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E-Health and E-Welfare of Finland Check Point 2018 REPORT

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E-Health and E-Welfare of Finland Check Point 2018 REPORT Tuulikki Vehko Salla Ruotsalainen Hannele Hyppönen (eds.) E-health and e-welfare of Finland Check Point 2018 REPORT 7 | 2019 Report 7/2019 Editors Tuulikki Vehko, Salla Ruotsalainen, Hannele Hyppönen E-health and e-welfare of Finland Check Point 2018 Contact address for requests for additional information about health care: FinnTelemedicum c/o MIPT, P.O. Box 5000, FI-90014 University of Oulu, Finland; Professor Jarmo Reponen, tel. +358405412718, E-mail: [email protected] Contact address for requests for additional information about social services: National Institute for Health and Welfare (THL), Information Department, Operational Management, P.O. Box 30, FI-00271, Helsinki, Finland; Development manager Maarit Rötsä, tel. +358 29 524 7276. Email: [email protected] Contact address for requests for additional information about The physician survey on use and usability of health information systems: Finnish Medical Association, P.O. Box 49, 00501 Helsinki, Finland; Research manager Jukka Vänskä, tel. +358 9 393 0814. Email: [email protected] Contact address for requests for additional information about The survey on citizens views of e-health and e-welfare services: National Institute for Health and Welfare (THL), Health and Social Care Systems Department, Social and Health Systems Research Unit, P.O. Box 30, FI-00271 Helsinki, Finland; Research Manager Anna-Mari Aalto, tel. +358 29 524 7252, Email: [email protected] Contact address for requests for additional information about The nurses’ experiences of health and social care information systems: University of Eastern Finland (UEF) Health and Human Services Informatics, Department of Health and Social Management, Faculty of Social Sciences and Business Studies, P.O.Box 1627, FI-70211 Kuopio, Finland; Senior Lecturer, Ulla-Mari Kinnunen, tel. +358 40 355 3953. Email: [email protected] © Authors and the National Institute for Health and Welfare Layout: PunaMusta Oy ISBN 978-952-343-325-0 (printed) ISSN 1798-0070 (printed) ISBN 978-952-343-326-7 (pdf) ISSN 1798-0089 (pdf) PunaMusta Oy Helsinki, Finland 2019 Abstract Tuulikki Vehko, Salla Ruotsalainen, Hannele Hyppönen (eds.) E-health and e-welfare of Finland. Checkpoint 2018. National Institute for Health and Welfare (THL). 193 pages. Helsinki, Finland 2019. ISBN 978-952-343-325-0 (printed); ISBN 978-952-343-326-7 (pdf) The Finnish Ministry of Social Affairs and Health has regularly commissioned national surveys on e-health and e-welfare to monitor state of the art and trends in e-health and e-welfare in Finland to gain evidence for development. The results of the latest data collection round in spring 2017 have been published in numerous national reports and international articles. For the first time, results from 2010, 2014 and 2017 were also published as dynamic database reports (www.thl.fi/digikyselyt). The report at hand was produced mainly for the international benchmarking as a compilation of main results. The report was produced by the Finnish National Institute for Health and Welfare (THL), FinnTelemedicum research unit at the University of Oulu, Aalto University, University of Eastern Finland (UEF) and the Finnish Medical Association. At the time of the data collection in spring 2017, the national e-services (Kanta services) in healthcare were already in common use. The national e-prescription (Prescription Centre) and MyKanta Pages for citizen had become established in all of public healthcare and in most of private healthcare providers. The Patient Data Repository was used in all of public healthcare and in many of private health- care providers. Kanta services for social services were ready to be deployed and implemented, and the national Kanta PHR was in its pilot phase. The Information Strategy for Social and Health Care 2020, published in the beginning of 2015, was being implemented. The indicators used for monitoring have been developed in collaboration with the Nordic countries and the OECD, and offer good basis for international e-health and e-welfare benchmarking. The five surveys of the report have been depicted in table 1. THL – Report 7 | 2019 3 Table 1. Surveys, their foci, informants and frequencies. Survey Focus Informants Years 1) e-health e-health Public primary and 2003, 2005, 2007, implementation secondary and private 2011, 2014, 2017 and use healthcare provider organisations 2) e-welfare e-welfare Public and private 2001, 2010, 2014, 2017 implementation and social service use organisations 3) Physicians’ Usability, experienced Public and private 2010, 2014, 2017 experiences benefits and physicians challenges 4) Nurses’ experiences Usability, experienced Nurses working in 2017 benefits and