Finnish healthcare provider is stemming the spread of COVID-19 with data and cloud technology

“Without the system we have put in place, I believe COVID-19 would be much more widespread in Finland,” says Aki Puustjärvi, IT Development Manager at HUS. 

Puustjärvi has every right to feel proud of what he and his team have achieved this year. At a time when countries across the world have found themselves battling the spread of the virus, Finland has set a global standard for how to best protect its citizens’ health while also preserving their privacy rights.

The test, track, and trace system developed by the Finnish government has been arranged in a specific way for southern Finland. HUS IT uses a range of different Microsoft technologies to provide Finnish citizens in the region with an end-to-end healthcare support system that is not only saving lives but is also helping the government to make critical policy decisions, like how to prevent the spread of the virus and protect the economy. It is an extraordinary achievement.

“We wouldn’t have been able to react so quickly to stem the spread without this system,” says Puustjärvi.

The speed of response has defined HUS’s work this year and is a result of the healthcare provider’s longstanding commitment to the digitization of its services. HUS puts data at the heart of its operations—a policy which far predates the outbreak of COVID-19.

“The data lake we established a few years back, which is built on Microsoft Azure, gave us a great foundation so we weren’t starting from zero. That opened a lot of possibilities for what we could achieve this year,” says Puustjärvi.

Building a hospital on a foundation of data and innovation

HUS is the country’s second largest employer, with about 27,000 employees working across 23 hospitals in Finland’s most populous region, Uusimaa, which is home to approximately 30 percent of all Finnish citizens. 

“The central organization is pretty unified,” says Puustjärvi. “There is definitely a HUS way of working and a HUS spirit.”

A major part of that unity comes from the role that technology plays in HUS’s operations. “One of the things that I like about HUS is that we are forward looking. We embrace technology, we are not afraid of it. We don’t cling to the past,” says Puustjärvi. 

“That’s what makes it interesting to work here, especially within the realm of data administration, which has played such a pivotal role in driving the evolution of the organization.”

Two key aspects of that evolution have been the establishment of the hospital’s data lake and the creation of a Health Village—an ambitious digital, twin project that has involved all aspects of the organization.

It is that foundation that allowed the hospital to move so quickly this year when faced with the challenge of controlling the spread of COVID-19.

Harnessing the benefits of a preexisting data footprint

“It was really weird when the pandemic first hit Finland,” recalls Puustjärvi. “I remember one of our doctors describing how there were actually more doctors than patients in wards at the start, because people were scared to come to the hospitals for fear of getting COVID-19 at the hospitals themselves. So, everything went backwards.”

The team at HUS moved quickly to begin the process of tracking across the municipalities in Uusimaa. But it soon realized the problem with the system they had in place. “Everybody had their own Excel sheets and their own parameters for tracking the spread,” says Puustjärvi.

What the hospital needed was a centralized database. “It was then that we realized we were already getting all of the test results. They were going to the data lake we established years earlier,” says Puustjärvi. 

“It was a pretty short leap from there to establishing our own centralized database because we didn’t have to build anything new. So, we started by creating a simple interface in Power BI to display the data we already had, which would let us visualize the test results we were getting.”

The team at HUS then moved to standardize the call center testing and assessment criteria, which was critical early in the outbreak when there were capacity limitations on testing.

“We created a guiding system for the call center professionals receiving calls from the public, so that they would all have a unified set of questions,” says Puustjärvi. “That helped to prioritize those most in need in a fair, transparent, and equitable way.”

But it soon became clear that more needed to be done to reduce the burden of the many thousands of calls and drop-in visits the hospital network was enduring. They needed a self-service testing model that all Finnish citizens could access.  

Creating a self-service system that protects citizens’ privacy

“We used a health bot based on Microsoft Azure Bot Services to create the self-assessment for citizens,” says Puustjärvi.

