Digital health tools are transcending international borders, with new players popping up all over the globe. 

During the "International Outlook for Digital Health" panel at the Connected Health Conference in Boston, speakers stressed the importance of collaboration and fusing ideas from various cultures and countries — not just those with a more developed health infrastructure. 

“This two-way traffic and ability to learn from each other in a humble fashion I think will help systems in the West, and obviously we can help them,” Brian O’Connor, chair of the European Connected Health Alliance, said. “You don’t ignore a market of that size. So in that sense we have connected with the European Connected Health Alliance, with the Canadian [alliance], and the Chinese [alliances] and we now have 70 countries with 3 billion plus people in that network. That doesn’t mean we do everything or know everyone … but what I would say is this, it is the connectivity of human beings assisted by the support of digital tools that can transform citizen care across the world.”

Recently O’Connor has been working with the Commonwealth Center for Digital Health on initiatives and collaborations. Commonwealth refers to the Commonwealth of Nations, which is a group of 53 countries formerly ruled by the British crown. The countries are dotted all over the globe from small islands to the south pacific to Canada. This often means countries have different needs. 

Sometimes having a different starting pointing can mean tackling problems in a new way. 

“Their journey is very different from ours. We started from landlines. Most of these countries never started from landlines,”  O'Connor said. “They went with their first communication device to mobile phones everything has to do with mobile and portable and tablets. Another term I learned was frugal invention, which means I’ve got no money but I’ve got a need and I’ve got to find a solution and I’ve just got to find it.” 

He gave the example of a young woman in Sri Lanka who came up with a virtual reality training tool that is now deployed in several hospitals in the country. When O’Connor asked her what she needed to start her company she told him "her laptop and her brains." 

O’Connor also noted that it is important not to write countries off based on preconceived notions. Take Rwanda, for example. In the 90s it was engulfed in a civil war, but it has now begun implementing digital health tools that rival its western counterparts. 

“Rwanda is to the point where everybody has got an electronic health record. Does everybody in Europe or US have that, does everyone have access to it?” O’Connor said. “Secondly, every village has a clinic. Sometimes it’s an actual clinic, sometimes it’s an iPad. Those iPads have allowed people, instead of going four hours to see a doctor, to communicate through the iPad. And when they need drugs and so on they are …sent by drone, parachuted down.”

Ideas are also coming from smaller countries. For example, Estonia is often called out as the star of the digital health world and now other countries are starting to take note. 

“The Estonian government has something called the X-Road. It is the exemplar in Europe for the delivery of public services through one digital platform,” Bleddyn Rees, an international health attorney and deputy chair of the European Connected Health Alliance, said at the conference.  “Estonia is really a city — 1.4 million people by population, but all of its public services are delivered through a blockchain digital platform.”

Estonia is now helping other countries use digital health. Rees said that the country is now proposing a “fifth freedom of Europe,” which is the free movement of health data around Europe. By 2027, the country has a “moonshot” of 100 million digital records of EU citizens.