public and private challenges health care and social services 5) Citizens’ Use, experiences and Representative sample 2014, 2017 experiences needs of e-services of population The e-health survey (1) includes data from all the public hospital districts delivering secondary or tertiary care and 86% of the public healthcare centres delivering pri- mary care (population coverage 95%). A sample of private sector service providers is also included. The e-welfare survey (2) focused on mapping the information ex- change in social services, organisations that had joined the Kanta services and avail- ability of digital social services for citizens. It included all public and private social service providers in Finland. Public social service respondent organisations covered 46% of all the municipalities and nearly fifth of private organisations. The survey of physician experiences (3) was addressed to all working age physicians in clinical work in Finland. The survey focused on e.g. technical quality, ease of use and IT sup- port for management with 22% response rate. The same study on nurses’ experienc- es (4) was conducted for the first time in 2017. This survey assessed the usability of health and social care information systems and further, explored the proficiency of use among nurses. Response rate was 12%, but the sample represented those nurs- es well who were employed in public hospitals, healthcare centres, private sector and social care. The survey of citizen experiences (5) response rate 47%, describes citi- zens’ ability to use e-services and furthermore, barriers and benefits of use. In this survey, citizens had already more experiences in using the national My Kanta Pag- es service. According to the results of the e-health survey, information exchange has in- creased and regionally information flow between primary and secondary care is more fluent. The Finnish health care is highly digitalized also among private sector service providers. There are also more e-health services available for citizens. However, with a large amount of data available, intelligent use of it needs further improvement. According to the e-welfare survey, no significant changes had occurred in the information management and information system development in social services compared to the situation in 2014. However, cooperation between public and pri- 4 E-health and e-welfare of Finland Check point 2018 vate sector and e-services targeted for citizens had increased since 2014. Still, some of the private sector service providers did not have a client information system in use. This is a significant observation when considering the national client data re- pository that is currently under work. Further, it seems that professionals do not have sufficient tools for information management. According to the physician survey, slight improvements were seen among pub- lic sector physicians in their satisfaction to EPR system’s ease of use and technical quality in 2017. In the private sector, physicians were more satisfied with their EPR systems than their colleagues in public healthcare. In health information exchange, paper was used less compared to earlier surveys. Obtaining prescription data from other organisations was perceived easier due to implementation of national Kanta and e-prescription services. However, obtaining patient data from other organisa- tions was still perceived time consuming. The survey on nurses’ experiences revealed that nurses rate themselves as profi- cient users when assessing their informatics competencies. However, there are issues in information flow that do not support nurses work processes. A concerning find- ing was that information systems were not experienced to support nurse-patient re- lationship. The results of the survey of citizens’ experiences showed that majority of the citizens were able to use e-services, but there are still people who are unable to use e-services. It would be important to deal with the barriers of use to prevent digital exclusion. E-services for citizens form the most often used e-service functionalities in healthcare. Even if the Finnish social services and healthcare are already highly digital- ized, more effort and investments on e-service development are still needed to en- sure equal access to e-services. It is important to consider health data security. Fur- ther, development of indicators for monitoring healthcare digitalization are needed. Information on usability of client information systems is needed to steer develop- ment of Kanta services for social services. From the professionals’ perspective, in- formation exchange and interoperability between information systems needs to be improved to minimize multiple documenting of the same thing and to facilitate search of the relevant information. Moreover, it is important to improve the quality
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