COVID-19 – a catalyst for digitalisation

The outbreak of the virus and the measures to reduce the infection rate have affected large parts of Norway’s business community and Norwegian society. Many businesses have been forced to close down or re-organise in response to the infection control measures. Others have experienced reduced demand or restrictions put on their production due to a lack of manpower or late deliveries. Other parts of the business community have experienced rising demands, changing distribution channels and new market opportunities.

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The coronavirus crisis has accelerated developments in several areas of digitalisation. It is likely that this will leave its mark on working life and society in general for years to come.

Remote working

Extensive use of video conferencing and collaboration tools may well be the most obvious effect for the average citizen after periods of home schooling and home working. A survey conducted by Norstat on behalf of the IT company Computas shows that as many as 8 out of 10 businesses have implemented digitalisation measures as a consequence of COVID-19.

More than 50 per cent have rolled out collaboration tools for their own staff, and almost as many have developed new solutions and services. Approximately one third have provided training for their staff in how to use new technology and digital tools. These are skills and ways of working together that will not disappear with the virus.

Working from home and changes to patterns of travel

In some periods, everyone who was able to work from home was encouraged to do so. This worked well for some people, while others missed the physical and social working environment of the office. Many find it lonely to be working long days without meeting up with work colleagues. Others enjoy the additional time freed up for leisure by not having to spend hours on commuting every week. It is difficult to tell what the long-term consequences will be for people’s work situation. It is likely that where possible, employers will continue to offer more flexibility in terms of where and when work is carried out, even after the coronavirus crisis.

The coronavirus pandemic has affected people’s travel habits. In the second quarter of 2020, Statistics Norway measured a 65 per cent drop in domestic travel for work and a 94 per cent drop in international business travel compared to 2019. The largest drop is in the number of flights, but fewer people travel by train, bus and ferry. The reason is likely to be that people work from home, meet up online and use video conferencing tools.

If working from home becomes more of a standard practice even after the coronavirus crisis, this may influence the long term demand for transport and office premises. Greater flexibility with regard to core working hours may reduce peak-time pressures on roads and public transport in the big cities. If living near your place of work becomes less important because digital interaction is the norm, we may see changes in residential patterns around the big cities.

Changes to shopping habits – more online shopping

The coronavirus pandemic and infection control measures has affected cross border shopping and the production and sales of food and drink in Norway. The sale of groceries and alcohol increased by 18 per cent in 2020, compared to 2019 according to Statistics Norway. This was probably caused by people eating and drinking at home, rather than in cafes and restaurants, and the fact that crossing the border to shop meant you had to go into quarantine. According to Statistics Norway, the value of online shopping was up by 48.2 per cent in December 2020, compared to December 2019.

Fewer cash transactions

In the middle of March, the advice given by the Norwegian Directorate of Health was that contactless payments were preferable and that cash should only be used in exceptional circumstances. In Norway, the use of cash was already among the lowest in the world. In autumn 2019, cash transactions amounted to 7 per cent of payments. In spring 2020, this has fallen to 3 per cent.

There is a changing trend in how electronic transactions are made at Norway’s physical payment points. There has been considerable growth in contactless card payments after the supermarket chains introduced this facility, and particularly after the health authorities encouraged the use of contactless card payment for reasons of infection control. Nearly 65 per cent of all BankAxept payments made by a physical card are now contactless.

Changes in the health sector

When society went into lockdown on 12 March 2020, it soon became clear that digitalisation in the health and care sector could help reduce the risk of transmission during the pandemic by moving treatment and follow-up monitoring online. The importance of digital solutions in the health and care sector is increasing.

In 2020, a number of e-health services have seen a rise in use due to the coronavirus situation. Digital health services were important for reducing transmission rates, because they made it possible for healthcare personnel and patients to meet without being in physical contact. Doctors could conduct consultations online, and the home-based services could use welfare technology to reduce the number of physical home visits while ensuring that service users were looked after and could feel safe. Healthcare personnel like psychologists and physiotherapists, who were not allowed to meet with patients in the early stages of the pandemic could continue practicing thanks to video technology.

Public portals like helsenorge.no provides quality-assured healthcare information and access to administrative services, such as booking appointments and ordering repeat prescriptions, as well as e-consultations and messaging the doctor. Several million residents made use of these services during the period of strictest infection control restrictions. Helsenorge.no was crucial for the work to put in place new digital solutions in the health and care sector. The platform helps reduce barriers and stimulates increased use of digital tools in the treatment of patients.

