Piret Hirv, Health Technology Division manager

at Tallinn Science Park Tehnopol, discusses the match-making role that the Estonian Connected Health Cluster provides between companies and investors and sees as a priority a less Tallinn-centered approach as a way to attract an even more diverse range of organizations.

Can you give our international readers a brief introduction of your background and tell them about the mandate, the functions and the scope of the Estonian Connected Health Cluster?

I took office in January. Prior to this, I worked in the Ministry of Social Affairs as an advisor of innovation and e-services and the chief operating officer behind the successful Estonian EU presidency program and the Tallinn Digital Health Conference. In addition to this, last year I graduated from the Tallinn University of Technology where I specialized in health technology. Currently, I work full-time for the Tallinn Science Park Tehnopol of which Connected Health is a business unit. The goal is not only to link healthcare developers – our members are universities and healthcare service providers, a few big hospitals and at policy level we have the Minister of Social Affairs as well as our health insurance fund. While we have very diverse members, I believe we are lacking a big piece of the jigsaw: the consumers. At the moment, we do not have active participation on behalf of citizens or patient associations for instance. It is in our to-do list to engage users of the services as it is also important to have them on board as a relevant part of a functioning ecosystem.

When was the cluster set up and how is it structured?

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It was founded in 2016. We are part of the Science Park Tehnopol and we currently count about 70 organizations among our members. All our companies, when they sign the membership contract with us, automatically agree to be part of the Science Park Tehnopol, too. It offers them incubator facilities, common space and everything else they might need in terms of business development. We have many services. Up until now, we are being financed by Enterprise Estonia together with membership fees and selling services (unlike Tehnopol which is not) which is supporting us in a big variety of activities. We see companies joining and leaving, depending on their needs.

After the initial three years financing, we are now starting the process of reshaping the Cluster. We are attempting to look at what are the strong and the weak points of the organization and what is the best way to move forward. Our membership may be very diverse, but all our companies share the same interest: a business-friendly environment. To a certain extent, we are fulfilling the role of a classic trade association and our aim is to strengthen this role of public affairs/lobbying both at national and EU level.

You cover different stakeholders, such as government, academia, healthcare providers, start-ups and big pharma. An important aspect of your role is to get all these stakeholders in the same place. What else would you say are your capabilities and your functions?

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It strictly depends on what our companies need. Some big companies might only benefit from information about upcoming seminars for financing and partnership opportunities and awareness raising campaigns for trending topics in healthcare such as AI. As of May, the EU General Data Protection Regulation (GDPR) will come into force and Tehnopol organized seminars and consultations involving all interested stakeholders. Another service that companies might need is seminars on financing opportunities in Europe and worldwide as well as finding partners for their applications – this is a very important part of our work. In addition to this, we provide coaching services covering different areas from how to enter neighboring markets such as Finland or Denmark, but also more distant markets.

Speaking of your match-making role, how does the fact that you are part of the European Connected Health Alliance (ECHAlliance) play a role?

Being part of the ECH Alliance is a very important factor. It was a strategic partner of our EU presidency. Estonia is a highly digitalized country and it did not happen overnight. As a Nation we have been working on digitalization for the past 20 years, because we realized that it was the way forward. We are a small country, yet digitalization makes us much bigger. The European Connected Health Alliance really helps us reach different organizations and ecosystems, not only in Europe but also in the US, Canada and Asia. We need such a partner to make connections in that part of the world to create markets for our members.

Can you give us some indications as to what the cluster is doing very well in and where there is room for improvement?

We realized that the e-residency is the perfect springboard for health-tech startups – we started receiving requests from Australia to establish a healthtech company in Estonia, as well as other countries overseas. The cluster is very good at making connections. Perhaps, what we should decrease is our Tallinn-centered approach, as for instance we have many exciting examples of innovation coming from Tartu, where the pharma regulator resides, and Narva, in the Eastern part of the country, and I feel that these regions are full of young people developing their businesses is absolutely crucial to have a more diverse and stronger membership. Regarding Narva, we have not yet realized the region’s potential; there are no science parks there for example. But for sure we have big healthcare service providers in Narva. This should be changed. We need to discover the potential of the eastern part of Estonia Advocacy should also be more consistent and generally improved.

