A long time ago, in a Council far, far away …



Daniel Forslund, Commissioner for Innovation and eHealth, Stockholm County Council

Posted with permission and thanks from DigiHealthCareScotland



It is a period of rapid and innovative change in society, but the health care sector has been lagging behind for quite some time. Innovating governance structures in the health care sector have never been more needed. In Stockholm, the adoption and use of eHealth services is slowly starting to grow.

In March, I was invited to the Holyrood eHealth conference to give a presentation on how Stockholm County Council is working to innovate governance structures in the health care sector in order to solve one of the biggest paradoxes in Swedish health care. Namely, that we have the latest cutting-edge technologies for providing treatment, but outdated and old-fashioned technologies for exchanging basic information.

And, furthermore, with digitalization progressing rapidly in all other sectors of society, one might wonder why it is progressing at such a slow pace in health care?

When I started my term as Commissioner for Innovation and eHealth in Stockholm County Council in 2014, I set out on a mission with the aim of solving this paradox. The mission is by no means accomplished. Nevertheless, after three years in office, we can summarize in ten concrete action points how we have managed to create a more systematic approach on how to accelerate the adoption rate of new innovative ideas and technologies in health care, by innovation in our own governance structures.

In short, our reform program for health innovation includes:

  1. Take leadership. Political and clinical leaders must support and empower creative employees, foster a culture that allows experimentation, and stress that digitalization is a critical tool to address the daily life problems in health care. Form an Innovation Committee to create political ownership and provide a strong mandate for change leaders in the organization.

  2. Focus on governance, policies and mandate. Include digitalization and innovation in overall health policies and reform programs, and make innovation an integrated part of health care instead of short-term projects. Move from short-term projects to an integrated innovation culture and empower change leaders and early adaptors.

  3. Identify, understand and systematically remove obstacles. Create incentives for change and improvement by systematically analysing factors preventing implementation of even successful innovation projects. Reform reimbursement systems to promote the use of innovative treatments and online appointments. Use public procurement as a method for change through innovation partnerships.

  4. Remove outdated policies, working methods and technologies. Digitalization is not only about creating the new digital tools, but is also about transforming an analogue set of rules to a digital world. Modernize policies and regulations that prevent new solutions. Change working methods and scrap old paper based routines. Accelerate IT consolidation by investing in the phasing out of old technologies.

  5. Measure outcomes and the alternative cost of doing nothing. We are very good at measuring the cost of buying new IT-systems, but, honestly, how often do we measure the cost of keeping the old ones? In Stockholm, the estimated time loss is 25-60 min per day  and employee with the current IT-systems. That time loss is equivalent to 2,000 nurses working full time every year in the region.

  6. Create incentives for implementation. Both incentives and stronger requirements towards care providers are needed to guarantee digital accessibility. Make basic eHealth services mandatory for care providers. Pay higher fees to clinics who offer more than the basic eHealth services. Pay a neutral fee for all GP visits regardless if it is a virtual or a physical appointment to create flexibility to offer different ways of contact depending on individual needs. Offer financial support for development and innovation to employees through an Innovation Fund.

  7. Invest in a better digital working environment for health professionals. It is time for a new generation of Electronic Health Record systems, built for collaboration, not only for local storage of data. Not only will the employees benefit from it, it will also benefit patients when the health professionals can focus on what they are educated and trained for – providing care – instead of unnecessary administration and paper based bureaucracy.

  8. Manage daily life frustrations for patients and citizens. Make eHealth a ‘free choice’ reform for patients in order to increase availability and individualize the service where the patient can choose to contact healthcare through text, telephone, video, e-services or physical appointments depending on the individual preference. Offer secure online access to medical records for all patients, and make a basic digital accessibility a requirement for all providers.

  9. Capture ideas and create innovations in collaboration. Establish an internal innovation organization for healthcare, to identify and eliminate barriers for innovation and digitalization and to capture innovative ideas from professionals, patients and relatives. Support and facilitate development through an internal Innovation Fund and facilitate collaboration with entrepreneurs and researchers by providing specialized test-bed facilities.

  10. Invest in digital competence. Make sure employees get sufficient training in digital skills in order to build digital competence. Not only how to use the IT-systems, but learn how to deliver care through digital channels. Stress that these investments are key for better working conditions.

In Stockholm, we have come a long way on our path to fully realise the potential of digitalization in healthcare by adopting and following the ten steps above, but we still have many challenges ahead. With endurance and a great portion of stubbornness, I will continue treading this path, safe in the knowledge that there is no turning back.

Why? Once you have made others realize the possibilities and see the benefits with eHealth and digitalization, you are no longer on your own. The force is with you.


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