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Sweden struggles to achieve ambitious e-health dreams

Think a world-class public healthcare system, a stable of leading tech firms, and an impressive track-record of digital innovation make Sweden a shoe-in for the top spot globally in digital healthcare? Think again.

Sweden struggles to achieve ambitious e-health dreams
Photo: Andreus/Depositphotos

Sweden has long been admired for its comprehensive system of social welfare in which taxpayers fund an impressive range of benefits, with public healthcare provision at its core.

At Sweden is also ranked in several indices rank as one of the world’s most innovative countries, and is home to several successful global firms as well as tech startup scene that’s churning out new firms that have the power to turn traditional industries on their heads.

More broadly, Sweden is also a very mobile savvy, connected society, with deep penetration of high-speed internet connections (93 percent of Swedes had internet access in 2015) and smartphones (77 percent). Nor are Swedes afraid to conduct transactions online, with 79 percent having bought goods and services over the net in 2015. 

With such favourable conditions, it seems obvious the country that helped rewrite the rules for digital delivery of music and banking services is doing the same with digital healthcare.

But while strides have been made in healthcare digitalization, progress has been far from uniform. Overloaded IT infrastructure, coordination difficulties, and other factors have slowed the sort of investment needed to fully accomplish Sweden’s digital healthcare transformation – the consequences of which are already affecting patients.

In March 2017, for example, the IT system at a hospital in Västerås in central Sweden went offline for several hours in the middle of the night. Suddenly, doctors couldn’t access information about patients’ medications or whereabouts in the hospital.

“We can’t guarantee patient safety right now,” a concerned nurse told the local newspaper.

The incident came just a few weeks after doctors in Region Kronoberg in southern Sweden were unable to login to a critical system for nearly two hours. And back in September 2016, an IT system malfunction in Uppsala disrupted operations at clinics and hospitals throughout the county for days, prompting nurses and doctors to revert to pen and paper.

Part of the problem, according to Vasil Gocevski, CEO at the Malmö office of international IT company Seavus, stems from a lack of IT infrastructure investment within Sweden’s healthcare sector.

“Hospitals in Sweden could learn a lot from what banks and telecoms firms have done when it comes to adding redundancy,” he says.

And while Seavus has been busy helping hospitals elsewhere in Europe digitize their data and processes, so far hospitals in Sweden have been slow to react.

“In some cases, we see healthcare systems in other parts of the world running much faster than Sweden,” he adds.

Meanwhile, Sweden’s current government has high hopes for digital healthcare, having recently approved the E-health Vision 2025, which calls on Sweden to be “best in the world” at using digitalization possibilities to improve access to quality healthcare. 

“E-health is a priority area for the government,” says health minister Gabriel Wikström.

And no wonder – a 2016 report by the McKinsey consultancy estimated that Sweden could shave 25 percent off its annual healthcare costs in the coming years, which translates into a saving of 180 billion kronor in 2025.

And many of the digital solutions to help streamline healthcare already exist.

For example, some parts of the country have trialed digital appointments, allowing patients to have a first consultation via an app rather than forcing them to travel to a physical doctor’s office and wait in line. The solution depends in part on Sweden’s BankID system, originally developed to facilitate secure transactions for online banking.

“At physical health centers it can take from one to seven days to get a time with a doctor,” says Sofia Kacim from Swedish health start-up KRY, which developed the digital appointment technology. “Our ambition is that you will always be minutes away from an appointment with a doctor.”

The solution saves time for patients and makes that first doctor visit less of a hassle and increasing chances that minor medical issues can be uncovered before they become more serious – and more costly.

Another e-health innovation being tested in Stockholm allows stroke patients to conduct therapy sessions at a distance from their own homes, rather than requiring them to remain in hospital for the duration of their therapy.  Using motion sensor technology and a screen that allows for two-way communications with a physical therapist sitting in a remote office.

Despite these and other solutions that can streamline data processing, treatments, and hospital management, Sweden has yet to cement its position as a true e-health leader.

“Huge investments, structural changes, and a clearer division of responsibility is needed to realize the full potential [of e-health],” McKinsey warns in its report, adding that an integrated medical records system ought to take priority, as well as internet consultations and monitoring of patients at a distance. 

The decentralized nature of Sweden’s healthcare system – care is managed by 21 independent county councils – also creates challenges when it comes to tech procurement and implementing systems that can facilitate coordination and patient information flow. 

And so far, attempts to coordinate across counties have proven difficult.

Despite nearly two years of negotiations between Stockholm County and Region Västra Götaland, which includes Sweden’s second-largest city of Gothenburg, politicians recently failed to reach an agreement for a common procurement of a comprehensive healthcare IT system. 

“I’m really disappointed we couldn’t do this together,” Daniel Forslund, Commissioner for Innovation and eHealth at Stockholm County Council, said at the time

Forslund and others had hoped the cooperation would lay the groundwork for a common IT infrastructure and increased cooperation among regional health bodies that would result in a better, more efficient system. 

