“We believe in a big paradigm shift. We believe that we are transforming from a reactive to a proactive city,” said Mikko Rusama, Chief Digital Officer, City of Helsinki, on a recent Bloomberg Associates webinar to launch the new Digital City Tools report in which the Finnish capital is featured as a case study.
“Talking about healthcare, we believe that we are moving towards preventive healthcare, on people’s terms,” Rusama commented.
Demographic trends such as an ageing and growing population and immigration, as well as the current COVID-19 crisis, are putting pressure on Helsinki’s healthcare system.
Estimates suggest that in Finland, 10 percent of people — mostly elderly residents and patients with multiple health problems — generate 80 percent of the country’s health and social care costs. Helsinki, and Finland more broadly, is also seeing a shortage of qualified medical professionals.
“Something needs to change,” Rusama said. Helsinki is working on a proactive Health Benefit Analysis tool which aims to help prevent ill health before it occurs for the benefit of citizens as well as the healthcare system.
“The idea is simple,” Rusama said. “We are trying to identify and proactively treat high-risk patients.”
The tool analyses a patient’s data and applies a set of rules — based on medical guidance — to identify care gaps and recommend the appropriate actions and treatment. All data is pseudonymised and pulled from existing health records, giving medical professionals an overview of a patient’s test results, previous diagnoses and medication history, but without disclosing their identity.
Rusama gave two example use cases: the identification of patients prescribed central nervous system drugs to ensure they have a dedicated doctor, and the identification of patients with high blood pressure to optimise medication to avoid heart attacks and strokes.
The great clash
“To truly scale up this solution, we need to solve the ‘great clash’,” Rusama said, highlighting the tension between privacy and healthcare laws.
Finland’s Health Care Act states that: “Local authorities shall monitor the health and welfare of their residents and any underlying factors per population group as well as any measures taken with regard to local authority services that are aimed at meeting the welfare needs of residents.”
Meanwhile, GDPR and other privacy laws place various restrictions on the processing and use of personal data, particularly around consent.
Rusama said: “In real life, if I pass out, you would call an ambulance. But if you see from my data that I’m at risk of dying or getting seriously ill, if you look at the strict interpretation of the privacy laws, you are not allowed to contact me unless I have given permission to do so.”
He told Cities Today: “The issue currently being investigated is: can the city proactively contact people based on the healthcare data (health risk identified from the data) and on what condition[s]?”
Alongisde this work, the Apotti system is being rolled out gradually. It is a common system for health and social care services in Greater Helsinki, developed in collaboration with six neighbouring municipalities and the Helsinki University Hospital (HUS). Apotti integrates both health and social care data into a single system so that it can be used by multiple health and social care agencies if permission is given by patients. In future, the Health Benefit Analysis tool will be integrated into Apotti.
Helsinki is working to become proactive in other areas too. Rusama said in the Bloomberg Associates report: “Wellbeing of people is not only about healthcare. Cities have a wide range of services. If we are better able to understand their individual needs and problems, we can provide more personalised suggestions of what should be done.”
Incremental is OK
Bloomberg’s Digital City Tools report maps the deployment of 41 technologies in 30 cities across five areas – connectivity, data, city operations, transport and mobility, and safety and security — looking at how these technologies are applied to specific city challenges and priorities.
It features case studies from cities including Helsinki, Tallinn, Seoul, The Hague, Tel Aviv and San Francisco as well as snapshots of others.
The report recommends that cities invest in digital resilience, ensure technology deployment is collaborative with residents and other partners, and take a people-centric approach which incorporates organisational processes and digital skills training for staff and residents.
It also urges them not to be afraid of an incremental approach to digital transformation.
“Small steps, shared narratives on the role of technology, and investment in digital foundations such as data standards and infrastructure lay the groundwork for future successes,” the report states.