With just five and a half million people spread out over more than 100 million square miles of land — and a nationalized system pledged to provide high-quality free medical care to them all — the nation of Finland is about as perfect a testbed for connected health innovation as you can imagine. Add in a surplus of developers left over from Nokia’s mobile phone heyday, and you have a country with the means, motive and opportunity to jump into digital health with both feet.
“In Finland we have the problem of people getting older and living longer,” Kaari Sari, a project manager at the Hospital District of Helsinki and Uusima (HUS), told MobiHealthNews. “So people are getting more and more [of] these chronic diseases, which is more expensive for our healthcare. It’s good that people are living longer, but in terms of healthcare cost it’s increasing the costs. So we kind of need to find ways to monitor those costs, and allocating the resources that we have more efficiently.”
For the last two years, HUS has been working with a variety of private and public partners to launch Health Villages (Terveyskylä in Finnish), a three-pronged online and mobile platform geared toward bringing as much of the care process as possible out of the hospital and into patients’ homes.
“In Northern Finland it can be 300 km to the closest health center, and then it can be another 300 km to the closest university hospital or the specialized medical care,” Sari said. “So [through Health Villages] the professional in the health center can check how they should proceed, and they don’t need to refer the patient to the 600 km-away hospital unnecessarily.”
“We have lots of patient groups that would actually like to have remote controls, not traveling all the way,” added Development Manager Heta Kolanen. “That saves also money from national level, government level, because we are paying, for example, the taxi costs of people when they travel a long way.”
How Health Villages works
An inviting landing page decorated with cartoon people belies a fairly complex offering. Health Villages consists of three online portals: one for patients who log in and create an identity, one for Finnish consumers who don’t log in and one for healthcare professionals.
All three are organized around a series of “houses” (hence the name Health Villages), or hubs for different medical areas.
“We have 30 different hubs in our website, and basically the hubs are either symptom specific, disease specific or body part specific,” Sari said. “For example we have a kidney house that’s basically about kidney and kidney failure and those sorts of things. And we have a diabetes house which is about diabetes. And we have a joint house that is about joint replacement and arthritis and so on. And then we have houses that provide services for a larger number of patient groups, like rehabilitation hub, which provides information about rehabilitation in different diseases, and a medicine hub that presents information about different medicines. They don’t need to know which hub they should seek information of; they can just use the search bar. So you can type in what you need to find it will give you all the different pages.”
The different kinds of users will find different digital tools waiting for them in the hubs. For the non-logged in user, the platform mostly gives educational information on different health conditions. In cases where it makes sense, that includes an interactive triage questionnaire. If the user inputs anything that suggests care is urgently needed, the system will prompt them to call the country’s emergency number and won’t let them go further.
For the logged in patient, Health Villages functions similarly to a patient portal. It includes specific goals and instructions for their treatment, which can be set to be freely navigated or to guide the user through a more rigid curriculum.
Telemedicine can also be delivered through the platform, and is a feature of, for instance, the mental health hubs.
There’s a reason different kinds of hubs are different: the tools are designed and built in consultation with the providers at the university hospitals.
“It’s up to the clinic how they want to build it,” Kolanen said. “There are different kinds of pathways. There’s these therapy pathways where the patient is not coming at all to the hospital and he or she is doing this task, reflecting something, and the therapist is commenting. And then there are these pathways where you are coming, for instance, for a surgery and we want to have this waiting time active, because in Finland you might need to wait in this system sometimes for weeks and sometimes for a couple of months to get into the operation. So these are the different groups we have and we can use the same digital platform for all these patients. … it’s like an empty room and we start to furnish it.”
Finally, the provider portal is accessible only by doctors, who, in Finland, are all registered in a central registry that provides chip cards to its members. This part of the site is used for professional education, and for generalists to consult with specialists.
“For example, rare diseases,” Sari said. “We have diseases that only few doctors know about. So we can search for professionals who know about those certain rare diseases, for example. Again we have those guidelines, how to treat specific diseases, courses or videos about certain subjects.”
Living beyond the pilot
Health Villages was born out of a two-year project called Virtual Hospital 2.0, financed by the Finnish government and the five university hospitals.
“They combined their strength and put in resources to build up these services,” Sari said. “And even though the money from the government has stopped, the university hospitals are still willing to develop the services and keep up the services.”
Health Villages has had customers coming for a year now and has seen more than 1.6 million website visits. So far the early push has focused on particular hubs, including the hub focused on pregnancy and maternity and hubs focused on depression and mental health.
There’s some hope that the government will see fit to invest in the project again — Kolanen said her team recently gave a demo of the diabetes hub and saw some interest. But the project will keep going with or without that support.
The key to keeping the project alive has been the involvement of the clinicians in building it, and the flexibility they’re given to build the tools they really need.
“You could easily say that it’s an IT project because we are building digital health services. But it’s definitely not. It’s changing the whole culture, the services we have for our customers and our patients and also the way our professionals work,” she said. “And we have the professionals from the University Hospitals doing the work for themselves. So they are building the services and they are using them, the building doesn’t happen somewhere else.”
They’re also careful to listen to the patient voice, using service design tools and data-driven design to continue to perfect the user interfaces. But it’s the clinician involvement piece that Sari and Kolanen herald as a secret sauce.
“When the professionals come, first they ask ‘What is it we need to do?’ And we don’t have the answer because it needs to come from them,” Sari said. “And that’s the key. We need that shift in the mindset that now is the time when they can say what they want, what kind of service they want to have. It’s a completely new thing for a healthcare professional. And it’s been really interesting how we’ve managed to make these multiprofessional teams where we have the engineers and doctors and nurses working together toward shared goals.”
Editor's note: This story was reported in Helsinki, Finland, on a trip paid for by Helsinki Marketing, a company owned by the City of Helsinki, which covered airfare and lodging for reporters. Health Villages was not part of the official press tour. As always, MobiHealthNews maintains its editorial independence and made no promises to Helsinki Marketing about the content or quantity of coverage.