Digital health (and hockey?): What Canada can learn from Finland
Every winter, Canadians get hyped up for the IIHF Ice Hockey World Junior Championships. A two-week tournament showcasing the best under-20 hockey players from around the world, it has grown in profile year-over-year to the point that the participating young men are treated like international celebrities (even though many of them are less than a year out of — or still in — high school).
I should caveat that statement by saying that the profile has grown in Canadato a point of borderline hysteria; to the rest of the world — even a prideful hockey nation like Russia — this tournament and its ultimate result is nothing more than a footnote in the holiday news cycle. But, for better or for worse, if you are on the Canadian World Junior Team, you are basically immortalized in Canadian culture. This is probably in part because anything that sounds, looks, or smells like hockey in Canada will always get viewership, but even more so I think it is because we win it so much; it is exciting and easy to root for a national team that basically has a coin flip’s chance to win the tournament before it even starts.
But then this year happened.
For those of you outside of Canada not keeping up with the latest in international junior hockey news (how dare you?), on January 2nd, Canada lost a quarterfinal match to Finland in overtime. It marked only the second time since 1998 that Canada failed to make the tournament’s semifinals. The only other time they failed to do so was in 2016 when they lost a quarterfinal match to…Finland.
The Finns are by no means pushovers when it comes to hockey (they have won the tournament four times), but that’s two losses to a country one-sixth our size in a sport that we are bred (and borderline brainwashed) to be good at by the time we can walk.
So how do they do it? Well, I’m actually in the Canadian minority that neither plays nor watches hockey so I have no idea!
But the recent loss — that even non-hockey fans in Canada cannot avoid hearing/reading about ad nauseam — got me thinking about where else Finland beats us with seemingly less resources. And I didn’t have to look any further than one of my main interest areas to find an answer to that question: digital health.
Finland is to digital health what Canada is to world junior hockey (in any year that is not 2019): internationally recognized and respected, despite a relatively small population and somewhat-reserved personality. Like Canada’s ascension to hockey dominance, Finland’s journey to get to this point in digital health has been no fluke. They’ve taken a thoughtful, long-term, and incremental approach to any investment in the space since the new millennium.
Teamwork makes the dream work
Many jurisdictions — Canada included — have historically looked at digital health as a healthcare-only development area. As such, the onus has often been put exclusively on ministry of health-equivalents to figure out how to make digital health happen. The problem with this approach is that it already puts limits on what you feel digital health can (or should) enable.
In Finland, many of the country’s main digital health assets have been designed, developed, and rolled out in a collaborative way, with participation from multiple government agencies and the private sector. For example, Kanta — the name for their national eHealth infrastructure which I will describe in more detail shortly — is an ongoing joint effort between the Social Insurance Institution of Finland (Kela), the National Institute for Health and Welfare (THL), the Ministry of Social Affairs and Health, and a number of other social and healthcare organizations trying to continually improve the delivery and management of healthcare through digital means. This collaboration was not by accident, as at Kanta’s start, Finland’s healthcare system somewhat piggybacked on the public’s existing trust and comfort in Kela by choosing the agency as Kanta’s hosting and technical provider. An added benefit of this multi-agency effort is that it allows for a more cohesive eGovernment, which Finland has a keen interest in progressively establishing like their neighbours to the south.
Silos and bureaucracy are legacy constructs that will have an increasingly diminished role to play in a modern world that is built on fluidity, agility, and collaboration.
If you build it, they will come
Finland’s claim to digital health fame largely comes from the aforementioned Kanta. As the digital backbone of Finland’s health and social care system, Kanta enables a number of capabilities for both citizens and clinicians.
It provides citizens with the ability to access and share their up-to-date health record with whomever they choose, request prescription refills, and even input their own health data from apps and wearables which they can share with their care team as well. On the flip side, it provides clinicians (that are given consent) a longitudinal record of the citizen’s interactions with all contributing organizations. It is no wonder that it is now a well-known, accepted, and appreciated resource for Finnish citizens and healthcare professionals alike. What national or provincial digital health assets in Canada can share that claim?
Kanta includes health data from all public healthcare organizations (including hospitals), pharmacies, and most of the private sector — so essentially, it includes data from virtually everybody and is growing in its functionality every year because it was developed, at the start, as a long-term ecosystem enabler for all health system participants.
Let’s bring it home
Although valuable as a peer to learn from, building something similar in Canada presents many of the same opportunities (i.e. citizen empowerment, better care collaboration, at-scale health system innovation), but a vastly different set of challenges.
