Power to the patients

It’s one week now and you just can’t get rid of this cough. You feel you should go and see the doctor. But then again…

You know what to expect: first, it will take some time before you get through on the telephone to make an appointment. Then you will sit some more time in the waiting room. And when you eventually see the doctor, he will give you some standard medicine and maybe suggest some tests to make sure it’s not a serious infection. The results from the laboratory will be there the next day and you will try to get the doctor on the line to hear about it. But it’s difficult, the doctor is very busy.

Have you ever been through that? Or do you maybe live in Oulu in northern Finland? Because, in Oulu many of the steps mentioned above can easily be done from home, using the city’s digital self-care services.

Digital pioneers

More than ten years ago, in 2008, Oulu launched a first pilot for digital healthcare: the Kaakkuri Technology Health Centre, with five doctors and five nurses, responsible for 10,000 citizens.

Online banking was one of the examples the team had in mind when it started to test how new technologies could make health services more efficient, both to reduce costs and to allow for better care.

The Kaakkuri Centre introduced an individual digital health card where citizens can upload and store measurement results like blood pressure or pictures for diagnosis. Online information, quality-assured and more reliable than the common “Dr Google” approach, was made available to check symptoms. A secure messaging for the communication with doctors was set up. And patients got direct access to their lab results.

The key is to empower patients to take care of their own health
— Eila Erkkilä, Oulu Welfare Services

“In the beginning, most of the doctors were against showing lab results to patients,” says Eila Erkkilä, one of the doctors in the Kaakkuri Centre. “You know how professionals are: ‘We know better!’ But the world has changed.”

For Eila, today Deputy Chief Physician at Oulu Welfare Services, “the key is to empower patients to take care of their own health.”

Today, citizens in Oulu can do a lot themselves and get help online when they feel sick, using “Omahoito” (Finnish for “self-care”). Based on the symptoms, the service provides recommendations like self-care advice and offers a direct contact with a chat nurse.

Minna Kiljo is one of the nurses specialised in digital care and symptom assessment. She is constantly checking the information coming in online, assesses the necessary treatment and contacts the patient to give self-directed counselling or, if necessary, book an appointment with the doctor.

Consult a chat nurse online

“The symptom assessment service does not replace other services, but works alongside them and eliminates duplication of work,” says Minna. “Customers can evaluate their situation wherever and whenever they want and get a quick recommendation. It is not always necessary to visit the reception.” In addition, chat nursing is effective because the nurse can take care of several patients at the same time.

Airway inflammation, low back pain or urinary tract infections have proven to be typical problems that can be solved through online consultation.

While unnecessary visits to the clinic are reduced, this leads to faster availability of help for those who really need it. And patients give positive feedback on the digital support, reports Minna. “Customers say they get exactly the service they need.”

Chat nurses like Minna Kiljo have been introduced in 2017. About half of the nurses in Oulu volunteered to become “digi nurses” and received special training. Their remote care works especially well when the patient is already known, while a first contact is often done better over the phone.

After the success of the Kaakkuri Centre, five more healthcare centres have been established in Oulu. 2011, electronic social services were introduced and the technology was expanded to all health centres in the city. Today, more than 100,000 of the 200,000 residents of Oulu use the digital healthcare services at least once a year.

Besides saving time, people are really interested in the details of their health, says Eila Erkkilä. “They want to have their data.” The desire for full transparency and access outweighs potential security concerns, says Eila: everything should be available online. “This is a cultural shift and the pressure comes from the citizens – they want it all.”

A new relation between doctors and patients

The growing self-awareness and competence of people regarding their health also changes the relation between doctors and patients. Eila, who had been a doctor for more than twenty years when she started the digital pilot at the Kaakkuri Centre, has been herself “surprised by the capability of citizens to deal with their own health.”

After doctors long enjoyed a status as demi-gods, many of her colleagues might not automatically embrace the idea of giving away control and empowering patients, knows Eila Erkkilä. “My message: do not ask the professionals. Ask the citizens. Ask the patients.”

The digital healthcare in Oulu was from the beginning developed together with citizens and is still building on constant feedback from the users.

Do not ask the professionals. Ask the patients
— Eila Erkkilä, Oulu Welfare Services

Even in Finland, one of the most digital countries in the world, Oulu was an early mover, says Eila Erkkilä. At the start of the pilot in 2008, no patient data was available at national level, so people moving from Oulu to Helsinki would lose all their data. The national Patient Data Repository came five years later, in 2013.

Today, Finland is regarded as an international frontrunner in health technology. The national digital health services, Kanta, are among the most valued online brands in Finland, along with the national tv and the Finnish Meteorological Institute. According to a survey, the kanta.fi site “is used at least occasionally by more than half (54%) of Finnish people who go online on a weekly basis.”

Creative digital climate after Nokia’s fall

Oulu is proud of having been a pioneer of this development. And the journey continues. The Welfare Services in Oulu are collaborating with the university to implement the use of information systems in healthcare in the curriculum. And Oulu Health Labs are developing and testing innovative technologies.

The city benefits from a high digital competence. When the collapse of the Finnish mobile phone giant Nokia after 2010 led to the loss of thousands of jobs in Oulu, a number of former Nokia engineers studied medicine and have now a double qualification.

Eila Erkkilä herself has studied one year of information technology before becoming a doctor. She expects that the creative climate of Oulu will give rise to further innovations in healthcare.

“We are already using chatbots and medication robots and are currently trying a test version of a rehabilitation robot from Japan,” says Eila. “I think, in the future people will have more technical medical devices at home, as soon as these devices are affordable, easy to use and can be integrated in the system.”

So, when this cough hits you again, you might consider moving to Oulu.