What can we learn about digital health care from other countries?

The Covid-19 pandemic has precipitated a huge increase in the use of digital technology in health care. This is a welcome development following years of slow progress in embedding digital technologies into England’s NHS. Rachel Hutchings explores the approaches to digital health care from five European health systems which have made significant progress and have valuable learning for the NHS.

Blog post

Published: 24/11/2021

The impact of the pandemic on digital health care in the NHS has been extensive. We’ve seen an increase in remote GP and hospital appointments, greater use of technology to support people with long-term conditions manage their health care, and the use of the NHS app to demonstrate vaccination status.

Similar developments have also happened in other countries. In Denmark, for example, the Sundhed.dk platform used by people to access their medical records has also been what they have used to view their Covid-19 test results and their vaccine passport. And in Sweden, despite remote consultations being available before Covid, their use has rapidly increased during the crisis, with health care professionals provided with additional training to use them effectively.

Although the pandemic has been a game-changer, countries around the world were already making great strides in using digital to support their health care systems, and international collaboration and leadership has been instrumental in that. The European Commission’s Digital Strategy outlines the importance of developing digital skills and standards, and the World Health Organisation’s Global Strategy on Digital Health acknowledges how fundamental digital health technology is in supporting sustainable health care systems.

Digital health is therefore a priority across the world. Although there are differences between health care systems, looking internationally can provide valuable learning. Our report published today looks at the approach taken to digital health care in five European countries – Denmark, Finland, Sweden, Estonia and Portugal, all of which are considered to have made substantial progress on digital health care. Drawing on relevant literature and stakeholder interviews, we identify a number of factors that have contributed to their success. Here we outline three of them.

Consistent use of digital across all public services

There was a strong consensus that progress in health care was supported by a comprehensive focus on using digital tools and data across wider public services. This included infrastructure such as a unique personal identifier. 

Culture and the country’s context have also been important – a history of using digital in a clear and transparent way helped to foster trust and confidence where citizens both accept and expect that services will be used in this way. In Finland, this was considered essential for the development of Findata, which oversees how health care data is used for research, as well as the wider approach to e-government used in Estonia. Recent controversy in England surrounding the use of primary care data has reinforced just how essential it is to build public trust, confidence and skills in this.  

Clear governance and stakeholder engagement

Regardless of size or health care system, what is important is being clear about where the responsibility is, and ensuring that all stakeholders are engaged in a timely and effective way.

In some of the countries, health care is the responsibility of local areas or regions, who have also developed or adopted digital solutions appropriate for their local population. Although this means that tools can vary, countries have taken steps to bring them together. Sundhed.dk in Denmark, for example, acts as a portal for both patients and health care professionals to view data from multiple regional and local information sources. Some countries also have dedicated organisations to support digital health care, such as the Swedish eHealth Agency, which oversees e-prescriptions as well as national digital health projects.

Integrated care systems in England are set to take responsibility for digital transformation within their area, but getting the right balance between national and local approaches is an ongoing issue. Collaboration and partnership working will be key.  

The need for long-term funding and investment  

Up-front investment in developing digital services (such as Kanta in Finland) has been accompanied by a strategy for how it is funded in the longer term. Standards, for example on cybersecurity and on interoperability (making sure systems can talk to each other) have also been built into procurement processes. Where multiple organisations across the health care system contribute to funding, this was also felt to support buy-in with the use of these services.

A long-term investment approach is essential to keep technology up to date and to prepare for future developments. The additional £2.1 billion capital funding for IT and digital health technology in the NHS announced in the recent Budget is welcome, but equally important is ensuring there is a clear plan for ongoing funding. The ‘Who Pays for What’ framework recently published by NHSX should assist with this.

Embedding digital health technology into the NHS

Digital health technology is a policy priority and will no doubt play a key role in the NHS’s recovery from Covid. But more must be done to ensure that the benefits of digital health technology can be made sustainable and are embedded for the long term.

We know that digital transformation is not about the technology, but putting in place an environment that enables it to be adopted successfully is key. Importantly, the use of technology must be co-designed, driven by the needs of patients and staff. Our report shows that this is not necessarily specific to health care, and a focus on the building blocks across all public services is vital.

Digital technology is not an end in itself, but can provide significant opportunities to improve the experiences of both patients and staff. Other countries offer valuable lessons for how to do this effectively. Taking these lessons on board will help to ensure the NHS is able to not only respond to the immediate challenges of the pandemic, but also be prepared for the future.

Suggested citation

Hutchings R (2021) “What can we learn about digital health care from other countries?”, Nuffield Trust comment.