Annika Strandhäll har entledigats, socialförsäkringsminister
Innehållet publicerades under perioden
Socialminister Annika Strandhälls tal på Vitalis 2018
Tisdagen den 24 april 2018
Det talade ordet gäller.
Ladies and gentlemen,
Thank you for this opportunity to share with you the Swedish Government's vision for eHealth and digital welfare services.
But first – it is truly a great pleasure to be here in Gothenburg. This is where I come from, where I grew up, and where I started my adult life – in Bergsjön on the outskirts of town. Gothenburg is also where I became a trade union activist.
As some of you know, before I became a government minister in 2014, I was the President of Vision – a trade union for civil servants, social workers, administrators and other public sector groups. One of those groups is medical secretaries.
So when I became Minister of Health, I had already gained some experience in this area – both around the challenges it involves and the opportunities it presents.
Speaking about digital transformation, eHealth and information technology in the Swedish health care sector today is to present a somewhat dual picture.
On the one hand, Sweden has come a long way. We have one of the highest numbers of internet users in the world. We have launched start-ups that have become global brands, such as Spotify and Skype. Both the business and public sectors are embracing the digital transformation.
This is also true of Sweden's health care sector. Almost one hundred per cent of patient records are digital, and the percentage of pharmaceutical prescriptions through our national, digital system is almost as high.
Sweden has national quality registers that contain vast amounts of data on patient outcomes – vital for research and development.
On the other hand, we can see that the Swedish health care sector does not take full advantage of the opportunities offered by the digital transformation. And we still have problems with system interoperability and systems that could be more user-friendly.
Perhaps one of the most telling examples is that, despite our high degree of digital maturity, the fax machine is still very much in use in our hospitals and health clinics. Patient records are still being printed, faxed and re-digitised in many parts of our country.
This is, quite frankly, absurd.
We are working in several ways to solve this. But the complexity of data sharing and privacy legislation makes the task challenging.
Of course, in many ways, the use of fax machines poses more of a threat to the security of our personal data than more modern digital means of communication, but we need to ensure that the laws we put in place to regulate this are made to last, and are the product of good legal and political craftsmanship.
Unfortunately – or perhaps fortunately in some respects – this is not always easy. Personal integrity and sensitive personal data are subject to extensive and strict safeguards – in Swedish law, in the Swedish Constitution, in European law such as the new GDPR – the General Data Protection Regulation.
I think I just heard a few sighs. I know. This is the hard part of this discussion and this work. However, I am fully convinced that we can have modern and sensible laws on information-sharing in the health and welfare sectors. But it will require effort and expertise. Unfortunately, two of the government eHealth inquiries a few years ago failed on precisely this point. They conducted a sound analysis of the needs of the health care sector, of patients and professionals. But they simply didn't measure up when it came to the legal craftsmanship on personal integrity issues.
This is an issue we are now addressing at the Ministry of Health and Social Affairs. But I will return to this later.
An important point to keep in mind when discussing the Swedish welfare system is that, when it comes to health and social services, we do not have a unified national system. What we have is legislation that provides a national framework for the services – and a very decentralised system.
We have 21 regions and county councils responsible for most of the health care system – including hospitals and primary care centres. We have 290 local municipalities responsible for their social services – including care for older people and people with disabilities – and for a small portion of health care, primarily home care services.
And they are truly responsible, with a high degree of local autonomy – protected in our Constitution.
And on top of that, there are many other relevant actors in the field. We have patient organisations, trade unions and professional associations for health care workers, private tech companies and private health care providers. Just to name a few.
So, you see, I can't simply go around dictating terms and giving orders – however much I might want to in some cases.
The question then is: what do we do when we need to bring all these different actors together?
A few years ago, we made that choice. Together with SALAR – the Swedish Association of Local Authorities and Regions – we decided on a joint vision for our eHealth undertaking.
Being Swedes, we decided on a rather modest vision: we want to be the best in the world – by 2025.
