patient Portal was somewhat lower among those who completed the survey in Russian, though the latter group did praise the ease of use of the portal (as mentioned above).

What do people expect from the portal in the future?

The survey also included questions about users’ expectations and needs concerning features and capabilities that should be added in the future. The results showed that the most desired new features in the Patient Portal are the possibility to access all information available on one’s health and to contact one’s healthcare provider online. According to the results, interest in an overview of all healthcare professionals involved in one’s treatment and their contact details is highest among those aged 35–54 and patients in poor health. Meanwhile, users aged 15–44 and those in good health are most interested in the possibility to apply for a certificate for sick leave.

The potential of electronic health records has been investigated by universities around the world. NORDeHEALTH is a joint project between Estonia and the Nordic countries aimed at identifying opportunities for the digitisation of health services. The project is primarily focused on national portals already in place today where patients can access their health data, which includes the Estonian Patient Portal digilugu.ee.