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Closing keynote by the President of the Republic at “Health in the Digital Society. Digital Society for Health.”

18.10.2017

Ladies and gentlemen, distinguished participants of the concluding session of eHealth conference!

First, I sincerely congratulate you for these three days of wise discussions, inspiring exhibition and fruitful meetings about health in the digital society. It is of utmost importance to understand what digital society can offer to improve well-being of people in Europe and beyond.

Indeed, one may ask, what will change now, after this conference in the life of a 60-year-old lady in Tartu, Southern Estonia or somebody else, let's say, man in Rouen, France? Perhaps what they both expect from life is to enjoy it happily and healthily. As WHO has phrased it in the Preamble to its Constitution 71 years ago – people do expect a physical, mental and social well-being. It is no different in digital society. Human dignity comes before digital.

HEALTH FIRST. THEN DIGITAL TO IMPROVE THE OUTCOME

Countries with robust welfare systems have experienced dramatic improvement in the life expectancy of their citizens – more than 12 years from the times WHO constitution was signed. True, today we cannot attribute the rise to the advances in information and communication technologies (ICT) in the health sector. Rather, the growth of life expectancy is due to the overall advances in medicine and rise of living standards.

However, we have experienced that digital technologies have a potential to improve our lives in almost all domains. We can keep in touch with our loved ones via free video calls, create teams and businesses and even vote in elections via internet as many Estonians did last week. We have also seen services and products – such as choice of next book to read or clothes to buy – tailored better to our individual needs and preferences. We can easily find our way in totally unknown country and predict our arrival time with the accuracy of minutes. We even know where the traffic jams are. We can smoothly communicate with our governments and banks without leaving our home. In principal, we can reach all human wisdom in seconds from our mobile phone.

It is essential to expect that all these modern conveniences and obvious benefits of the ICT are present also in our health systems. I hope that this conference has a real impact and it will improve the well-being of people by digital means as we have already experienced in other spheres of life.

Digital technologies can enhance accessibility. It is especially important for people living in rural areas – they face the heaviest burden to pay a visit to the doctor. Also, those poor or with heavy domestic burden may find it hard or troublesome to displace themselves, a nudge by online doctor might encourage them to make the effort before it will be too late.

EUROPEAN SCOPE AND AMBITION

What can we do? In Europe. Together. Three weeks ago, at the Digital Summit in Tallinn, the Heads of States and Governments of EU Member States agreed we must embrace technology and reap the benefits. At the following Ministerial e-Governance conference on October 6th, the Tallinn Declaration was signed to reinvigorate Europe's efforts to advance Digital Single Market. This step marks a new political commitment at EU level on significant priorities towards ensuring high quality, user-centric digital public services for citizens and seamless cross-border public services for businesses. Our citizens and societies, they need it because they anyway communicate and transact in technological world. It is just the governments who are the missing link nowadays. Governments and with them, unfortunately, also health services.

The scope of the European Digital Single Market strategy contains a direct reference to health: "To fully unlock the data economy, the EU must also harness such assets to maximise the digitisation of the European service sectors, in particular health and care, energy, transport and finance." Now it is time to act for all health sector counterparts. We get too often into debates about the competencies of Member States and the European Commission, when we should instead focus on how to deliver to our citizens in pragmatic collaboration of Member States, the Commission, but also private and non-governmental sector – each within their mandate and capacity.

I am truly proud and happy for the Digital Health Society Declaration that was yesterday opened for signing by all interested parties. I know that more than 100 organisations have contributed to it so far. It gives me hope that we can collaborate in Europe even in complex matters. Because our people want it.

The EU eHealth Action Plan for 2012-2020 defines four action areas for Europe:
• Supporting research, development and innovation;
• Promoting international cooperation;
• Achieving wider interoperability of e-health services;
• Ensuring wider deployment & facilitating uptake.

The Estonian Presidency of the Council of the European Union has suggested that for making advances in all these directions we should agree concretely that the aim in the field of eHealth is to support innovation in healthcare using digital technologies and digital data. Only clear definition of priorities can lead to better prediction, prevention, faster diagnosing and more precise and personalised treatments. This approach supports the triple win goals of European health and digital policies.
1. Increased access and safety in healthcare can be achieved through empowered citizens. The real change comes through people using digital tools to manage their own health and to take an active role in the process of healthcare services provision.
2. Sustainability of health systems will be supported by value-based approach. Digital solutions can contribute to more efficient use of healthcare resources as well as to better targeted, more integrated and safer care.
3. New economic opportunities, jobs and investments will be created using data-driven health care innovation. The combination of large data sets from different data sources will enable the creation of new knowledge to prevent diseases and to improve the treatment methods while also boosting the development and implementation of innovative data-based technological solutions.

