How public and private collaboration drives digital change in Finland

Co-operation between public and private providers is well-established aspect of Finland’s healthcare system, but the relationship between public hospitals and private business has been distant until relatively recently. The situation is changing fast thanks to initiatives such as the CleverHealth Network.

The article is published in the recent issue of HIMSS Insights issue on Finland. Get your free copy and welcome to HIMSS22 Europe conference in Helsinki on 14-16 June to learn more!

Article by: Piers Ford, published in HIMMS Insights 10.1 on February 2022

Covering a catchment area of 2.2 million residents, HUS incorporates five hospital areas including Helsinki University Hospital. As well as being the country’s leading hospital district, it is the largest provider of specialist care, and has built a strong reputation as a digital health transformation pioneer.

The HUS pedigree includes the creation of a data lake which contains structured and unstructured data from more than 100 patient registries, enabling the provision of data sets for research and knowledge management purposes. The data lake was an important initiative during the preparation and scoping of legislation for the secondary use of health data, which came into force in 2019.

Since the formation of the CleverHealth Network in 2017, HUS has also been the co-ordinator of an innovative health technology ecosystem bringing together clinicians, pharmaceutical companies, global technology players and startup businesses with the aim of developing tools that will improve the health and wellbeing of Finns, and ultimately find international markets.

The HUS data lake, constraining data from more than 100 patient registries, is in the core of all CleverHealth Network projects.

HUS chief digital officer Visa Honkanen says the pandemic has helped to break down the traditional barrier between public and private actors. The main proviso for CleverHealth Network is that a development project must be based on solving an immediate and relevant healthcare issue, he says, with the potential to be built into a product with commercial appeal.

“It has been a learning curve for us as a public hospital,” says Honkanen.

“Not just because of legal issues but because of the trust that both sides must have that everybody is working in everybody’s best interests. Sometimes, we are having to build trust between competitors. It’s good that as the head of this ecosystem, a university hospital like HUS can make it easier for them to work together.”

Cluster power

Honkanen explains that because HUS is a cluster of hospitals it can call on a rich resource of information and expertise.

“The biggest fruits come from situations where you can reach over the whole care continuum,” he says.

Complex initiatives require competencies from different companies, as well as clinical expertise and validation.

“It has helped that we are all in the same EHR in the Helsinki Metropolitan area, which includes social, primary and tertiary care. That creates an abundance of available data, as long as we use it responsibly.”

There are currently five major CleverHealth initiatives under way. Among the most prominent of these is the AI head analysis project for developing algorithms to diagnose the nature of and suggest appropriate treatment for brain haemorrhages.

This collaboration between HUS Helsinki University Hospital, Finnish health technology company Planmeca and Canadian IT services group CGI, gives clinicians cloud-based access to tools to support decision making in the emergency room, when a radiologist or surgeon is not at hand.

“You can’t develop these things anywhere other than a hospital structure,” says Honkanen.

“You have to test the algorithm all the time. It might look fine in a data lake but when you try to make it work in real life, you can get into all kinds of technical problems.”

CleverHealth Network project director Mirka Tammi says that development initiatives like this are so complex that it is not enough for HUS to work with a single partner – they require different competencies from different companies. And clinical expertise and validation are essential.

“The data lake is the core of all our projects,” she says. “We want to use health data in new and clever ways, combining it with the competencies of the other actors in the ecosystem.”

Clever clinicians

“It’s a win/win situation for HUS, and very much something that is the future,” Tammi continues.

“Multi-partner projects where clinicians and private companies are working together. Our experience is that it isn’t very good if technology companies are just creating tools without help from clinicians. A startup might create something, only for HUS clinicians to say they don’t need it.”

“For the AI head analysis, our neurosurgeons had to teach the algorithms – there was a lot of manual work for them at the start of the project. But it would be impossible for a health tech company to have that competency. The clinicians have to clarify what the data is all about. It’s so important that they are part of the development.”

CleverHealth projects always combine three elements: clinical, health technology and pharmaceutical expertise.

Another project, eCare for Me, also uses AI technology with the aim of developing tools for early rare disease detection, automated diagnostics, treatment selection and advanced homecare.

A parallel acute leukaemia project uses AI to mine data lakes in order to discover disease-related biomarkers and related personalised therapies, with the ultimate goal of building an intelligent dashboard application for clinical and research use.

“This is a very innovative project which will be quite easily scalable to other diseases with modifications to the algorithms,” says Tammi.

Preventive healthcare is very much at the heart of another initiative, to develop an AI-based digital service model to support the treatment of gestational diabetes, potentially reducing the number of mothers who will go on to develop type 2 diabetes.

Many CleverHealth projects attract government investment. For example, a major venture to develop solutions for managing indoor air in clinical settings has brought Kone, the world’s second largest elevator company into the ecosystem, where it is collaborating with three hospital departments and 12 other businesses.

Tammi explains that CleverHealth projects always combine three elements: clinical, health technology and pharmaceutical expertise. A minimum of three partners are required for a project to be considered viable.

Business minded

“Everybody involved brings something to our projects,” she says.

“No money is transferred between the main partners, but when solutions are created, private partners are responsible for their commercialisation and global markets. HUS is simply co-ordinating them.”

The global players are starting to believe.

“While we try to build these digital tools that we consider might be a product to sell somewhere else, I think it’s important that those private companies take care of that,” agrees Honkanen.

“We are a public hospital! So we try to have one big international company with a geographical presence in Finland on every project.”

Honkanen says this isn’t an easy proposition. Negotiation with the upper management of a global company and convincing them that their involvement in a development project would make perfect sense is a new challenge for HUS.

“Finland is a small country, and we have to prove ourselves a little more,” he says. “But we see that [the global players] are starting to believe.”

Want to learn more? Watch the Health TV event recording on CleverHealth Network.

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