Rethinking healthcare for multimorbid patients

By addressing coordination challenges, we can create more connected, efficient, and patient-centred care solutions.

During the Nordic Hackathon, the fictional person Arne was in the focus – an 82-year-old patient with multiple illnesses and complex healthcare needs. By bringing together experts and innovators from healthcare, social care and technology, the participants worked to develop applications that can improve coordination and information flow within and across care providers. The results from the Hackathon show how open standards and modern technology can create a more cohesive and patient-centred care. 

Coordinated care of patients with multimorbidity faces significant challenges. The fictional Arne suffers from several chronic diseases, including stroke, diabetes, angina, emphysema, high blood pressure, leg ulcers, and advanced prostate cancer. These conditions require comprehensive and coordinated care from various actors, a typical situation of a growing population of elderly patients with complex needs.

According to the National Board of Health and Welfare in Sweden, multimorbid patients are defined as individuals aged 75 or older who have been hospitalized three or more times within inpatient care over the past 12 months, with three or more diagnoses. As the 75+ age group (and especially those aged 80 and above) is expected to grow significantly in the coming years, it is reasonable to assume that the number of people meeting this complex definition will also increase.

Arne's care is complex and involves many caregivers and services. He is helped by municipal care for daily activities such as showering, cleaning, cooking and transport to hospital visits. In a typical week, he is visited by several different healthcare providers, including nurses, physiotherapists, and doctors, which can lead to up to 10 visits per day. This fragmentation of care creates an unmanageable situation where information and responsibilities need to be clear, to minimize the risk of mistakes and inefficiency.

Nordic Hackathon for Arne

The Nordic Hackathon was organized by Stockholm University and Karolinska Institute, with support from Health Data Sweden. The Hackathon brought together about 80 participants from about 15 different companies during 2,5 days in March and several experts to jointly solve complex challenges in health and social care, especially for patients with multiple illnesses like Arne.

Health Data Sweden (HDS) is a European Digital Innovation Hub (EDIH) that works to improve access to and use of health and medical care data in Sweden. As part of this national network, HDS focuses on supporting digital innovations in healthcare, with a particular emphasis on interoperability, data governance and AI solutions.

The participants in the Hackathon consisted mainly of representatives from companies, healthcare regions, universities and authorities, creating a forum for collaboration and knowledge exchange between different actors in the health and social care sector.

Modern open platforms unlock the full potential of patient data

The Hackathon showcased how modern open platforms offer flexibility for customization and adaptation to unique operational needs and, equally importantly, as needs change over time. They empower healthcare and social care professionals, enhance patient experiences, and support the diverse requirements of different care providers.

Tietoevry Care and other actors demonstrated the possibilities of new open platforms, such as Lifecare Open Platform. Built on openEHR and HL7 FHIR standards, the software integrates seamlessly with existing systems, ensuring all patient information is easily accessible. By aggregating and organizing patient data from multiple sources - including electronic health records, laboratory systems, and patient-reported data - into an intuitive and cohesive interface.

More than just an adaptable solution, Lifecare Open Platform is a catalyst for innovation which was demonstrated fully during the Hackathon. With integrated low-code development tools, and built in software development kits, the participants showcased how health and care providers can customize workflows quickly, integrate new tools, and implement new ideas at low cost - fostering continuous improvement without costly system overhauls.

Connected care is here to stay

Lifecare Open Platform distinguishes itself by integrating not only traditional healthcare data but also social care information from municipal services, offering a more holistic view of an individual's well-being.

By connecting health and social care data, Lifecare Open Platform enables a more holistic approach to patient and citizen care. Healthcare providers, for instance, can access patients’ health records alongside details about home assistance, rehabilitation services, or social support programs they are utilizing. This reduces fragmentation, improves coordination between different care providers, and ensures better decision-making.

A connected care ecosystem helps municipalities and healthcare organizations avoid isolated data silos. Instead of maintaining separate, disconnected systems, Lifecare Open Platform provides a shared, structured openEHR data model for data persistence and HL7 FHIR messages for data exchange. This facilitates real-time updates, minimizes duplication, and ensures that all relevant stakeholders have access to the right data at the right time.

Collaborative application development

During the Hackathon, several companies collaborated to create and test applications aimed at supporting Arne and other patients with multimorbidity. These applications were developed on top of open platforms such as Lifecare Open Platform. The Lifecare Open Platform provides low-code tools to simplify and speed up creating new forms, widgets and simple applications.

Clinical professionals, patient representatives and software developers were working together as agile, collaborative teams. It was great to see how quickly clinical input was considered in the user interface design.

Leveraging the Lifecare Open Platform as a foundation, the participating companies developed a range of innovative solutions. These applications were seamlessly integrated through the Care Desktop, the platform’s unified interface for data visualization and entry. The Lifecare Open Platform enabled doctors, nurses and social care workers to access relevant, real-time information, regardless of the original data source, enhancing decision-making and improving patient care.

Although the Hackathon itself ran for just 2.5 days in mid-March, preparations began several months earlier which were crucial to its success. All Hackathon teams received user accounts for the Lifecare Open Platform following two training sessions, along with a step-by-step user guide on how to progress from an idea to accessing and utilizing data within the Care Desktop.

Tietoevry also provided on-site support throughout the event. To encourage collaboration, vendors working towards the same objective were grouped into teams, fostering a more focused and efficient development process. The Lifecare Open Platform enabled support for developers working with openEHR and HL7 FHIR, ensuring flexibility and interoperability across both open standards.

Coordinated care is a win-win for everyone

As a result of the Hackathon innovative applications were developed including a self-reporting tool for physiological measurements, a PROM-related application, a visualization tool for medication dispenser data, a social care journal interface, and a prostate cancer data view —showcasing the potential of the platform to support diverse use cases.

These applications enable doctors, nurses and social care professionals to work more efficiently and coordinate their efforts more effectively, ultimately leading to improved care for patients like Arne.

Patients will experience a more transparent and structured care process, empowering them to actively follow their treatments and receive meaningful support in managing their own health.

“It was a great event focused on fostering collaboration between various application and platform vendors in the health and social care industry. The emphasis on an open ecosystem allowed for some truly groundbreaking ideas and innovations to come together. What truly stood out for me was the incredible team spirit. The shared energy and passion for problem-solving created a space for numerous ‘aha moments’ that will stay for a long time”, summarises Jaakko Sammelvuo, Portfolio Lead, Lifecare Open Platform.

The hackathon showed that it is entirely possible to create a coordinated and standardized communication about health and social care for patients with multiple illnesses. Modern platforms such as Lifecare Open Platform increase interoperability and ensure that the right data is in the right place, in the right context for the right staff at the right time.

Different healthcare providers can then collaborate more effectively and ensure that patients like Arne receive the care they need, regardless of where they are, or which organisation is responsible for the interventions. This is an important step towards a more patient-centred and efficient care in the future.

Participants from Tietoevry Care: Jaakko Sammelvuo, Anette Larsson, Aman Jha, Sara Klingefur, Carina Wiman, Lukas Lindeberg, Helena Vramming, Sahcin Sonawane. Monica Winge from HDS is also in the picture.

Find out more about Lifecare Open platform

Book tip!

Read about Mr. Arne’s Journey through the Healthcare Ecosystem (in Swedish) – a timely and thought-provoking book about how fragmented healthcare and social care affect the individual, and how digitalization and collaboration can create more integrated and person-centered care. Through the story of Mr. Arne, theory is put into practice, making the book a valuable resource for anyone working with organizational development, information systems, or management in healthcare and social care.

The book is written by Health Data Sweden.