COVID-19: Lessons from the Nordics

A recent HIMSS Nordic Community webinar addressed how Denmark, Iceland, Finland, Sweden and Norway have enabled a sustainable human-centred health environment that influenced their crisis management during the pandemic.
By Sophie Porter
03:43 AM

Top row: left to right - Kathrine Myhre, Norway; Daniel Forslund, Sweden; Bjorn Jonsson, Iceland. Bottom row: left to right - Claus Pedersen, Denmark; Illka Kunnamo, Finland; Bogi Eliasen, Denmark.

In August 2019, the Nordic countries embarked on a collaborative, data-driven approach to healthcare. In the HIMSS webinar "Pandemics: How Has Innovation Prepared the Nordic Countries," health representatives from each country discussed how the Nordic Health 2030 scheme influenced their response to the COVID-19 crisis. It was clear that a shared engagement with digital innovation and integrated data solutions transcended their individual approaches to benefit the Nordic response.

WHY IT MATTERS

Pre-crisis Denmark already had telemedicine integrated into its healthcare model, so the release of two online consultation tools – Min Laege for GP appointments and another for specialist video-consultations – was achieved within two weeks of the outbreak with immediate uptake. “We’ve spent 20 years preparing the system, creating the infrastructure, pushing for the use of video-consulting and then suddenly it came out of the box,” said Claus Pedersen, director of sentinel unit for the Danish eHealth Portal Sundhed.

Digital healthcare tools were also central to the Finnish healthcare system, with digital prescriptions and the national electronic health record managed by the KANTA Services garnering over one million discrete users per month. This enabled Finland to respond to the crisis early, launching a successful, COVID-19-specific online symptom checker and education tool in just six days. “Now we can record all the data, we can get statistics on the symptoms, and we have research plans to combine all the data from different sources,” commented Illka Kunnamo, adjunct professor of general practice at the University of Helsinki.

In order to avoid harsh lockdown restrictions, Iceland implemented strict preventative measures such as extensive testing, tracking and isolation. These were coordinated through a tailor-made clinical portal that utilised existing IT infrastructure. Around 15% of the population have now been tested for the virus and 70% of confirmed cases successfully tracked. “Only 10 patients have died in Iceland due to the COVID-19 virus and the number of new cases is almost zero, so we don’t expect more deaths in this wave,” said Bjorn Jonsson, CIO of Landspitali. “To handle a pandemic like COVID-19 requires a strong IT support and one also has to be able to act fast. Having a flexible EHR system is an important part in that respect.”

Sweden’s approach focused on how digital tools could be used to provide information and to accommodate remote working. A simple COVID-19 self-assessment tool, corona.sll.se, was developed with entrepreneurs which significantly reduced pressure on the national telephone-advice service. Stockholm also launched additional online consulting services that connected hospitals and specialised care services. These complemented platforms already used by primary care services and increased video visits by over 1000% in two months. “Everything from maternity care, psychiatry, oncology, heart clinics, diabetes centres and so much more are now connected,” said Daniel Forslund, chairman of Innovation and Development Committee, Stockholm.

Unable to procure sufficient PPE or testing apparatus, Norway mobilised meaningful collaboration between public healthcare and private industry in the national effort against COVID-19. Furthermore, the cluster was able to address short-, medium- and long-term needs, through PPE, media consultation tools, infection control systems and at-home communication systems for those suffering mental illness. “One of the largest challenges in Norway has been the lack of collaboration between public procurement, the public healthcare provider system and industry,” commented Kathrine Myhre, CEO of Norway HealthTech. “But now all parts in the ecosystem have seen the value of the other partners in the ecosystem, so I really hope that this will continue after COVID-19.”

All of the panellists agreed that there would be a ‘new normal’ after the crisis, with integrated digital healthcare having shown its potential. Looking forward, there was a focus on fostering sustainability through meaningful evaluation of technologies, increased funding to ensure up-to-date systems and a fostering interaction with risk groups.

THE LARGER PICTURE

The Nordic Health 2030 agenda suggests changing the way we look at health to shift to a more preventive approach and highlights the need for a new social contract between the individual and the organisations within the ecosystem, reflecting on all data points that influence our health and wellbeing.

Having universal healthcare for the entire population is a major factor in the Nordic countries enabling fast and smooth responses. Kunnamo pointed out that “It is crucial that we can identify everyone and connect them with the healthcare providers via the eHealth system.”

Forslund highlighted further recent learnings that have deep roots within the Nordics, such as the importance of digital skills - especially for the vulnerable and elderly, while also maintaining the trust between citizens and the public authorities. In regards to the crises management approach in Sweden, which avoided total lockdown, he said: “We have a trust based system where we encourage people to stay at home with strong recommendations and we see people following that. We have to inform them that they can do their daily life routine digitally. You can visit healthcare and public services online.”

There is a new wave of collaboration between the public and private sectors triggered by the COVID-19 crisis across the Nordic region, which enables the ecosystems to act in a more coordinated manner.

As the peak of the crisis reduces globally, Eliason offered some insight into what we can learn from the response to COVID-19 and how healthcare systems can adapt moving forward.

 

ON THE RECORD

“The biggest learning of the crisis is that, if you really want it, you can do things really fast and really efficiently,” commented Pedersen. “I also think that we now can see the solutions we have set up are not going to be sustainable. When we get a bit further down the road we need to revisit the set up and restructure part of our infrastructure so that it can be sustainable.”

“Iceland has been able to handle all patients as planned with no bottlenecks in the healthcare system,” said Jonsson. “A key indicator is the COVID-19 mortality rate and the Icelandic figures are an input into that discussion. I’m sure there will be a lot of ethical discussions in the future after the dust settles and this will be an input into that.”

Myhre added: “My main point is the value of need-driven innovation processes and also the value of the innovation collaborative ecosystem is crucial. We have a large ecosystem - with the healthcare authorities, municipalities and hospitals, with the companies all focusing on the patients and the needs of the patients and of the society as well – with that focus and knowledge of the ecosystem we have started to develop new solutions, scale existing solutions and start production in Norway.”

The full recording of this webinar is available here