A lack of incentives and standardisation meant that Slovenia was lagging behind other European countries in terms of healthcare IT. Now, however, it is slowly progressing to the forefront – and many of the solutions are the work of home-based companies
Every first Wednesday of the month, Jakob Šušterič, Jure Pučko and Blaž Triglav meet for lunch somewhere in the city centre of Ljubljana. With their playful, relaxed attitude towards each other and jokes flying around, you might easily mistake them for students. They are, however, the CEOs of three of Slovenia’s most visible and fastest-growing medtech startups. These monthly lunch meetings aren’t just friendly gatherings but consciously adopted catch-ups on the latest developments in their companies, on medtech in Slovenia and on trends in the digital health industry. Being up to date and agile is a must for innovators in this highly competitive sector, where fast expansion into foreign markets is expected in the early stages of company development, especially when coming from such a small country as Slovenia.
The small, chicken-shaped country, squeezed between Italy, Croatia, Austria and Hungary, has a population of only two million people. In theory, its size and relatively easy access to important decision-makers, specialists and advisers, should make it easy to develop and spread good medtech solutions. But when it comes to healthcare, this is not the case. Direct-to-consumer sales of medtech products is limited because the healthcare system is public. As in other European countries with solidarity-based, universal-access systems, patients are not willing to pay much for health – they expect their insurance to cover it. But the insurance-paying models are not changing in accordance with the speed of disruptive innovations. It’s true that many tools for virtual medical consultations and connecting stakeholders exist, but doctors don’t use them often in Slovenia. From a financial point of view, it makes much more sense for a doctor to see a patient personally in his office instead of using one of the patient-friendly web-based platforms. One national insurance company dictates the price policy for all health services, and the payment for an electronic doctor-patient communication with a specialist is less than €2, while a GP gets just over €6 for it.
Most of the hospitals in Slovenia invest just 1 per cent of their budgets in IT, making it difficult to include modern solutions in their workflows. With this in mind, it’s easy to understand why Slovenia has been slow in implementing eHealth, even though there is a thorough national Strategy for eHealth policy from 2005 to 2010 designed a decade ago. ‘It was visionary, but way too optimistic,’ says Doctor Dorjan Marušič, the strategy’s co-author and Slovenia’s Minster for Health from 2010 to 2012. Although not much was done by 2010, many ideas from the strategy are now starting to see the light of day. Last year, for example, ePrescription was launched, this year eReferrals and the ePatient portal are scheduled to start operating before June. Electronic exchange of patient information among providers with different IT systems should finally become easier, thanks to the obligatory use of the so-called ‘interoperable backbone’ – a platform serving as an electronic clinical database. It enables doctors to send some patient information, such as discharge letters, to the platform so that other specialists can access it.
So things are slowly improving. As Dr Marušič says, a lot of setbacks occurred due to a lack of incentives and standardisation. But now the country is, in healthcare IT terms, slowly progressing towards the forefront among European countries. And many of the solutions used are the work of home-based companies.
Most of the established bigger players in Slovenian digital health focus on IT. The majority of hospitals are covered by an information system provided by SRC Infonet, whose latest solution (which has raised quite a lot of interest) is a so-called ‘friendly waiting room’. It’s a system that solves the big frustration of hanging around in waiting rooms. On arrival at a specialist’s appointment, the patient registers at an electronic terminal and they can then monitor the waiting line on an app, enabling them to leave the hospital while waiting and return when they’re next in the queue.
Another practical solution is TeleTransfusion designed by XLAB. This telemedical system enables transfusiology specialists to be virtually present at any location. Nationwide deployment has optimised the organisation of transfusiology in the country and brought substantial cost savings and organisational improvements. Even more importantly, it improved care for some patients, since they now get the same professional care no matter where in the country they are being treated. ‘This is especially valuable for patients with more complicated haematology issues who are now treated regionally instead of having to travel to the large centres,’ says transfusiology specialist Dr Marjeta Maček.
The national ‘interoperable backbone’ was developed by Marand. Its core product is the Think!EHR Platform for real-time, transactional health data storage, query, retrieval and exchange. The platform has already also been adopted in Moscow, by Brazilian healthcare provider Hospital Sírio-Libanês and DIPS ASA, the largest supplier of electronic patient record systems to Norwegian hospitals. Marand’s next big project is an electronic medication management and prescribing system developed in collaboration with the NHS.
If the bigger and older companies provide solutions for large institutions, startups are mostly single-product outfits. The biggest startup in Slovenia is MESI, led by Jakob Šušterič. The company is focused on primary-care physicians, offering them a screening device for early detection of peripheral arterial disease – a common circulatory problem causing reduced blood flow to the heart, brain and legs. Mediately, led by Blaž Triglav, is a software company developing apps for doctors. Its primary product is the Registry of Drugs app where all information about the country’s approved drugs are gathered, including official descriptions of dosing, packaging, indications, etc.
Jure Pučko leads Doctrina, which sells and develops an online platform connecting pharmacies and pharmaceutical companies. With the help of e-learning, pharmacists are informed and educated about new drugs more quickly. There are also a few promising newcomers just entering the market. Kinestica, a sensor-based system combining virtual-reality gaming with rehabilitation methods to help stroke patients and those with neuromotoric disorders recover faster. Or Adora, a hands-free medical record system that surgeons can refer to during operations, which reduces interruptions and stress, and enables them to plan procedures. Many of these projects were started by PhD students and, according to Dr Matjaž Gams, Head of the Department of Intelligent Systems at Jožef Stefan Institute – the most important national research organisation – there’s a growing interest in digital health solutions in academia. There are at least 100 ongoing projects around the country, he claims.
Most VCs will say that success of a company is at least 50 per cent dependent on the team. You could probably say the same at national level, be it healthcare or any other sector. Collaboration and connecting is something that many companies have started working hard on in the last two years. Marand, XLAB, MESI and Tehnološki Park Ljubljana (an organisation offering a stimulating business environment to support tech entrepreneurship) formed an alliance under the name Healthday.si. Its mission is to help all the members of the medtech community when entering international markets. It holds networking and educational events for everyone interested in digital health. Last year the alliance became a chapter partner of Health 2.0, the international catalyst for the advancement of new health technologies. On 18 February, Healthday.si is launching the Slovenian European Connected Health Alliance (ECHAlliance) ecosystem, in its first attempt to improve integrative care in the country.
It may be because they’re working on different products, or simply because they’re mostly software- and IT-driven – where nothing works without connectivity – but these companies have recognised that everyone could benefit more by working together. Some of them, like Šušterič, Triglav and Pučko, have become friends. Now they’re slowly trying to encourage other stakeholders in healthcare to play along. The goal? Speeding up innovation adoption to foster better healthcare for patients.
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