It allows a person who suspects they may have COVID-19 to do a symptom self-assessment. If the person self-tests positive, their details are then logged using the Finnish authentication service or a bank ID or driver's license. Once the person is identified, the system facilitates booking a test in the local vicinity. The test takes 5 minutes to complete and results are received back within 24 hours.

“I read about a Finnish rock star who used the bot,” says Puustjärvi. “The bot suggested a testing space that was 10 minutes from his house. He couldn’t make it in time, so he chose another testing station 15 minutes away. So, the whole process is very quick.”

“And it’s all done while protecting the privacy and security of the individual,” he adds. “Because Finnish legislation doesn't allow data to be shared across municipalities. So, it’s only the domicile municipality that receives and is allowed to see the data on the tested individual.” 

HUS can then control who, within the healthcare system, has access to this data. “Because we have this centralized data system, it is easy for us to restrict who has access to what data, so everybody gets access to the data that they need, but not to the data that they don't,” Puustjärvi says.

“There are crews of people assigned to each municipality who monitor the situation only within that geographical area. Whenever there is a new person who tests positive, that person is contacted, by phone, by a member of their municipality’s monitoring crew who already has the patient’s contact information from the identification process. The caller suggests that the person isolate and then starts tracking the people that may have been exposed, accumulating and categorizing data for research purposes so that we can understand where and how the contagion spreads.”

“From there, the entitled agency enters the data of anyone who might have been exposed too,” Puustjärvi continues. “And as soon as they know which municipality that person is from, it automatically then appears on the list of exposed persons.”

Providing service with the power of Azure

The extraordinary service developed by the team at HUS has greatly contributed to Finland's management of the infection. And the key has been the speed at which data is collected, transmitted, analyzed, and shared.

“The core services are all based on Microsoft Cloud for Healthcare,” says Puustjärvi. “We are using our Azure Data Lake Storage, Power BI for data visualization, the health bot for citizens' self-assessment and data collection, Azure Active Directory for identity and access management, and a web app on top of that.”

“The key is having all these services as part of Microsoft Cloud for Healthcare, and therefore natively interoperating,” he adds. “So, we can think of them as different tools from a magic toolbox.”

HUS is also using Microsoft Cloud for Healthcare in its twin project, Health Village. “Of course, we also have the blueprints we created for Health Village. A lot of the technical components, like authentication, authorization, and audit logging, didn't have to be built because we could utilize what we had already done. It all contributed to us being as quick as we have been,” Puustjärvi says.

The hospital has not operated in isolation but has used the expertise of key partners TietoEvry and Innofactor, both part of the Microsoft Partner Network. In keeping with HUS’s collective work ethic, TietoEvry and Innofactor have operated in collaborative and transparent teams. 

“We have mixed teams with members of all companies and organizations involved,” explains Puustjärvi. “So, when we have a new development, we put together teams that are the best for that specific development. There is no rivalry or competition because we are all working for the same purpose—to stop the spread and save lives.”

Services fit for the future of epidemiology

“In terms of suppressing the spread of COVID-19, time is of the essence,” says Puustjärvi. “So, I want to finish with an example of just how fast the system is.”

“There was a recent case of someone in the system who had been diagnosed with COVID-19. In checking the case, I happened to see that after that patient was notified of testing positive, within four hours, 40 other people who might have been exposed as a result had been tracked down and contacted. And whoever needed to be put in quarantine, had already been quarantined.”

“We are providing a service that is quick and comprehensive and it is benefiting both our citizens and the government,” Puustjärvi states.

As Puustjärvi is quick to point out, the data being collected is not just used to test, track, and trace in a responsive way. It is also being used by researchers and the government to better understand the complexities of how, where, and when the virus is spread. And the learnings from the process may result in benefits for healthcare beyond COVID-19.

“Our epidemiological unit has been really enthusiastic about this project,” says Puustjärvi. “And we're already building features that will allow us to cover different viruses in the future. So, hopefully the work we are doing now will have a lasting impact and be the foundation for a more comprehensive bio-surveillance platform in the future.”

Photography: Matti Snellman, HUS