Sweden, Digital North Star, Leads The Eu Toward Connected Health

21 February 2023
Could you please briefly outline the state of digitalisation in Sweden's healthcare in 2023? Sweden is fully digitalised – Electronic Health Records (EHR) systems are implemented everywhere and have been for quite a long time. As patients, we also have good access to our region's digital services and quality-assured healthcare advice through a nationally available healthcare portal. How have all these been achieved? I think it has a lot to do with the fact that it was kind of a grassroots movement. It started with initiatives at local healthcare centres acquiring systems that supported their needs and allowed doctors and nurses to influence the functionality to some extent. And from there, it sorts of grew organically. And what doesn't work in healthcare that still needs to be fixed with the help of med tech? As a consequence of us being early adopters, the first systems were not designed to be interoperable. That wasn't the focus. Luckily, all regions have, or are in the process of, exchanging their central EHR systems for newer, more modern ones. The exciting thing about med tech is that we are never done or finished. It is a science in itself to constantly strive to find better, more effective ways to solve problems or create a better process for something that might not be too bad, to begin with. Sweden ranks 4th among 27 EU Member States in the 2022 edition of the Digital Economy and Society Index (DESI). Historically, what was the path to such a high ranking? That is such an interesting question and there are probably many explanations for it but I would like to point out a few contributing reasons. Sweden has good fundamental conditions, including broadband coverage and connection and high internet usage among the population. A significant influence on our computer skills was an initiative in the 90s where "home PCs" were subsidised so that many people could get a computer to use at home. At about the same time, internet use took off and broadband became a Christmas present. Security, resilience, prosperity, democratic values and the rule of law are the goals of Sweden's Presidency of the Council of the EU. Is there a place for projects like EHDS or other med tech-related topics? Absolutely, all of the presidency's goals play into both the use of med-tech and EHDS. Regarding prosperity, life sciences, including med-tech, are one of the largest export sectors in Sweden. The EHDS proposal puts a lot of emphasis on the citizens' rights to access and control their own data, which I think is a fundamental condition in democratic values. Cross-border health still doesn't work in Europe: The exchange of e-Prescriptions and Patient Summary is rolling out slowly. What's the obstacle? I can't speak for other member countries. But from Sweden's perspective, I would say that in the case of e-prescriptions, it is purely a legal obstacle. We are waiting for an update on the law that regulates access to the information in the national register. All prescriptions in Sweden are electronic and we know that technically our services work with the European ones. For Patient Summaries, the circumstances are a bit different. We do not have a complete national one to start with. Although we have the possibility to share information through the nationally available platform I mentioned earlier, it is not mandatory for the data holder, the regions, to share information there. So that is a challenge. Is Sweden ready for the EHDS? We are ready and cautiously looking forward to adapting to the regulation, but some issues must be considered. The proposal points to a number of areas of responsibility that no national agency has today, so it must be decided by the government who will be appointed in those areas of responsibility. The timeline is also a bit of a challenge. But at the same time, we are preparing. We are in the process of sending in applications for funds from the commission to start the capacity building that we need to do. Do you think the first proposal of the EHDS is already near the final version? One of the responsibilities a country has when they hold the Presidency of the European Council of ministers, as Sweden holds now, is to lead the negotiations of a legal act in a neutral way and represent all member states opinions, not just our own. But, of course, that includes total negotiation secrecy, so I don't know how close we are to the final version. I know there have been compromised versions put on the table, both by the Czech Republic and by us, so it seems the proposal needs some work before it can be decided. You are a pharmacist. What made you switch to digital health? I started in a pharmacy and realised early I wasn't really interested in what we were doing as much as how we were doing it. I was given the opportunity to work with systems the pharmacy developed both for administrating the prescriptions and also with introducing a web service for clinicians so they could have access to prescription information for a group of patients with a particular consent. I went on to work with digitalisation in health care, both with the pharmacy company and private companies that developed health- and social care systems. When the monopoly was deregulated, I got an offer to work with national services for healthcare and pharmacies at the predecessor of the agency. And I stayed when we were transformed into a government agency, and now I work with our international relations. So this field is constantly evolving and keeps getting more and more interesting. I have always seen digital solutions as an integrated part of health care and pharmacy. I feel very fortunate to have had the opportunity to grow my career alongside the advancement of digital health. So, in a way, I don't think I switched.