Finland benefited from its size and health system structure when putting together Kanta, whereas Canada is significantly larger — both geographically and population-wise — and effectively has 13 autonomous provincial/territorial health systems within its borders.
To compound the complexity, many of these autonomous health systems already have their own regional and/or provincial digital health assets that should theoretically achieve at least pieces of what Kanta enables. Unfortunately in practice, many of these assets are underwhelming in their capabilities, maturity, and adoption amongst clinicians and citizens to date.
Canada has some of the best healthcare, business, and tech talent in the world, so why is our digital health sector consistently lagging behind our peers? Where is our Kanta? What can we do differently to unlock our potential and bring impactful digital health solutions to our country?
1. Don’t just make it another large public sector project
Many of our major digital health projects have faltered because they were largely designed and developed in a public sector silo (non-collaborative) with a public sector mindset (short-sighted). They try to be too much, too quick and governments — somewhat rightfully so — always struggle with giving up control on how these solutions should evolve over time. So although well-intentioned, we end up rolling out these clunky, overly-prescriptive solutions that are not being built for sustainability, innovation, or private sector participation.
There is definitely a role for the public sector to play, but they cannot be the sole developers, managers, and innovators of the solution. Instead, they need to develop the base version of a platform-like product that allows vendors to come together to create an ever-evolving ecosystem of digital health solutions on top of it. The asset that government brings to the table is their access to massive quantities of health data and their ability to secure this data. As such, they should create a first-gen platform that enables secure access to health data, but leaves the platform’s subsequent development to the private sector via natural market forces and user needs.
Think of an app store but for digital health solutions for Canadian citizens and clinicians to access. Any good app store — Apple, Google, Salesforce — doesn’t restrict the apps it publishes to apps only developed by the host organization; it creates the environment to foster and incentivize innovation; the rest is up to external parties.
We need to develop the digital health backbone that isn’t just perceived as another large public sector initiative, but one that actually encourages and incentivizes private sector participation.
Successful platforms also remove friction from the process of onboarding users and vendors. Think how seamless it is to become an Airbnb host or an Uber driver. It is important to make whatever the manifestation of this concept is as easy as possible for vendors (and eventually, citizens) to meaningfully participate.
Canada Health Infoway appears to be in the process of developing something potentially similar to the above with something they are calling the ACCESS Gateway, but it is still early days and I have a feeling they will end up developing another one of those well-intentioned, but overly cumbersome assets that ends up being underwhelming.
2. Focus on creating value first, and monetizing value second
With healthcare organizations and systems facing increasingly dire fiscal situations, there has been a heightened focus on identifying new revenue sources to fund capital projects (or just keep the lights on). From hospitals building “innovation hubs” to commercialize more in-house products, to provincial agencies increasingly selling access to health data to researchers and vendors, we are starting to become more revenue-driven than impact-driven.
When developing massive digital health assets, it is important to be seen as doing so for all the right reasons. If there is a perception from the vendor community, clinicians, and/or the public that something is being primarily developed as a government revenue generator, its credibility is instantly compromised.
Take a page out of the Finnish playbook and be open and collaborative with all health system (and other government) stakeholders from the get go, so that whatever is built is serving a true clinical purpose and its development is informed by those that will be adding and deriving value from it in the future.
3. Build it with the citizen in mind
Our large-scale digital health initiatives in Canada have historically been predominantly clinician-facing. As citizens increasingly want to become the quarterbacks of their healthcare, we need to equip them with the tools to do so safely and effectively. It is still a hassle to get copies of our health record, and when we do, we usually get them on a CD! None of my devices even have a CD drive anymore.
All of Kanta’s features were built with a citizen use case in mind, and that continues to be the mindset as future capabilities are considered. They did not look at the citizen as a secondary stakeholder, but as a primary one alongside health professionals. I wish I could say the same about Canada. We need to start treating our citizens as informed healthcare consumers instead of passive recipients, as the day of the unidirectional clinician-to-patient relationship is over.
Getting a large-scale digital health asset off the ground is hard enough.
Getting a large-scale digital health asset off the ground that is used by its intended audience is even harder.
Getting a large-scale digital health asset off the ground that is used and liked by its intended audience is mission impossible.
But it is a mission impossible worth pursing because we not only deserve one, we need one.
And maybe since the Finns have been beating us at our game in recent history, we can start beating them at theirs moving forward.