The Nordic Welfare Centre has conducted a survey of the activities currently underway in the Nordic countries to digitise the health and welfare sector and introduce welfare technology. The report focuses on central government activities, i.e., the policies, visions and strategies developed over recent years and the financial and other investments made to support development.
We have identified official government reports that are being prepared or have been published over recent years that have some bearing on the field of health and welfare digitisation. Finally, we have examined the situation in the various Nordic countries with regard to regulation and praxis concerning the privacy of personal data. All Nordic countries are bound by the General Data Protection Regulation (GDPR) and one question of interest is how these countries choose to protect the personal data of their citizens. Do staff in the health and welfare sector always log in to management systems and medical record systems in a secure manner?
Our survey reveals that a great deal of activity is underway in all countries to improve the efficiency and quality of health and welfare services for citizens by digital means. It is also readily apparent that the countries are keen to improve their international ranking. All of the Nordic countries describe themselves as international leaders in innovation and technological development and state that the aim of digital development is to maintain or improve their position in this regard.
Visions and strategies
All Nordic countries have visions and strategies for digitisation and e-health. These were adopted during the period 2015–2017 and their goals lean more towards the development and introduction of welfare technology. As the goals and visions have been subsequently updated, more recent documents have broadened the concept to encompass digitisation in general, including other digital technology that can support health and welfare. These visions contain goals and strategies relating to older adults and other groups in need of society’s support if they are to live independent lives, as well as digitisation goals to benefit society as a whole, such as meeting the growing challenge of recruiting staff to the health and welfare sector.
Most Nordic countries have parallel, often overarching visions and strategies that overlap e-health strategies, such as the broader digitisation of society, industry and the public sector. Recurring themes include investments to roll out broadband and research grants related to various aspects of digitisation, including welfare technology and e-health.
Central government initiatives
In four of the five Nordic countries, the state has taken economic initiatives to accelerate digitisation and the introduction of welfare technology in social services, especially in the care of the elderly. While in terms of national investment, Iceland is the exception, development work is underway in two regions and, not least, the capital city Reykjavik, in the form of initiatives that have received indirect government support through calls for funding. Having invested since 2013, Denmark implemented a welfare technology programme between 2017 and 2020. Since then, no direct funding has been targeted at municipalities. There are however support structures in place at Local Government Denmark (KL), the association of Danish municipalities, where municipalities can obtain information and knowledge about digitising their operations. Having conducted development projects for many years, in 2020 the Finnish Institute for Health and Welfare (THL) launched the KATI programme to introduce and use technology supporting smart ageing and care at home. A development programme underway in Norway since 2014 has been extended until 2024. This is a long-term investment with funding going to government agencies and municipalities. In Sweden, agreements to support the development of digital working methods have been in place since 2013. The most recent investment in digitising elderly care covered the period 2020–2022. This initiative involved funding that municipalities could apply for from the Legal, Financial and Administrative Services Agency and a grant to the Swedish Association of Local Authorities and Regions (SALAR) to build up a competence centre to support municipalities. Funds were also allocated to 10 designated model municipalities for the digitisation of elderly care.
Recent studies and reports
In additional to national strategies and initiatives, a number of studies and reports have been published over recent years.
In Denmark in 2022, KL published a policy for the use of digitisation and technology by municipalities,
Gentænk velfærden – Kommunernes digitaliseringspolitik [Rethinking Welfare: Municipalities’ Digitisation Policies]. The policy contains proposals for how municipalities can rethink and meet the staffing challenges of welfare with digitisation and technology. Among other things, it recommends that municipalities place digitisation on the agenda in all areas of operation. Workflows and welfare services need to be reviewed and decisions reached about which processes can be digitised, so that hands can be freed up for those tasks that require human intervention. Municipalities must also be better at sharing knowledge about proven digital solutions with one another, so that they can be disseminated to more locations. New technologies with great potential for modernising and elevating welfare solutions must be explored and implemented.
In 2020, the Finnish government adopted a programme to maintain the functional capacity and well-being of the older adults living at home. An economically and socially sustainable service system is to be built up that, among other things, deals with the digitisation of care and services for older citizens. The Finnish Ministry of Social Affairs and Health is currently developing a plan to implement the National Programme on Aging. This work is expected to be completed during 2023.
No official reports have been published in Iceland over recent years, nor are any government inquiries underway.
In Norway, the Storting will publish a report during 2023 on the new National Health and Hospital Plan, which will apply from 2024 onwards. This will be partly based on the Hurdal Platform, a declaration of Norway’s current Labour Party and Centre party government’s policy for the mandate period 2021–2025.
In August 2018, the Swedish government appointed a commission of inquiry to review measures and make recommendations that may promote the implementation of welfare technology to increase security and independence and improve the quality of life of older adults, as well as reduce the burden on staff and modernise operations. The commission of inquiry’s official report, Framtidens teknik i omsorgens tjänst [Future Technology in the Service of Care] (SOU 2020:14), was submitted in March 2020. The report contained a number of proposed legislative amendments to make it easier to introduce digital technologies into social services.
In December 2019, the Swedish government appointed the Welfare Commission to identify and analyse specific measures to strengthen the future ability of local authorities to provide high quality welfare services. The commission worked throughout 2020 and 2021 before submitting its final report in December 2021. The report contained a number of proposals to strengthen welfare, including some proposals related to digitisation.
National status for secure identity and permission management within social services
Denmark has a publicly-owned national e-ID for private citizens, NemID. This service provides users with a secure login to internet services offered by public authorities, banks and participating companies.
KOMBIT offers tips on its website on how municipalities should approach data security and cybersecurity when staff work remotely and in digital communications.
The Finnish Act on Electronic Processing of Client Data in Social and Health Care (27.8.2021/784) is intended to ensure that client data generated within social services and healthcare, as well as data that the client generates themselves concerning their wellbeing, are processed in a secure manner. The act is also intended to promote the client’s opportunities to obtain information about how data concerning them is processed. The act contains provisions that supplement and further specify the provisions of the General Data Protection Regulation (EU) 2016/679 (GDPR).
New legislation concerning the digitisation of social services, data security and privacy is being prepared by the Finnish Government and it is planned to introduce a bill in parliament before the 2024 Presidential Election.
The Digital and Population Data Services Agency issues certificates for the electronic identification of social services and healthcare staff in various systems. Medical records and prescriptions are also signed electronically using the certificates.
Finland has a Bank ID system that citizens can use for authentication in banking and other online services. A process is underway to develop a national e-ID.
Iceland has a national e-ID issued by a state-owned company that can be used for digital services throughout society. Users log in to the e-ID using their mobile telephone number and an eight-digit PIN. There is no requirement to change the PIN at regular intervals. Municipalities use the national e-ID to allow staff to access data on individuals. Citizens can also log in to digital meetings etcetera.
All healthcare professionals in Norway have an e-ID with permissions specific to their role. In state hospitals and municipal healthcare, staff require a personal e-ID with two-factor login to access personal health data. The term health data is defined with care. The Directorate of e-Health has issued a standard for information security and privacy in the health and welfare sector.
In Sweden, there is no state-owned e-ID system for secure authentication. Instead, the BankID system is widely used throughout society. In healthcare, staff are required to use two-factor authentication when logging in to the medical records system. There is also a card-based e-ID, the SITHS card, used by healthcare professionals. This is linked to the card holder’s role and permissions within healthcare. While there is no comparable regulation in social services, there is a general consensus that two-factor authentication is a requirement. This has not yet been implemented in all municipalities nor in all systems in which personal data are processed.