Sweden will be best in the world at using the opportunities offered by digitalisation and eHealth to make it easier for people to achieve good and equal health and welfare, and to develop and strengthen their own resources for increased independence and participation in the life of society.
This vision applies to both our health care sector and social services.
I would like to clarify that this vision is not about having the coolest systems in place by 2025. We need cool systems and other digital tools to get there, but our vision is about enhanced health and welfare, independence and participation.
But such a tool! And such opportunities! Just to name a few:
For patients this means : to be able to interact with the health care system and take part in their own care.
For professional healthcare workers, it means having access to good clinical decision support systems, and efficient systems for accessing and recording patient information.
It also means much better opportunities for following up on medical and patient-reported results at patient level – for the benefit of the individual patient as well as for the development of new treatments and pharmaceuticals.
But a joint vision is not enough to get things rolling in the public sector. We have also adopted a joint action plan for its realisation. In addition, we have set up a joint cooperation organisation with participation from SALAR, the national government and government agencies. We also invite other relevant organisations and companies to take part in our efforts.
The vision and joint action plan comprise three areas of action:
Regulatory framework – here we work to ensure that laws and regulations support development in the sector.
Standards – here we work to ensure that we have technical standards – in line with international technical standards – that promote interoperability.
Then there is the consistent use of terms – or semantic standardisation. Information exchanged in our systems must mean the same regardless of where it comes from.
Different activities are planned for the three action areas. For instance, during the first half of this year, the Government and SALAR are establishing a national forum for eHealth standardisation.
Now, some of you may be thinking: there are a lot of working groups but not much action. That is not the case –for two reasons.
Firstly, aiming to become the best in the world at something is a bit like trying to build one of the wonders of the ancient world. The question we need to ask ourselves is this: which wonder are we building?
Is it the biblical Tower of Babel – reaching high into the sky and impressing the world, but ultimately collapsing. Actually because of the lack of a common language?
Or is it the pyramids – with a huge and robust base still standing many centuries later?
Now, I don't think that Sweden will be able to be the best in the world at eHealth for as long as the pyramids have been standing. But I do think that that they have something to teach us. We need to build a strong foundation before we can reach high into the sky – that is, if we want to build something that will endure. And that foundation is about regulatory frameworks, about technical and semantic standards.
But, of course, building a foundation is not all we are doing.
Just a few weeks ago, we presented a Bill to the Swedish Riksdag on the necessary legislation for a national medication list. This list will be a common source of information for medical professionals, pharmacies, and patients containing accurate and updated information on prescribed medications. This will help, for example, to prevent harmful combinations of drugs prescribed by different doctors. The national medication list is originally a proposal from one of the government inquiries I mentioned earlier – and a good example of what needs to be done to ensure modern and appropriate legislation.
Here, some of our best civil servants took the previous proposal, which did not meet the standards on issues of personal integrity, and worked long and hard on it. Doing the necessary legal craftsmanship. And now we have a Bill before parliament that we are sure does meet the necessary standards.
Of course, there is more to building a national medication list than legislation. The Swedish eHealth Agency has also been tasked with building the actual system.
Our Government is investing heavily in the welfare sector. –billions of Swedish kronor every year. EHealth is a key part of this effort. A couple of hundred million are earmarked, mostly for our quality registers, a couple of billion are investments that allow county councils the choice to use their funding for eHealth solutions.
And just last week, in the spring budget, a SEK 350 million investment was announced in welfare technology for the elderly care sector.
Digital transformation is naturally also a central part of the Government's efforts in the life sciences area.
On a final note, this is an election year. As I see it, the role of digital transformation in health care and social services should be part of the election debate. Not primarily for its own sake, but because it can offer solutions to many of the challenges we are discussing.
And it is those challenges and solutions you are here to discuss. The unfortunate thing about being a government minister is that I rarely get to attend the most interesting parts of conferences like these. I am very envious of you being able to take part in discussions and seminars over next few days that are sure to be inspiring.