A common IT infrastructure would bring savings and improve patient satisfaction by making it easier to make sense of the massive amounts of data currently collected in the healthcare system, says Gocevski of Seavus.

“Right now, the data collected within Sweden’s healthcare sector is fragmented. There is sharing on a regional level in some cases, but not on a national level,” he explains.

This “information scarcity” makes it impossible to map the data and create systems that are self-learning and which could ultimately lead to better, faster diagnoses, especially when it comes to rare diseases that involve consultations with multiple specialists before the correct diagnosis can be made.

“To maximize the benefits that Big Data and artificial intelligence (AI) can bring to the healthcare industry, Sweden needs a system where all the data and the insights gained from hospitals and clinics across the country are shared from the start,” says Gocevski. 

“That will help cut the time it takes to identify illnesses, which would benefit both patients as well as the healthcare budgets.”

Stockholm alone has set aside 2.2 billion kronor over the next four years for IT procurement, as well as an additional 750 million kronor to be spent over the next three years to phase out old technology.

Indeed, the investments required to realize Sweden’s ambitious e-health vision will be substantial. But the long-term benefits in terms of efficiency, personalization, and safety – not to mention eventual cost savings should make those investments pay off.

“If healthcare digitalization is implemented completely, Sweden can within ten years be an international success story for e-health,” the McKinsey report concludes.

This article was produced by The Local’s Client Studio and sponsored by Seavus.

SHOPPING

The unmanned supermarkets rescuing Sweden’s rural areas

One after another, grocery stores are shutting down in rural Sweden, leaving villagers to travel miles to buy food. But a new type of shop has sprung up in their wake: unmanned supermarkets in mobile containers.

The unmanned supermarkets rescuing Sweden's rural areas
Store manager Domenica Gerlach enters the Lifvs unmanned supermarket store in Veckholm, 80km outside Stockholm. Photo: Jonathan Nackstrand /AFP

In Veckholm, a village of a few hundred people 80 kilometres (50 miles) from Stockholm, the last grocery store closed more than a decade ago. Then, a year-and-a-half ago, even the little convenience store at the only petrol station locked its doors.

Villagers were left with no choice but to travel a half-hour by car to the closest supermarket.

But in July 2020, an automated, unmanned grocery store came to town. In a container dropped in the middle of a field, open 24 hours a day, the 20-square-metre (215-square-foot) supermarket sells hundreds of items — and there’s no cashier in sight.

“Since a while back, there has been nothing in this area and I think most of us living here have really missed that,” said Giulia Ray, a beekeeper in
Veckholm. 

“It’s so convenient to have this in the area,” she told AFP, doing her own shopping and restocking the shop’s shelves with her honey at the same time.

Shoppers unlock the supermarket’s door with an app on their smartphone. “We come here three times a week and buy stuff we need,” Lucas Edman, a technician working in the region for a few weeks, told AFP. “It’s a little bit more expensive but it’s fine. It’s a price I can pay to not go to another store.”

He scanned his pizzas and soda on the app on his phone, which is linked to his bank account and a national identification system — an added anti-theft security, according to the store. And it’s all done under the watchful eye of a single security camera.

Keeping costs down

In Sweden, the number of grocery stores — everything from superstores to small convenience stores — has dropped from 7,169 in 1996 to 5,180 in 2020, according to official statistics.

While the number of superstores has almost tripled in 24 years, many rural shops have closed down, often due, like elsewhere in Europe, to a lack of
profitability.

Daniel Lundh, who co-founded the Lifvs, has opened almost 30 unmanned stores in rural Sweden and in urban areas with no shops in the past two years.

“To be able to keep low prices for the customer, we have to be able to control our operation costs. So that means controlling the rent — that’s why
the stores are quite small — but also controlling the staffing cost,” Lundh said.

He plans to open his first unstaffed supermarkets outside Sweden early next year.

Domenica Gerlach, who manages the Veckholm store, only comes by once a week to receive deliveries. She also manages three other shops, all of them mobile containers.

Peter Book, the mayor of Enkoping, the municipality to which Veckholm belongs, has only good things to say about the three container stores that
have opened in his patch. And he’d like to see more.

“It makes it easier to take a step to move there if you know you have this facility,” he said.

Meeting place and ‘salvation’

In Sweden, one of the most digitalised countries in the world, Lifvs, like its Swedish rivals AutoMat and 24Food which have also popped up in rural
areas, benefits from a very wired population.

In 2019, 92 percent of Swedes had a smartphone. Ironically, the unmanned shops — plopped down in the middle of nowhere — also play a role as a “meeting place” for locals.

“You come here, you get some gas and you go inside and get something, and maybe someone else is here and you can have a chat,” Ray said.
Mayor Book echoed the notion, saying the stores make it possible to connect society”.

The pandemic has also proven the stores’ usefulness, since no contact with other people inside the shop is necessary.

Because of Covid-19, only one person at a time is allowed inside the Veckholm store.

“My mother lives nearby as well and … this has been a shop she could actually enter during all this time. She hasn’t been (able to go) anywhere,”
Ray said of her 75-year-old mother. “This has been a salvation for her.”

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