During last year’s EU presidency, Estonia was trying to promote many initiatives in the field of e-health. What are your insights on this matter?

At the moment we are pushing for some of those initiatives not to be forgotten, as it can happen unfortunately. With the digitalized health society declaration, we proposed a few bullet points on A4 paper on what and why it is important for the EU to have cross-border healthcare services. Estonia together with our strategic partner ECHA presented this declaration in Malta during the Maltese presidency eHealth Conference and we expected some 20 people to turn up. In fact, we found an overcrowded room, where people had to stand, and Erik Gerritsen, Secretary-General of the Ministry of Health, Welfare and Sport in the Netherlands stood up saying that the EU does not need another paper, but rather it needs real action. This is how the Digital Health Society was born – out of the urgent need for action.

In addition to this, we had council conclusions which went surprisingly well. Estonia touched upon gentle topics using healthcare data for developing healthcare services and research, including cross-border settings. Different member states have different approaches to this, in Estonia we are more open, while we understand that security is important. We believe that healthcare data should not be secured from being used, but to be used securely. Considerably smooth process of endorsement of the Council conclusions tells us that this topic is important in all member states and the value has been recognized. Our goal is to remind Europe of this initiative now and to keep the progress going.

What would you say are the major planks of Estonia’s vision for a digital healthcare Europe?

I would like to propose:

For the future health it is very important to implement Digital Single Market principles and free movement of personal health data cross border for research and development of future health services. Good example is the European Rare Diseases Network bringing value to the patients, science and service providers.

Based on the subsidiarity principle healthcare is a national matter but to improve public health in general we need to join international efforts.

During our presidency we have proposed to the European Commission an idea to suggest a political goal for health and data related cooperation at the European scale. “100 Million Connected Healthy Europeans” is a strategic “moonshot” goal for Europe, which is capable of stimulating natural convergence of various complex activities, which are otherwise difficult to manage actively. It will aim at making Europe a global leader in developing and actually providing data-driven and AI-supported solutions in the area of health and care towards more value-based and efficient system based on digital opportunities and intelligent analysis.

During the Estonian Presidency of the European Council also a broad stakeholder movement came to life, with around 100 organizations having signed the Tallinn Digital Health Society Declaration and four Task Forces have been established to define and agree specific actionable set of necessary components to address concrete health and care challenges in a comprehensive manner using the full potential of digital solutions.

Security is a topic of increasing concern and we can see how cyber activity is being used for geo-political angst. Estonia itself has been subject to cyber-attacks. What can you say to approaches to secure digital data in the healthcare & life sciences field?

The Estonian cyber-security concept has been robustly tested in real-life cyber-attacks in 2007. Our healthcare service providers take cyber security very seriously including bigger hospitals as well as small family doctor’s practices. The main question is how to make electronic systems secure by design. We have some incidence of cyber-attacks, but nothing is comparable to what happened in Britain last year, where the national health platform stopped working for several hours. There are two main issues to be considered – on the one hand patient confidentiality and personal data protection and on the other there is a hard-core security threat to the system as a whole. Well managed cyber security is the enabler of the digital innovation.

What would you say are the main milestones in terms of Estonian engagement with digital disruption?

In the mid-1990s Estonia chose digitalization as the way to go forward. I do not know any other country that is engaging in one single system as much as we are. We started with e-governance in 1997, with e-tax in 2000, the digital ID in 2001 that allows to use the person’s unique ID code (answers the question: Who are you?) to implement different roles within the system using dynamic authorization (answering the question: what you can do in the system?). The ID card is the only mandatory ID document in Estonia.

Our Health Information system (implemented in 2008) allows patients to access their personal health information no matter where they are and doctors can make better informed treatment decisions based on the collected information about their patients.

Why do you think Estonia has been able to become a pioneer in a trailblazer?

Estonia had young leaders in the turbulent times of the ‘90s and the public sector had a very active role in affecting the development information society. We were practicing so-called development- driven policy making (not policy driven development) in the beginning of the development of the e-government as we know it today. The development of the digitalized society was, and still is, a strategic choice to improve the life of the people living in Estonia. And innovative solutions are designed to reach the goal of saving resources and make progress in our lives.