Keiu Saarniit
Medical Information Centre of Tartu University Clinics
Puusepa Street 8 - 51014 Tartu (Estonia)
Keiu.Saarniit@kliinikum.ee

General project objectives.

The development of medical information systems as well as the training of doctors in Estonia has been the responsibility of each single medical institution.Until recently, there was no coordinated effort in the field of medical information systems. Furthermore, hospitals, medical schools annd libraries in the capital of Tallinn and in the university town of Tartu have occupied an advantageous position as far as infrastructure development is concerned.
Consequently, the project was launched for coordinated establishment of a national information network supported with access to professional information and training on how to retrieve and manage that information.
The Estonian Programme was coordinated and managed by Tartu University Clinics. The control and supervision of the Medical Internet Programme were vested in an Expert Committee of the Programme formed of members of world-renowned medical professionals.
Establishment of Internet connection in medical institutions in regions outside the two largest towns of Estonia and providing them with access to on-line and CD-ROM electronic databases has been equally important. That would enable to disseminate medical knowledge across the country and to establish Internet information centres at local hospitals for doctors working in these regions. Improvement of equipment and approriate training would contribute to increased and faster networking both in Estonian and international medical communities.
The Programme identified some hospitals in different parts of Estonia on the basis of the selection criteria set by the Expert Committee of Programme. These hospitals became "centers of competence" in each respective region. The project included workshops on the application of the Internet in medical profession: how to find medical information on-line and how to create one's own information resources on-line.
A separate grant programme was launched in the framework of the Medical Internet Programme. The aim of the programme was to initiate and support implementation of medical information technology and content provision projects via open public competitions.

Within the three-year programme, three open competitions were announced the purpose of which was improvement of the quality of medical services through a more extensive application of information technology resources. Of the 42 submitted projects 21 were approved.

One of the projects that received support was the continuation project Medinet III which focused on the updating of the Medical Information Centre of Tartu University Clinics, involving primarily purchasing of new medical databases in addition to the existing ones as well as provision of access to them via the Internet for all Estonian medical professionals, practising physicians and students. Within Medinet III, continuing education at the Medical Information Centre was brought to a new level. The Centre drew up distant learning programmes that allowed to train more persons in a shorter time. Continuing education courses were given via the Internet and study blocks were organized on a regular basis. In the year 2000 the computer practice unit of the Centre was improved by supplying it with new fast computers. DVD equipment, CD writers , a slide scanner, a digital camera and a videocamera were acquired for a more efficient conducting of education courses.

As a result of an open competion, organized in the first Programme year, experts selected two hospitals, Pärnu Hospital and Mustamäe Hospital, to be supported in the following years.
The project of Pärnu Hospital aimed to complete the development of the Intranet as well as to integrate and develop connection between Pärnu Hospital and the medical institutions of Pärnu county via the Internet. A computer training unit was set up, which enables to carry out continuing education on computer software programs and on database software for the staff.

Since Tartu University Clinics in Southern Estonia had founded a medical information centre, the need for such a centre in Northern Estonia, serving medical professionals in that region, became evident. One of the continuation projects within the Programme was also the establishment of a medical information centre at Mustamäe Hospital, which has already been started. The computer training unit of the hospital can be used by patients at the time when it is not occupied by scheduled activities. Acquisition of databases and manuals is coordinated with the Medical Information Centre of Tartu University Clinics.

Among more prominent projects that received support at the competition was Internet in the process of rehabilitation (http://www.msk.ee), aimed at the development of a system for people with chronic diseases, namely MS (PwMS), as well as the creation of a compherensive information system for health care professionals, enabling quick access to the most contemporary information in the Internet.

Virtual health information is directed to the elaboration of an Internet information system for health education in schools This will be achieved via publication of related resources in the Estonian language. Both teachers and pupils can obtain knowledge from the WWW that would serve as a supplement to the national curriculum. Improvement of health awareness contributes to the development of a healthy and productive society. All schools in Estonia are connected to the Internet.

The Pharmacological Database in the Internet aims to create a database with the following functions: serve as an electronic pharmacological manual assisting doctors in selection of optimal medication, serve as a source of constantly updated information about new medications, represent a novel means of teaching for students, and act as a source of information for doctors concerning new medicinal products offered by pharmaceutical companies.

The page "Baby Site", providing information to prospective mothers before and after childbirth has proved to be of interest.

Conclusion.

1. The Medical Internet Programme has allowed the application of new resources of information technology in medicine. The Programme has supported the advancement of information technology in various medical establishments in Estonia (development of the information system at Pärnu Hospital, creation of an information centre at Mustamäe Hospital) and the updating of the Medical Information Centre of Tartu University Clinics.

2. A programme of continuing education for doctors, nurses and other medical staff, covering the whole Estonia, has been launched on the basis of the Medical Information Centre of Tartu University Clinics. During three years, 945 persons have participated in relevant education courses. The Medical Information Centre of Tartu University Clinics has drawn up distant learning programs that allow to train more doctors in a shorter time. Continuing education courses are given via the Internet and study blocks are organized regularly.

3. In 1999, the Medical Information Centre of Tartu University Clinics introduced itself to medical libraries and information centres of the world at the EAHIL'99 workshop " Towards quality in medical information services - virtue of virtual environment", which was held in Tartu and was attended by 124 persons from 23 countries, among them Australia, the USA, Canada, Israel and Ireland. In this event participated also representatives from NLM and MLA.
4. On the basis of the Medical Information Centre of Tartu University Clinics, the most necessary medical databases ( Medline, Biomedical Collection I-IV, Evidence Based Medicine , Micromedex databases, etc.) have been acquired for Estonian medical professionals. Free use of databases via the Internet is provided for the whole medical community.

The Medical Internet Programme has achieved its main aim - up-todate information is available on each doctor`s desktop. Also, the development of a system of public health information is under way.