There is one word which I have almost never seen mentioned when someone speaks about healthcare reform: imagination. In 2022, the Finnish healthcare system will undergo the most massive changes in it history. Huge changes in digital services will be made. Yet very few people seem to think about innovative things that could be done.
I can understand this. I myself believe risk management is the number one issue for the first elected council. The reorganization is a success if salaries are paid and no one is killed or injured by the changes. Anything more is a bonus.
And yet.
Pessimism and brutal realism may be deep in my DNA, but so is innovation. I am co-inventor in more than thirty patents, and from that perspective I can say that this reform could give us an opportunity to do things very differently than before. The services are now centralized enough that there is enough money to do real innovations. In particular, we could try to do things no one has really even thought about doing until now.
Digitalization and non-native speakers
We could do particularly unique things for our non-native speakers (those who do not speak Finnish or Swedish). According to the Statistics Authority, in 2020 there about 38,000 non-native speakers in Finland Proper, or 8% of the population. To compare: there are 27,000 Swedish speakers. Over 100 languages are spoken in our county. There are ten language communities with over a thousand speakers (Russian, Estonian, Kurdish, Albanian, Somali, English, Persian, Ukrainian and Romanian) while more than half the communities have less than 40 speakers.
When the communities are this fragmented, there is no real way to offer services in these languages with existing processes. Even the Swedish-speaking community is struggling to maintain its services.
However, if we don’t need to stick with existing technologies, suddenly things look very different. A good local example of a new technology is the Åbot corona virus chatbot at the City of Turku. It uses artificial intelligence to offer corona advice in most of the languages spoken in Turku. (I helped launch the Åbot system while working at the City of Turku in 2019-2020, but I was really just a bureaucrat and technical documenter).
The key strength of Åbot is that the underlying information is written only once, in Finnish. The artificial intelligence then handles automatic translations into one hundred other languages. In a fast-moving scenario like the coronavirus pandemic, the city could be quickly overwhelmed if everything had to be translated manually. The Åbot translations can be quite clumsy at times, but in general they are good enough for the purpose they serve.
Åbot is far better than this Google “translation”
Åbot is quite tightly focused on just one application, and it does not replace any health professionals. However, it is a good example of where we are now, and where we could be in 5-10 years, if we want to be. Even in the 2030’s, we simply will not have enough non-native nurses and doctors to offer high-quality health services in Kurdish, or Arabic, or Russian. However, we could easily have a system that produces clumsy but sufficiently good translations in all these languages at the push of a button.
Digitalization and the elderly
Likewise, elderly care should already be planned with digitalization and remote services in mind. Remote services are now thought about almost in the horror movie genre; there is fear that the elderly will be neglected and left alone to cope with digital services that they cannot operate.
This is actually a relevant fear, if we try to stick with services whose usability is as terrible as it is today. For example, digital authentication is currently a nightmare, if one is not reasonably comfortable with technology. I myself did not learn to use mobile authentication until early 2021, having used paper-based authentication until then.
We should not accept this fact quietly; instead, we should fight this fact actively. It is unbelievable that no one is really trying to make these services easily usable to ordinary people. User interface design is not a black magic art, but it does require a great deal of expertise, time, work, and money.
This is not a good user interface (Source).
At the moment, it seems that private companies don’t see enough commercial potential to design ultra-usable applications. The public sector does not know to design them (and has no money). It may very well be impossible to make a user interface that 100% of the elderly can use. But if even 99% can use it, the rest can be given personalized services. An injection of public research and development money is urgently needed.
Digitalization and the timeframe
I wish to remain firmly pessimistic at heart, and thus will not claim that digital solutions will give magical answers to all our problems. In the current reforms, there a digital basics that need to be solved before digital innovations can be even considered. Most of the resources in the next few years need to be put into making the boring basic IT systems compatible and functional.
Not all of the resources, however. A few percent should be invested into innovative experiments. Our elderly population is increasing rapidly while our younger population is decreasing even more rapidly; our health-care system will run into a wall soon. The crash will be much less painful if we manage to do things differently and digitally.
I have a PhD in physics, work professionally with data, and am a Green candidate (number 172) in the 2022 county elections for Finland proper. You can find out more about my thoughts here (in Finnish) or here (in English).
