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Riga, Latvia: Lessons from the Baltic

Updated: Nov 15, 2019

Interoperability across the globe: Shared challenges sometimes spring from opposite sources. If we are open and creative, we can learn much from each other.

I have to admit, I looked Latvia up. I didn't know where it was or anything, really, about the country. And I certainly did not know why the European Union (EU) Commission and HIMSS chose to hold a meeting there in May. The Office of the National Coordinator (ONC) asked for volunteers to represent the work being done on ONC Federal Advisory Committees (FACAs) and the impact of U.S. policy in HIT implementations nationwide. I, along with a few other committee members, took up the charge.


“The tension between innovation and regulation was evident. This especially played out in discussions around the use of mobile technologies and apps for patients.”

I now know much more about Latvia, particularly the area of Riga. It’s a lovely port city with a beautiful park system, friendly people, and a rich historical center, and it’s a pivotal place for U.S. diplomats working on the crisis in Ukraine. I learned that large conferences are often held where the current EU President resides, and this year Riga was home to many of them, including the EU/HIMSS conference.


Navigating common and uncommon ground

The U.S. and the EU have much in common: interoperability issues, the mobile health explosion, and patient engagement challenges. In fact, there are more similarities than differences in the problems each faces; it’s the genesis of the problems that seems different.


The Triple Aim challenges us all to deliver high quality health care at a lower cost. In the U.S., we strive for a system that uses evidence, medical judgment, patient values, and informed decisions to get to appropriate care. In the majority of cases, the lack of right care is caused by overuse of the health care system. For this European audience gathered in Riga, the conversation was about the need for patients to get appropriate access, the flip side of the very same coin. Shared decision making (SDM) in the U.S. leads to patient choices that are more conservative.1 It will be interesting to see how SDM can be used in the EU to help with choices related to access of care, like self-care and patient understanding of treatment risks and benefits while making a decision.


Panel sessions provided insight to successful EMR integration, the use of mobile technologies, and a growing interest in population health. The frustrations in the lack of interoperability were the same in the EU as in the U.S., and many were beginning to look at solutions like DIRECT, a secure messaging platform. But I did not hear the emphasis on open APIs that is all the buzz here in the States.


Questioning and learning together

The tension between innovation and regulation was evident. This especially played out in discussions around the use of mobile technologies and apps for patients. What is regulated? What is not? What is subject to privacy and security law, and what is not? What about market oversight and regulatory oversight?


As the EU works to solve these problems, the U.S. can be reminded that these discussions are happening in support of multiple countries, languages, and cultures. Our vastness brings us different challenges, but in Riga, Latvia, I was reminded that we have many of the same challenges and can learn from each other.

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