Robots, rain and Edvard Munch.

Stop 2: Oslo, Norway.

I’ll get this out of the way first up. For someone who used to fly regularly for work and considers themselves an intrepid international traveller, the jet lag has well and truly chewed me up and spat me out! I am tired.

Nevertheless, I made it to Oslo, Norway from the US. I love the little details and differences when you arrive in a new country for the first time – the pleasant immigration officer at the airport was genuinely fascinated as to why I was here, stamping my passport and wishing me well. The swish Flytoget train whizzed me from the airport, through green fields and into the city centre at 220km/hr (in a zippy 17 minutes, no less).

This unbelievably comfy train ride had free on-board wifi, a plug for charging your device, and perhaps the most up-beat driver announcement: “We’re grateful welcome you to Oslo, have a wonderful stay and enjoy your time here!”

Transport for NSW take note.

With a foggy head, but feeling optimistic from the seamless airport transfer, I met with Nard Schreurs, CEO of EHiN / E-Helse i Norge (“EHealth in Norway”). Originally hailing from the Netherlands, Nard emigrated to Oslo 30 years ago and has been deep in the digital health space for at least 20 of those. EHiN was born out of a need to connect the digital health dots and get the right people – in government, industry, healthcare and tech – talking to each other. They also host a yearly conference bringing those stakeholders together and providing a forum for sharing new ideas, evidence translation and best practice.

We took the lift to the top floor of The Grand Hotel Oslo for a chat and introduction to digital health in Norway. For the trivia buffs out there, the Grand Hotel is where the winner of the Nobel Peace Prize resides each year and receives their ovations on the balcony facing the Norwegian Parliament and Karl Johans gate.

The likes of President Obama, Malala Yousafzai and Nelson Mandela have all stood in this spot to wave to the people.

Looking down on the Norwegian Parliament building from the rooftop, Nard explained that Norway’s advancement towards a digital society has been a long road. However a key turning point was a decade ago with the Governments’ declaration for “one citizen, one record”. An ambitious policy decision imagining one single source of truth for all patient information and welfare services. Beside the technical wizardry required to make this happen, I asked Nard whether there were any social or cultural factors that had contributed to the acceleration of healthcare’s digitisation in Norway. He answered simply: “trust”.

And so it was trust which became a key theme over the next week of interviews, meetings and discussion. Multiple stakeholders put forward the argument that Norwegian’s trust in government to use their healthcare information for delivering streamlined health and social services was indeed the “secret sauce”. The OECD reports that Norway has one of the world’s highest levels of trust in public institutions at 77%. The robustness of their welfare system and service user demand for better integration of social and healthcare services seemed to be crucial components for making widespread information exchange a reality.

The following day was the first of my formal meetings in Oslo. I had the pleasure of catching up with Karen Dolva, CEO of No Isolation. Established in 2015, No Isolation has a goal of reducing social isolation and loneliness by developing warm technology. For example, AV1 (pictured below) is a telepresence robot placed in the classroom to support children who have extended periods away from the school due to chronic illness, developmental or mental health conditions.

AV1 provides a window to the classroom from home or hospital via live-streamed video functionality. It can move, interact and express emotions while keeping the student connected and engaged to their teachers and classmates. Karen spoke at length about the importance of privacy and data security, particularly when applying this tech in classroom settings with children. Truly innovative technology!

And then came the rain. Proper cats and dogs stuff with flooding across parts of Norway.

It was the weekend, so Nard played tour guide and we took shelter in the Nasjonalmuseet (National Museum) to view the Edvard Munch collection, including the famous Scream (below) and an impressive (but fake) Mona Lisa. I thought it was interesting that much of Munch’s work depicts sickness, human fragility and despair which in many ways thematically reflected the topics and conversations I was having with stakeholders on the trip so far.

On Monday, I was invited to meet with the Norwegian e-Health Directorate, spending time with Medical Director and CCIO Dr Jacob Holter Grundt and Special Adviser Jon-Torgeir Lunke. The team gave me great insights into the structure and purpose of the Directorate, and how they are delivering on the new National e-Health Strategy 2023-2030.

Most impressive was the Helsenorge patient portal, similar to Australia’s MyGov and My Health Record platforms. Norway has managed to seamlessly integrate a number of healthcare and social services into a central record, which includes everything from patient notes, an appointment booking engine, eScript requests and renewals, a healthcare provider directory, patient transport ordering and viewing test results. Helsenorge also has in-built clinically validated digital mental health tools for adults and children. These text, telephone and CBT-based services target anxiety, depression, ADHD and eating disorders and are free for all Norwegians to enrol in and use.

The integration of these two concepts into one place got me thinking about how similar models could be applied in Australia – a digital one-stop-shop for wholistic healthcare and wellbeing.

The following day saw two further interviews: a great discussion with my Norwegian nursing counterparts at the Norwegian Nurses Organisation (NNO) and with the Norwegian Centre for e-Health Research.

At the NNO, members from both digital and mental health nursing speciality groups dialled in from around Norway for a chat. We discussed workforce issues such as advanced practice capabilities for nurses and strategies to improve digital literacy among clinicians. The NNO team highlighted several innovative digital interventions, like a substance misuse app which can be used by members of the public if someone is found to have overdosed.

Being a nurse myself, it was so great to be warmly welcomed and connect in with clinicians from my own discipline on the other side of the world!

In the afternoon, Dr Monika Knudsen Gullslett, Professor in Mental Health and Digitalisation joined me virtually from the Norwegian Centre for e-Health Research in Tromsø to explain several digital mental health research projects led by her team. A key takeaway from our discussion was harnessing the power of virtual care (telehealth) to support remote and isolated populations and the importance of consumer-led evaluation of service delivery. There are some geographical parallels between Norway and Australia and it was exciting to see how long-standing virtual care models and welfare technology have been leveraged to provide high-quality services to patients in remote areas of the country.

I finished my time in Oslo with Nard and his wife. A home-cooked meal, final thoughts, reflections and goodbyes ending a wonderful week with so much to ponder and think about. A massive thank you to Nard for connecting me in with his network and taking me under his wing. Takk!

Next stop: Copenhagen, Denmark!