I have every reason to believe that in December EU health ministers will adopt in their council conclusions a clear and strong political commitment for action in the domain of eHealth for the support of our citizens and societies across Europe.

Now, as the President of a digital society I can say that we have succeeded to build up in Estonia a society which trusts technology. I would like to share with you some thoughts and lessons learned as society, based on our own experiences. Technology is gadgets, for change the disruption is needed in society. It has nothing to do with gadgets, only people and mindset matter.

TRUST, SECURITY AND PRIVACY

First, security, privacy and trust are of utmost importance.

In health, more so than in any other domain, benefits of the digital society would not be possible if people did not trust in the digital environment. They have to be sure that their data does not get lost, stolen or manipulated.

I can tell you from my experience in Estonia, but also, from what I have learned listening to others all over the globe: digital solutions by itself will not create trust, but they can help to maintain, encourage and broaden that, if governments use it wisely. Trust has to come from transparency and from the government's will to build the trust, to generate the trust. That is why Estonian society has fully come digital and has done this with the support of its government engaging closely with civil and private sectors. This engagement has balanced effectively the freedom and flexibility of the opportunities offered by digital solutions and, especially from the government's side, ensuring privacy and cybersecurity as the pre-requisite for building our e-government and public ICT infrastructure.

More specifically, Estonian government supports our digital society in four elements, every single one of them is equally important:
• we have a legal bases to make transactions in analogue world and in digital world legally equal;
• we have digital identification for safe exchange of information on universal platform;
• we have e-government services using the same universal platform as our businesses are using;
• we have possibility to create private digital services through the same platform as the government does.

Trust does not arise immediately – we need to build it gradually starting from services people perceive less risky and going to high- level services like healthcare. It needs commitment and patience.

Guaranteeing and safeguarding trust is not an easy task. It requires constant investments; it requires time and constant effort and commitment. We know there are risks in technology, we acknowledge them, but there are also always advancements that help us to counteract these risks. Risks are publicly broadcasted, not hidden from the people.

We continue every day to face cyber incidents, I don´t want to hide that at all. We deal every day with cyber criminals. All this experience has simply shown us how to mitigate these risks and threats. We can say that Estonian cybersecurity know-how and arrangements are really battle-tested.

But not only cybersecurity – cyber-hygiene as well. Our people know how to protect themselves. When we globally faced the WannaCry virus, which attacked also medical systems all over the World, there was not a single successful WannaCry attack in Estonia. People who have already lived for almost a generation in digital world have learned cyber-hygiene.

It must be simpler to teach people cyber-hygiene than it was when we tried to teach normal hygiene, like to wash hands and use toilets. Cyber-hygiene comes from experiences, from starting to use digital services gradually. This is a long way to go but it needs to be undertaken to build this trust. We need to tell people honestly that they themselves are responsible for cyber-hygiene.

Good thing is, that In Europe, according to recent Eurobarometer study, 52% of European citizens want access to their health data and 70% are willing to share their data with others (incl. 63% with their doctor). Importantly, 23% are not willing to share their health data. Perhaps they still lack the trust. But as I described before, this is totally natural that people embrace change at different speed. It is the responsibility of the governments and all other stakeholders to work steadily towards delivering to those that are already inpatient of getting the digital solutions to improve their experience with health systems and winning the hearts and minds of the hesitant ones.

According to the OECD, one in ten patients is unnecessarily harmed during health care, and more than 10% of hospital expenditure is spent on correcting preventable harm, at the same time only a minority of countries are using health data to monitor healthcare quality and performance and for clinical decision support.

Therefore, I fully endorse the principle that in health-care the privacy of data does not mean that the data should be secured from being used, but instead the data should be used securely.

Estonia is ready to share our experience in digital trust services – social, technological and legal. A simple but powerful example of how this combination is executed in real life, is the fact that in Estonia every citizen has a complete overview of who has accessed their digital data. The data is in the state servers, but belongs to people. Snooping in the state servers is criminal offense.