Online consultations

In 2018, the Norwegian Consumer Council conducted a survey showing that the population was keen to communicate and consult with their doctor digitally. Even though the technology has been available for several years, the survey showed that only 8 per cent of doctor's offices were able to offer video appointments. The coronavirus pandemic has led to an increased demand for online consultations. More doctors have acquired video technology and put it to use for the first time in order to reach out to the people with respiratory symptoms who were barred from attending the doctor's office in person, but also to other vulnerable patients who preferred to avoid crowded places.

The health authorities have introduced several initiatives in order to support the use of technology. Online consultations were put on par with physical consultations with respect to remuneration. Doctors could communicate digitally with personnel in the primary health and care service. Telephones were also accepted as an e consultation tool during the pandemic, and as from the summer of 2020 telephone consultations were put on an equal footing with physical consultations in the accounting system. Reimbursement schemes have also been introduced for other types of digital follow-up services in the specialist health service.

The Norwegian Directorate for eHealth issued guidance to help healthcare personnel get going with secure video consultations, and set up a website with practical advice about appropriate use of video technology.

These measures have had an impact: e-consultations increased from approximately 3 per cent before the pandemic to more than 40 per cent in the first weeks after 12 March 2020 when the strict infection control measures were introduced. Throughout 2020, more patients have been returning to physical consultations, and e-consultations have stabilised at between 25 and 30 per cent of appointments.

The coronavirus pandemic also caused a significant increase in e-consultations provided by private-sector medical services. Thanks to working in partnership with the insurance industry, they were able to help many Norwegians abroad.

There are several benefits from digital solutions, such as video or text consultations or remote health monitoring: the patients save time that they would otherwise have spent on travelling and waiting, and both society and patients save the cost of travel. This can also help healthcare personnel rationalise their use of time, and help patients and citizens feel safer and more in control when in their meeting with the health services.

Digital contact tracing tools

Infection tracing and testing are important parts of the Norwegian strategy against COVID-19. Everyone who experiences symptoms should get tested, and everyone who has coronavirus infection confirmed, must self-isolate. It is important to trace infections among those who have been in close contact with confirmed cases of COVID-19 in order to reduce and quickly stop further transmission of the virus in the community. Local authorities carry the prime responsibility for infection tracing in Norway.

Infection tracing by local authorities

When the pandemic hit, local authorities had no tools for tracing infection. However, the market soon produced solutions that were made available to local authorities. Virtually all local authorities have now introduced digital infection tracing tools, which make the job simpler and more efficient. This makes it easier for them to co-ordinate their tracing efforts, and to follow up on those who are infected or in quarantine. It also gives the Norwegian Institute of Public Health a better picture of the national situation.

The infection spreads fast, and it is important to break the chains of infection as soon as possible. In December 2020, the Norwegian Institute of Public Health launched a new version of its mobile phone app for infection tracing: ‘Smittestopp’. Anyone over the age of 16 can download and use the app, which is designed to quickly notify anyone who has been in close contact with someone with confirmed COVID-19 infection. By April 2021 more than one million people had downloaded the app.

Using technology to locally monitor COVID-19

The interest in using welfare technology and digital monitoring of patients in their own homes has increased considerably as a consequence of the coronavirus pandemic. With great success, several local authorities have offered digital monitoring at home to COVID-19 patients. For example, the use of a pulse oximeter – a device attached to the finger of people with COVID-19 – and an app installed on the patients’ smart phone or tablet, has enabled healthcare personnel to remotely monitor the oxygen saturation of their patients’ blood and other vital measurements. Oxygen saturation is a particularly important indicator for those infected by the coronavirus.

Regional testing of such home monitoring technologies has had good results. For example, monitoring of patients in their own home means that local authorities have been able to maintain a good level of service during the pandemic while also protecting patients and staff from infection from direct personal contact.

This reduces the need for personal protective equipment, which was particularly important during the early stages of the pandemic when there were challenges associated with procuring such equipment. Remote monitoring of coronavirus patients can be used for patients is in hospital or at home.

Six local authorities and municipal partnerships have taken part in the project ‘Digital home monitoring of the chronically ill’, which provided a framework for the use of pulse oximeters to monitor coronavirus patients. Before the pandemic, the local authorities were testing various digital home-monitoring technologies for patients with chronic illnesses such as COPD, heart disease and diabetes. The project is a part of a national welfare technology programme run in partnership by the Norwegian Association of Local and Regional Authorities and the health authorities.

The programme aims to ensure that more local authorities introduce welfare technologies. Experience tells us that appropriate use of welfare technology can contribute to more cost efficient use of resources in the primary health and care service, and enhance the sense of safety and independence among patients.