Components of digitalization: evidence, knowledge and technology

The Norwegian Centre for E-health Research (NSE) has an ambitious goal: To accelerate the development and implementation of policy on eHealth. But how to transform health care services while placing patients at its center? How to create efficient national digital health solutions? An interview with Stein Olav Skrøvseth, Director of the NSE.

What is the main purpose for founding The Norwegian Centre for E-health Research? Norway already had quite a strong focus on digital health, also supported by The Norwegian Directorate of eHealth (NDE), a sub-ordinate institution of our Ministry of Health and Care Services.

The Norwegian Centre for E-health Research was established at the same time as NDE, and its role is to produce, gather and disseminate knowledge that is relevant to the development of the e-health field in a broad sense for national and international stakeholders. There are several large national initiatives in e-health, and it is important to have sound and research-based knowledge to inform these processes. The national goals are formulated in the white paper “One citizen – one health record” from 2012, with three overarching goals relating to health personnel and patients’ access to digital services, and data availability.

One of the goals of the NSE is to „collect, produce and disseminate knowledge required by the authorities to develop and implement a knowledge-based policy on e-health”. How is it implemented in practice? What has been achieved so far?

NSE works closely with national agencies in national projects where we follow their development, carry out evaluation research, and provide knowledge for the projects in both the planning and execution phases. We work on transforming research results into accessible and communicable knowledge that is relevant for ongoing national projects as well as research into specific areas that are of broad relevance for the e-health field.

Another research area is „personal health systems and welfare technology”. What are the pillars of „personal health systems”?

Patients and citizens are a strong voice in the health care systems, and many people with chronic conditions and their dependents are managing their own conditions at home. Personal health systems are technological solutions that enable good living at home. This includes welfare technology, mobile systems, and connected solutions that either monitor the condition, enable self-management or technologies that enable a proactive healthcare service.

»Trust is essential in health care.

Digital security is an important component of building trust.«

Which aspects in healthcare systems - that are facing many new difficulties - can be reconstructed and improved using ICT?

ICT is not a goal in itself, but a means to provide improved health care for citizens. As such ICT can transform most aspects of healthcare. One example is the area of artificial intelligence, that enables the reuse of data for the creation of a learning healthcare system that learns from its own data and can make healthcare into a continuously improving system.

What kind of digital health solutions are already available for citizens in Norway? What is the vision of digital healthcare in the future?

Patients and citizens are using technology every day, and that includes technology related to health, for example through mobile apps. Although these are rarely integrated into public healthcare, they are digital health solutions actively in use. From the public side, all citizens have access to the public health portal helsenorge.no, where many have access to their own health information including reading their own health record. The political vision for the future is outlined in the aforementioned white paper “One citizen – one health record” where information is available to all that need it in safe and secure ways independently of the organizational structure, as well as data being available for research, governance and quality assurance.

Which obstacles to implementing innovative tech solutions in healthcare are most challenging and how can we address them?

This is a very hard question, and not easily solved. There are many good and innovative solutions that do get implemented, but often do not scale. It is necessary to have a foundation in terms of interoperability and standardization.

One of the barriers that delays the implementation of digital health tools are safety barriers. How can we ensure balance between data security issues and digitally-friendly policies and gain trust for digitalization among citizens?

Trust is essential in health care, and digital security is an important component of building trust. Today technological solutions exist that ensure data privacy at the same time as being able to analyze data across different institutions. Trust is a matter of personal interaction, but security of data is an essential component of building trust, and we must use technological solutions that enables both security and at the same time enables data sharing when necessary.

During the Symposium „Future of digital health systems in the European Region” you mentioned three words that define health system of the future: trustworthy health systems, equal access and integrated health system. Why are these components crucial in your opinion?

Many patients and citizens today experience a health system that is fragmented where the patient should experience one health care service rather than a set of different parts. Also, health care is not equally distributed but depending on geography, economy and many other factors. Equal access to services independently of where you live should be a vision for future healthcare. Trust, fairness and integrated healthcare may seem obvious, at the same time as it is far from the reality many places. These words do not address technology directly, but technology is an enabler for all. 