Maria Bäcklund-Hassel, Senior Advisor and International Coordinator at the Swedish eHealth Agency, shares Sweden's path to becoming a digital health leader: from insights into the country’s early adoption of e-prescriptions to the challenges of interoperability, the importance of trust, and the growing role of artificial intelligence.
When we step outside the digital health “bubble,” where everything is modern and new, we see healthcare systems still facing significant challenges. From your perspective, what problems remain?
Quite a few. One of Sweden’s both advantages and disadvantages is that we digitalized very early. We have EHR systems throughout healthcare and digitalized social care, but each of our 21 regions developed its own infrastructure. That created fragmentation and interoperability issues. The systems were built to solve immediate clinical problems, not with future data reuse in mind. Now, we have numerous quality registries that duplicate data that should ideally be extracted from EHRs. If we could do it again, we’d definitely think two or three steps ahead.
How did healthcare digitalization in Sweden begin?
From two central angles. As a pharmacist, I often point to e-prescriptions. In the mid-1980s, our state-owned pharmacy introduced them, mainly to avoid deciphering doctors’ handwriting. At the time, only pharmacies had computers, so it didn’t work well until the late ’90s, when digitalization reached healthcare providers. E-prescriptions were a success because the legislation made them easy to validate. That gave regions a clear roadmap. However, for other clinical information, individual clinics procured systems based on workflow needs, without much consideration for future data sharing.
Swedes seem very open to digital services. Why is that?
One key factor was the “Home PC” reform in the mid-1990s. The government and unions subsidized personal computers, encouraging people to learn at home. That coincided with the internet’s rise, making digital literacy mainstream. Today, even people over 85 use the internet weekly. That broad comfort with technology has supported the adoption of digital health services.
Does geography also play a role?
It helps, but it's not the only reason. Even people near major hospitals prefer digital convenience. I live next to Sweden’s largest university hospital, yet I renew prescriptions online – probably talking to a bot. In rural areas, people can consult doctors from library rooms instead of driving for hours. Our broadband strategy also played a major role. Over 95% of Sweden has high-speed internet, even remote mountain cabins.
Estonia’s digitalization was driven by a broken healthcare system. Was that the case in Sweden?
No, our system worked well. But we’ve always had workforce shortages. We don’t have enough people to meet future demands. So we need smarter, more efficient systems – especially in remote areas.
Let’s list the success factors behind Sweden’s digital health journey.
Digital literacy and broadband access. But also collaboration. The 1177 platform – our national phone and web service for health advice – was a joint effort by the regions. It’s now a trusted brand. People know to turn to 1177 when they need help. Beyond that, Swedes are used to digital services in all areas of life.
However, some people still struggle with digital health, especially older generations.
True, but there’s a difference. In Sweden, people don’t have a single “family doctor.” We go to healthcare centers and may see different doctors or nurses each time. So we’re more accustomed to systems, not individuals. And during the pandemic, we already had digital infrastructure in place. We just used it more intensively.
What is the role of the Swedish eHealth Agency?
We were created after the deregulation of the pharmacy market, taking over the prescription infrastructure. Now, we’re tasked with helping to develop a national digital health infrastructure. The current setup, with 21 regional systems, is too fragmented and expensive. Our job is to propose a future-proof national infrastructure, identify reusable components, and start building the core digital building blocks.
What still needs to be done?
We need agreement on standards and specifications. Right now, we can only make recommendations. Interestingly, the regions themselves are asking for someone to make decisions – they want clear rules. Legal frameworks must also align with EU regulations, and we need technical specs for seamless data exchange.
Do Swedish doctors love their computers?
I wouldn’t say they love them, but they see them as essential. EHR systems don’t always meet expectations, but doctors recognize their necessity. There’s also a generational shift: those who started with paper records have adapted over time.
So can AI fix EHR frustrations, as many hope?
That’s the hope, but it’s not simple. Clinicians must be involved in AI development to ensure its usefulness and understand how it works. Structured data is also essential. There’s a lot of hype. Sometimes things are labeled “AI” when they’re not, but it’s exciting. There’s always something new to learn.
How did your journey into digital health begin?
My father was a teacher and a hobby inventor, so we had a home-built computer early on. I’ve always been drawn to chemistry and technology. When I started in pharmacy in the ’90s, computers were coming in, and I was fascinated by how they changed workflows. I also helped older colleagues adapt; it was a real generation gap.
What advice would you give countries starting digital transformation?
Think beyond solving one problem. Make sure data can be validated and reused. Our prescription system, for example, connects to registries for both prescribers and pharmacies, making validation easy and enabling secondary use like research and trend analysis. Also, a unique personal ID helps tie everything together. But trust in data handling is crucial.
Can trust be designed or co-created?
Trust is hard to build and easy to lose. Transparency is key. People should see who accesses their data and be in control of sharing. Organizations need to work daily to earn and maintain that trust.
Is there ever an endpoint to digital transformation?
No, it’s a continuous process. There will always be new technologies. But we need to have the basics – interoperability, good data, and user-centered design – solidly in place. People need to see real benefits. Change is hard, especially when people think the old system worked “just fine.”
On a personal note, what digital tools make your life easier?
I track my steps and monitor my blood pressure due to a past health scare. I use an app approved by my doctor. I’m also exploring AI-powered tools, like those that convert documents to presentations, but I’m waiting for agency guidance before adopting them widely.
Have you come across any recent digital solutions that inspired you?
I’m impressed by AI tools that transcribe doctor-patient conversations directly into EHRs and holographic imaging for surgical planning. However, we must remember that what we see at conferences is often far ahead of clinical reality. Many clinics still struggle with basic systems.
Finally, what will Swedish healthcare look like in five years?
Digitalization must make a real impact, especially with ongoing staff shortages. Clinicians need to help shape the tools they use, and processes may need to change to match new digital capabilities. The next five years will be crucial.
