Punching Above Their Weight: How small countries are quietly leading digital healthcare innovation.

Paris, France June 11, 2025. Le Palais Des Congres HIMSS Conference

In the fast-evolving world of digital healthcare, small countries often fly under the radar—until they don’t. As healthcare systems globally wrestle with fragmented infrastructures, aging populations, and the rising cost of care, smaller nations are quietly emerging as agile laboratories for innovation. At a recent international forum on healthcare digitalization, leaders from Slovenia, Estonia, and the Netherlands revealed how compact size, centralized governance, and cross-border collaboration are helping their countries punch well above their weight.

The Agility Advantage

“Let’s not be naïve,” said Prof. Nick Guldemond of the Medical University of Gdansk. “Governments that lack leadership or clear vision risk leaving healthcare systems fragmented for decades.” Reflecting on the Dutch experience, he pointed out that an overreliance on market forces—without strong state coordination—has stifled progress. In contrast, many small countries are taking a more hands-on approach.

Slovenia is one such example. Teja Batagelj, Acting Director General for Digitalization in Healthcare at Slovenia’s Ministry of Health, highlighted the nation’s strategic decision to legislate centralized digital solutions across all public healthcare institutions. “We wrote it into law,” she noted. “This ensures that even under-resourced facilities must adopt unified systems, which helps streamline care, reduce procurement complexity, and improve outcomes.”

Estonia offers another compelling case. “We’re small, but not without fragmentation,” said Agris Peedu, CEO of the North Estonia Medical Centre. The country’s 21 hospitals once used five separate electronic health record systems. But things are changing. “We’re now moving faster with centralization. When we created a unified intensive care platform, doctors from across hospitals agreed on parameters in less than a year. That kind of alignment is rare—and powerful.”

Small Countries as Innovation Labs

While limited market size can deter major tech vendors from investing in bespoke solutions for smaller nations, there’s an upside: the ability to pilot new technologies at scale, with speed.

“Small countries can be controlled environments for testing,” said one attendee from Ukraine. “You can observe outcomes in a clear, structured way.” Peedu agreed, citing Estonia’s successful integration of digital prescriptions with Finland. “You can get a prescription in Estonia and fill it in Helsinki. That level of interoperability is hard to achieve in larger, more complex systems.”

Batagelj also emphasized the benefits of structured health data in smaller systems. “If healthcare data is standardized and centralized, it becomes a powerful tool for both clinical decision-making and national policy.”

Talent, Not Just Tech

But innovation isn’t just about systems—it’s about people. Peedu cautioned against assuming that only younger professionals can lead digital transformation. “One of our best national invoicing projects was led by a 65-year-old woman. Age isn’t a barrier to innovation. Motivation and expertise are.”

There’s also growing recognition of the need to build internal teams with deep domain expertise in IT, procurement, and legal affairs. “If we don’t have people who understand intellectual property and contract negotiation on our side,” Batagelj warned, “the supplier always wins.”

The Role of the EU: Obstacle or Opportunity?

When asked whether EU regulations help or hinder national strategies, panelists were generally optimistic. “Interoperability standards, innovative procurement frameworks, and shared legislation are enabling smarter cross-border collaborations,” said Guldemond. “These mechanisms give small countries access to larger markets and more viable solutions.”

Still, collaboration remains patchy. While Slovenia conducts field research across Europe before implementing major digital reforms, broader coordination is limited. “We need more cross-country projects among small nations themselves,” Peedu argued. “We’ve done it with Finland, but why not with others?”

Suppliers Must Evolve, Too

Panelists also called for a new kind of supplier—one that acts more like a strategic partner than a software vendor. “The ideal provider isn’t just delivering a product,” said Batagelj. “They’re helping us build something better together—and doing so with integrity.”

That requires more than a good sales pitch. As Peedu explained, meaningful procurement starts long before a formal tender is posted. “You need dialogue. With companies from your own country and abroad. We’ve been working on a new electronic medical record system for over four years. COVID delayed us, but it also taught us the value of perseverance and open communication.”

A Path Forward for Europe

The panel closed with a clear message: small countries are not just capable—they’re essential. Their ability to iterate quickly, implement reforms broadly, and share insights transparently makes them valuable partners in shaping the future of digital healthcare.

“Latvia launched e-prescriptions in six months,” Guldemond said. “The Netherlands? We’re still waiting. So don’t underestimate the transformative potential of these nations. Their stories are blueprints for resilience and reform.”

In an era where scale is often equated with strength, these smaller states are proving that smart policy, focused leadership, and international cooperation can be just as powerful.