THE FUTURE

We know and aspire that digital transformation will change the healthcare: empower citizens, personalize treatment, make health systems more sustainable, and create opportunities for growth from data-driven R&D.

Digital solutions can already support people in managing daily their chronic health conditions. We have digital assistants for blood sugar control without the need to prick your finger for blood multiple times per day. We have digital assistants to support effectively us in controlling our mood, if we have depression. We have solution Cognus developed in Estonia to assist people to restore their cognitive skills and speech disorders after stroke.

It is possible only digitally to equip everyone with instant best medical advice using Artificial Intelligence. In North London National Health Service is already testing out a medical chat-bot as a non-emergency helpline.

In this context, it is important to enable people to better understand and manage their own health with easier access to information and digital tools.

According to the 2014 Eurobarometer study, six out of ten Europeans go online when looking for health information (almost eight out of ten of 15-39 year-olds have done so, compared with less than a third of people aged 55 and over) and 90% of those said that the Internet helped them to improve their knowledge about health-related topics.

The EU General Data Protection Regulation (GDPR), which will become applicable as of May 2018, provides the legal basis for the free movement of personal data, the right to access and the right to portability of personal data. Allowing people to have control over the use of their data and providing transparency about its use, is instrumental for public trust in e-services.

We do have already first success stories from European cross-border collaboration. Next spring some fellow Europeans can expect that their digital prescription will be valid for purchasing their drug in another EU Members State; be it because of an emergency or because they are on a longer holiday or work assignment abroad.

We can already build virtual medical knowledge and treatment teams across borders: European Reference Network for Rare Diseases facilitates best possible diagnostic and treatment options in respective centres of excellence for all citizens in Europe. The patients have the guarantee, that if they want, their health data from their previous doctor is available for use there quickly and accurately.

Last but not least, the future is brighter for everyone, if we make use of the vast amount of data generated every day in health sector to contribute to the outcome based organisation and financing of health and care services by allowing monitoring of healthcare quality, providing more transparency and enabling evidence based policy and decision-making.

Big data applications in research and innovation in health care will enable better prevention, diagnoses and treatment. It can also enable the early detection of infectious outbreaks and accelerate development of medicines and medical devices, and stimulate innovative healthcare solutions such as telemedicine and mobile health application.

Health systems are also potential new economic growth engines – through business opportunities, jobs and investments created by data-driven healthcare innovation. This is good for the people, both sick and healthy.

However, we need to acknowledge the new uncertainties we must face with implementation of digital solutions. For example, could we use artificial intelligence for optimising the use of limited public resources and let the machines decide the entitlement for services? Or, should AI first and foremost be the tool for doctors to optimise their treatment decisions and be financially rewarded for that?

How can we accommodate robots and artificial intelligence into the sector, which is primarily about human touch and feelings?

Yes, it is probably more efficient. Yes, some people will accept it more willingly, but in order to make it a part of mainstream, we need wise and longstanding effort to get ourselves used to it as well as to learn what these new miracles will not solve for us.

CONLUSION – COMMITMENT TO ACTION

To conclude I would like to answer the questions "Why Europe?" "Why now?"

I gave you some examples previously, but they are not yet available as the mainstream solutions. We have barriers on the borders, so that people travel more freely than their data. Last, but not least – European public finances cannot be effectively managed, if we do not modernise our health systems using data and analysing it.

Doctors across Europe should start prescribing trustworthy and effective apps and European citizens should be able to benefit from solutions from all European companies – this is the nature of the Digital Single Market of the European Union put to work for its people.

All European citizens should have user-friendly digital access to their health data and own ability to facilitate the use of this data by other players that can offer better services by using this data. For example, we can assist to make AI tools cleverer and sharper. The data will always belong to a human being but people should learn that safe donation of data is as valuable as donation of organs.

I am thankful to all the people that have made this conference a success: the organisers, the presenters and moderators by filling the content, the companies by showing what is possible, but most of all – the participants by being active. You have proven that the topic of digitisation of health systems in Europe is possible, especially considering how much our people are using the internet to research their own health anyway.

The Digital Health Society Declaration encourages us to act, these three days you worked through how to act.

I wish you healthy and safe journey back home. I hope you had a nice stay in Tallinn.