Trust and millions of co-creators: How the Nordics’ laboratory of digital future thrive

Jonas has fallen off his bike in rural Norway. Help is on the way. The paramedic in the ambulance puts on video goggles that connect him to a doctor via a telephone network. The doctor sees the same thing as the paramedic in real-time through a camera on his tablet, and they collaborate to provide the best care for Jonas. This is not science fiction, it is an example of how digital technology is speeding up access, even in the sparsely populated regions in Scandinavia. And this is far from being the only fascinating application in use in northern Europe in the realm of digital healthcare.

The Nordics are seen as pioneers of digital health systems. Much of what’s still being debated in other parts of the world has already been implemented – and embraced – in Finland, Norway, Denmark, and Sweden. The result: physicians and researchers have comprehensive electronic patient records and can make data-based decisions for approximately 27 million inhabitants. Their trust in the correct handling of their data by public authorities is high.

Finland has one of most advanced healthcare systems in the world. 100 percent of the population (about 5.5 million inhabitants) has an electronic health record. Wherever the patient goes, the data will follow. The government is focused on how to bring together healthcare ecosystems so that academic, private, and public sectors can work together to facilitate research. Legislation provides clear rules on how patient data can be used. The online service Kanta.fi is the cornerstone of digitalization in the Finnish health system, it includes e-prescriptions and renewals, and parents are able to access children’s health records. The service was selected as Finland’s second most highly valued online brand (WhatsApp: rank 3, Google: rank 5).

The Norwegian government takes a proactive role in developing national eHealth solutions for the 5.4 million inhabitants, including e-prescriptions, a national summary care record, and web-based health services for all citizens. Over the years, nationally coordinated initiatives under the vision "One Citizen, One Health Record" have shifted the health sectors’ communication from paper and telephone to electronic communication. The vision is still to be fully realized and efforts are now intensified to bring Norway as a leader in eHealth.

Denmark’s Civil Registration System provides a unique digital identification for each one of the 5.8 million inhabitants, and all healthcare records are digital. This allows for real-time updates to and information-sharing for each patient’s medications between hospitals, GPs, municipalities, and pharmacies. Patients have access to their data through an app and can request prescription renewals. Parents also have access to their children’s data.

In Sweden (about 10 million inhabitants) there were 96 million logins to the national eHealth system in 2020. Sweden’s system has the largest number of annual visits per capita in the Nordics. 79 percent of the visitors report that they have very high or quite high confidence in using the online services. The Swedish eHealth Agency considers the population to be active co-creators of digital health information.

What led the Nordics to this impressive position?

It’s a combination of historical experience, innovative strength, and cultural factors. The countries have a long history of welfare statehood, where healthcare has been delivered by governmental and municipal services. To understand their mindset a little better, it’s worth taking a second look at Finland. The country takes a unique approach to the secondary use of clinical data: It enacted a law explicitly intended to clarify the legal basis for the broader secondary use of clinical data under the General Data Protection Regulation. One of the building-blocks of this strategy is Findata, the Social and Health Data Permit Authority. It’s a one-stop shop for the secondary use of data, granting permission to the national data registers for scientific research and the private sector. Careful handling of data helped Finland to build its population’s trust, the acceptance of digital health is high.

Help for the helpers: It goes without saying that we are proud to be strong partners for the digitalization of healthcare in Scandinavia. In Denmark we provide solutions so that medical data and images can be exchanged safely with other regions and across various healthcare providers. In Norway, we collaborate locally to enable the electronic exchange of medical information nationwide. In Finland, we installed a digital image archive at the Helsinki University Hospital, including training and support, integrated into their workflow. The pediatric radiology at Karolinska University Hospital in Sweden uses digital tools for its CT scanners that provide remote access to imaging systems and centralized management of exam protocols.

“Looking at the Nordics, the question is whether we can simply copy their solutions. The answer is no: There’s no one-fits-all solution.”

What we can do is to identify building-blocks of a high-functioning eHealth system. In short: Establish a digital infrastructure that leaves no one behind. Empower children and the elderly with digital literacy. Collect high-quality data in a well-structured manner. Get the decision-makers to the table. Make sure all stakeholders understand what’s being done and feel confident that their medical data won’t be misused. The keys are to formulate a clear strategy and implement it consistently. Maybe most important: Build trust. The theory is not rocket science. Implementing it is another story – one full of challenges, but above all, opportunities.

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Is there any element from the Nordic digital health approach that you would like to see implemented in your country? Let me know your thoughts.