Episode 3: Public Health

Full transcript

Peter Englisch: Hi everyone. I'm Peter Englisch. Welcome to our third episode of our podcast series, Up Next For Your Private Business. In our previous podcast, we have discussed two different aspects of PwC’s, entrepreneurial and private business Heatmap. Looking first at what comprises an enabling environment for private businesses, and then focusing on the first out of seven specific categories, the tax and regulatory regime.

Now we are looking at the attractiveness of the public health environment. I'm honoured to welcome today's special guest Katariina Silander. She's the Head of Digital and Innovation Services at HUS Hospital Children's Department in Finland. One of the leading hospitals in Europe and globally. Welcome Katariina.

Katariina Silander: Thank you. Great to be here with you today.
 

Peter: Looking at our Heatmap scores from a public health perspective, what strikes you the most?

Katariina: Looking at the actual Heatmap scores. I think the scores really do reflect reality and do not come as a surprise to anybody who knows about public health in general. When we look at the scores that Finland has, Finland has a strong track record of creating good public health outcomes with extremely efficient use of resources.

And this is an area that, of course, makes it a very attractive healthcare environment for companies in general. 

Peter: So the Heatmap shows that the positive enabling environment for private businesses consists of much more than reasonable tax rates. We know that different metrics are often interlinked just as the overall high Heatmap score correlates with higher GDP per capita in a country.

Do you see any linkage between Finland's strengths in public health and other categories? 

Katariina: Absolutely. There are many different metrics that actually affect public health itself, such as education, the literacy rate and skills. And these are very important proxies of how attractive public health in Finland can be to public businesses.

There are also many other things that actually affect public health outside of healthcare itself. And these do contribute substantially to the public health of a certain country. We can, for example, think about things related to sports, education or leisure activities, the subsidisation of how a country helps people and supports people to go outside and do sports and be outside in the fresh air.

Also different ways of how we can support children to move more. And also ensure that there are different ways of people to transport themselves from one place to another. So these are all areas that really do affect the public health score. But then if we go backwards to the education and literacy rates, these are very important things when we think of public health and how a country does in this aspect.

Because we do know that people who are well-educated, often very talented and are part of higher socioeconomic groups are usually, in general, healthier than other people. And this is something that can be seen in different parts of the world as well. Not only Finland. 

So we can say that there's a very high correlation between public health and the quality of education in general. And then if we look at the public educational system in Finland, it's actually rather standardised and definitely most of the children and youth and students, in Finland, can go to public schools and public universities where the education is rather standardised.

And this of course helps our socioeconomic gaps as well because the divides are narrower compared to many other countries. And this on itself, of course, also supports good public health.

Peter: I found, especially the correlation between education and public health, very interesting, even if it doesn't surprise me too much, but there's also another category where Finland is very strong at, which is digital infrastructure. To what extent does it help to boost the public health? 

Katariina: I think it's a very good and important question. First of all, public health is a lot more, as said, than only the usual health care combination of old traditional doctor's appointments and so on. 

We have to look at public healthcare from a more holistic perspective and how we can actually support the wellbeing of people in general. And a good digital infrastructure, it really helps us to improve the network for example, of different kinds of services that we can have. And we're very lucky in Finland that the government has been ready to invest rather big amounts and to help out to actually improve the digital networks around Finland with companies itself.

And nowadays you can travel nearly anywhere in Finland. We’re a huge country with very remote areas. One can be in the very north, in Lapland or in the south, in the archipelago and you can still find 5G near to anywhere you go. And this, of course, on its own really makes society a lot more agile because people can move around.

They can work remotely. We can find different ways of communicating with people. And this of course also reflects healthcare and we can then see this within the healthcare area as well, because as said, we are a huge country and the possibility to actually work in different places within remote areas through digital tools really does help a lot.

Peter: Yeah, amazing. And I think in these days where more home office and remote work becomes more attractive, I think this is a super important aspect. But what does digitisation of healthcare really mean? And how does it impact a country? Can you elaborate a little bit more on how this works in Finland?

Katariina: Thank you. That's also a very interesting question because we all know most probably that defining digitalisation itself is already a challenge. But if you look at digitalisation from the perspective of healthcare, you can look at different kinds of tools and platforms that can be used between patients or they can be used between patients and healthcare providers.

Or they can also be used between different providers, for example, between different kinds of healthcare professionals. So I would also say that all kinds of digital tools that support the actual provision of healthcare and also the gathering of information, which has a key role in the healthcare sector, because it's a very knowledge intensive area. All of these can be seen as part of healthcare digitalisation. 

Peter: That must be hugely efficient, but there might be some related risk as well. For instance, in some countries there would be serious concerns about people's data privacy. 

What challenges and pitfalls exist on the road to digitalisation in healthcare, and how are you dealing with those challenges in your organisation? 

Katariina: First of all. I think it's very important to recognise that digitisation and digital healthcare records, for example, definitely have a risk and they are things that have to be taken into account when developing different tools and also implementing different tools in healthcare.

We do definitely take it into account very seriously. There are a lot of different rules and regulations that one needs to adhere too, in the Finnish environment. We are, of course, part of the European Union. So the GDPR is part of the framework, but we also have very strict internal laws and regulations within Finland that do then affect the way of how we can use this data.

And one very good example of this is that in Finland and by law, the patient always owns his or her personal data and healthcare data. So although we have a rather well-working digital platform in Finland, where we have all of the information of the electronic health record systems around Finland, there are multiple different electronic healthcare records systems. 

But this platform combines the information in a way that wherever a patient is or wherever a professional is within Finland, they can always access this information depending on which healthcare provider they will present, and an example also is that we have an e-prescription so that when a medical doctor prescribes a certain medication to a patient, this same prescription can be seen anywhere in Finland and also in all of the pharmacies in Finland.

But at the same time, we have to remember that the patient owns the data and thus a patient has the right to, for example, say that he or she does not want to show all these patient records within this platform. It is important to take into account what patients also believe and what we as individuals want to also regulate of what information flows so-called freely between different providers within the network. So there are definitely things to be taken into account, but they are things that we also work with rather fully. Another example is that we have a very special feature in Finland, called a social security number, which is not very common in the world in general. And what this means is that when a new child is born in Finland or somebody moves to Finland and registers as a resident in Finland, one is given a social security number.

And the social security number will be the same your whole life. This is an identifier that is used throughout the healthcare system, but also in other governmental areas, banks, et cetera. So it's a very special digital number set that always ensures that you are not mixed up with another person. And this, of course, also enables the combination of different data sets together without using patients' names, for example.

And then if we look at it from a regulatory side and we look at registry use, it's very important that privacy is taken into account and is taken into account seriously. So through pseudonymisation for example  of these patient codes, that we have our social security codes that we have, it's possible to create very large data sets without any clear identification as in name or the social security number, and still be able to combine huge data sets from different providers, in healthcare.

Peter: I think this is fantastic news, Katariina. And I think the combination of the government providing the platform and the individual can control the use of the individual patient data by using the social security code is a fantastic example, how an efficient digitised healthcare system can work.

On the other side, I understand that there's a huge amount of data available, which can be used for research in health and for further innovation. How does this work in Finland? 

Katariina: I think this is also an interesting area and definitely evolving all the time. So if we think of research in general and registries, it is true that Finland is not a gold mine, but close to that, when we think of big data from a registry perspective. This is definitely used a lot in research.

We have very clear legislation that says what can be done and what cannot be done and what kinds of permits are required to actually do this kind of work. But we are building new kinds of networks and frameworks all the time to take this legislation into mind, but at the same time enable the use of these different big datasets.

And one very good example that we have, that I can explain shortly, is that my employer is a very big hospital district in Southern Finland with a population of 1.6 million people. So the data that we actually create all the time through patients is huge. And we have created a data lake for all this information.

That can combine different data sets from different kinds of registries related to healthcare from the patient. These data lakes can then be used to mine and find information in a very efficient way. Still taking into account these regulations. And there's a very interesting analysis platform, for example, that can be used internally by the hospital.

But also if permissions are correct, it is also open for other researchers. And also for innovators, for example, from private companies, let's say startups or pharma or so on, whom we definitely also collaborate with in certain projects.

Peter: All this innovation means healthcare is changing, obviously, at a rapid pace. So what do you think is the future of healthcare and how will healthcare in the future look?

And the second question: has the pandemic changed your outlook? 

Katariina: So thinking of the first question first, as in, what does this mean for healthcare in general? And what is the future? I would say that digitalisation, just like everywhere else in society, is here for good. And we have to take that into account within the healthcare sector as well.

It's very important to identify when digitalisation helps and what are the areas that actual digitalisation can support to enhance. And it's also, I think, very important to understand. And to critically think, what are the actual areas where digitalisation might not be the right answer and we might not get the best results.

This is of course always a challenge, but when we go forward and we learn more about how we can use different digitalisation tools and so on in healthcare, we also gain a lot of very valuable experience on what actually can be done and what should be done. Because if we think, what is the point of digitalization, it is value creation, and we should always focus on thinking how we can really improve value to both society, patients, healthcare researchers, healthcare specialists and society in general, as said. And another thing to be taken into account, I think, relates not only to healthcare, but a lot of other industries as well is that digitalisation is a concept. It's a tool, it's a set of different kinds of tools, but to be able to use these tools efficiently, we have to be sure that we implement them in the right way.

And thus it's not only about glueing new digital tools into the processes and into the way we think currently, but actually thinking outside the box and being ready to open our ideas and how we can actually enhance our service provision within what we do nowadays by taking into use different digital tools.

So from my perspective, I think this is the most important thing at the same time, as I started, digitalisation is here for good. And I think healthcare should be in the driver's seat to ensure that we really get it right. And then you also asked about how has this pandemic changed this outlook for healthcare?

I would say it has definitely strengthened it. It has shown just like in many other industries that we have to get out of our comfort zone when we have to, right? The pandemic has really pushed us outside of our comfort zone and has really accelerated the development of digitalisation that was already there before the pandemic.

I also think that the pandemic has shown that change is possible and that we can be flexible when needed, and that there are a lot of capabilities within the health care sectors to really jump on this car and drive it to increase the use of digitalisation. 

Peter: These are great insights. I like how you explained the role of government in helping to create a good digital infrastructure.

And, as in your examples, a single platform for patient data. So my final question goes into another direction. You've got the tools, there's a platform. What can business owners and entrepreneurs do? What is their role in developing a world-class digitally-enabled public health system? What do you think?

Katariina: I think there are very many ways business owners and entrepreneurs can play a very important role because I think they already do. First of all, the availability of patient data from across population, as already discussed today, it creates great opportunities for collaboration within the public sector and innovation with private companies.

And that also includes startups. As we know, there is a very big med tech startup area in the world in general, and this is also important in Finland as well. I believe that with this data and collaboration, we can really improve the effectiveness of public health by taking, also, private sector startups, other companies with us into the wave of development to develop and create new innovative tools to be used within the healthcare sector.

Peter: Excellent. Many thanks, Katariina, for joining me today. This has been a very insightful conversation. We discussed the interlinkage between education and health, the impact of digitisation and the role of governments and the private business sector. 

Thanks to everyone for listening. And I hope you found the discussion interesting too. In the upcoming episode, we will focus on ESG, another very important area to dive in. Until then, stay safe and goodbye.