Digital Technologies Improving Patient Outcomes Maritta Korhonen Ministerial Counsellor Ministry of Social Affairs and Health Finland 3.10.2017
In theory, there is no difference between theory and praxis. In praxis, there is. (Yogi Berra) 3.10.2017
Challenges in Finland/Europe/world Ageing population Increased demand of services Urbanisation Accumulation of social and health problems; poverty, unemployment, poor health, poor mental health 10 % of population are using 80 % of social and health care resources Increasing inequalities 14.10.2014 TSO/el
Population density in Finland Inhabitants / km 2 3.10.2017 4
Finnish Public Healthcare System 2017 5 university hospital districts: HUCH Helsinki University Central Hospital (HUS) KUH Kuopio University Hospital TUH Tampere University Hospital TUCH Turku University Hospital OUH Oulu University Hospital OUH These are divided into hospital districts, 20 altogether in Finland KUH Primary healthcare is provided by the communs TUCH TUH HUCH
Objectives of the Finland s social and health services reform 2020 Reduced differences in health and social wellbeing Better and more fluid functioning of services More expedient administration Improved equality, efficiency of fundamental rights Renewal of services Citizen participation Administration as a service to promote and enhance the activities of citizens and enterprises Openness Customerfocus. Interaction and dialogue Slowing of the expenditure growth (1.5 % to GDP) Costeffectiveness Enhancement of economic growth
Public health work and structural social work into focus again Emphasis on a stronger primary level instead of focusing on hospitals Primary services given at health and social services centres supplemented by demanding consultation services (by medical specialists and social work professionals) The model of financing will change significantly: it will be based on residents needs New, personalised service model and assessment of service needs combined with the promotion of health and wellbeing of the whole population 3.10.2017
Digitalisation: new kinds of services Through digitalisation, services can be provided in completely new ways, and processes enhanced. Electronic services also encourage residents to independently maintain their functional capacity and health. Basic principle of ICT solutions: client information can be used across the boundaries of organisations and regions. 3.10.2017
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Information to support wellbeing and service renewal (ehealth and esocial strategy 2020) 10 10/3/ Name
The decision to build a national ehealth solution Government decision in 2002: Finland should have a nation wide interoperable EHR system by end of 2007 By 2005 agreement on the National archive for health information (Kanta) comprising three nation wide services eprescription eaccess (My KantaPages) earchive (Patient Data Repository) Based on structured documents (HL7 V3 CDA R2) In cooperation with local systems to feed care documents and using them New legislation was needed to allow the new features Placing the centralized service to Kela (National Insurance Institution) Consent management, privacy & security aspects
epsos NCP Kanta messaging layer Patient data management service Public healthcare providers ORGANISATIONS Hospital districts (20) Primary USING care org. THE (192) NATIONAL SERVICES THROUGH Private healthcare providers (4000) THEIR Pharmacies SYSTEMS (~800) INTERNATIONAL CONNECTION (epsos, CEF) Health care professionals ehealth DSI / CEF ACCESS FOR CITIZENS TOP 3 WEB SERVICE IN FINLAND Citizens (> 5 000 000) Social care providers Main standards HL7 V3: CDA R2 L3 and Medical Records HL7 FHIR BASED DSTU2 (PHR) ON JSON, XHTML (PHR and social services) INTERNATIONAL PDF/A (legacy data and social services) IHE ITI Profiles (Imaging and epsos) W3C STANDARDS XML DSig WS Addressing, WSI TLS, X.509 Kanta services Pharmaceutical database Architecture for ehealth Web GUIs for HCPs My Kanta pages Other national services National code server Patient data Encounters EPRESCRIPTION repository Logs Health records, structured Health records, legacy Consent and will management Consents and Living wills and other wills their restrictions (organ donation, etc) Code systems and terminologies SUPPORTING Pharmacy register SERVICES Organization register 10/3/ Name 12 Certification services HCP and SCP register Form structures XRoad eprescription Prescriptions Dispensations NATIONAL DATA STORE service Renewals Logs Radiology DICOM studies Patient summary management Diagnoses Risks Other summary data Personal Health Record Customer s mydata PERSONAL HEALTH AND WELLBEING Data repository for social services Customer docs Legacy data PATIENT DATA (patient record) SOCIAL CARE DATA DATA Customership and service item data Summary management Logs
De facto: Electronic Prescription Electronic prescription is mandatory from 1.1.2017 Doctors may not write paper prescriptions or prescribe over the phone, except in extraordinary situations All paper or phone prescriptions will be entered in the Prescription Centre by the pharmacies. Kela provides a webbased service (HCP portal) for handling electronic prescriptions, to be used mainly by individual doctors and small organizations 13
Electronic Prescriptions Promote Pharmaceutical Safety Prescriptions of medicines safely to to Prescription Centre Available to all (patients, physicians, pharmacies) Prevents patients from losing prescriptions Prescription instructions are also given to the patient in paper format Centralised information about patient s prescription medication Enables monitoring of the use of medication Misuse of prescriptions is difficult Welcomed by physicians liked by the patients 3.10.2017 14
1 4 7 10 1 4 7 10 1 4 7 10 1 4 7 10 1 4 7 10 1 4 7 10 1 4 7 10 1 4 7 10 Electronic Prescription Renewal Service 250,000 2010 2011 2012 2013 2014 2015 2016 2017 200,000 150,000 100,000 208 232 (5/2017) Electronic Prescription Renewal Requests 50,000 0 3.10.2017 15
Cross Border Exchange of Data and Services Exchange of electronic prescriptions between Finland and Estonia as a permanent reciprocal crossborder service Bilateral service deployment will be aligned with a joint EU Member State process carried out under the Connecting Europe Facility (CEF) (Partial) financing from CEF Project goal: 2018: Finnish eprescriptions ready for dispensation in Estonian pharmacies 2019 Estonian eprescription ready for dispensation in Finnish pharmacies
Growing: Patient Data Repository A national centralized repository into which patient records are entered nationwide Contains the patient s health record, data about encounters and periods of ward care, lab results, referrals, etc. All public healthcare organizations store data in the Patient Data Repository Private healthcare service providers are joining 810 mill. documents of 5.7 mill. patients (7/2017) Process and EPR renewal in healthcare organisations 17
Benefits of the Patient Data Repository Provides access to individual medical records Previous test results can be utilised, which avoids unnecessary treatment Encrypted data transfer, professional cards, monitoring of log data safeguard appropriate use of the data Patient can decide who has access to his/her patient data The availability of patient data supports patient s option to choose treatment unit An actively used data repository 3.10.2017 18
Information Management Service in Patient Data Repository (05/2017) 5 554 753 persons 5 080 679 informings 2 550 179 consents 56 001 denials 225 143 wills 181 831 Organ donation wills 43 312 Living wills 3.10.2017 19
Popular: My Kanta pages 2010 2011 2012 2013 2014 2015 2016 2017 1 140 557 (5/2017) All logins 514 969 (5/2017) Number of Visitors 2,02 Mill. Persons have used service by 31 March 2017 3.10.2017 20
My Kanta Pages for Citizens Citizens can view their own prescriptions and medical records Access to the same information as for the physician (Until further notice) no right to edit the data Citizens (18 years and over) are able to manage their own data Monitoring the use of information on the log data Management of consents and refusals Issuing declarations of intent (living will, organ donation consent) Prescription renewal requests Caregiver of a child under 10years old can view the child s prescriptions and patient records The information can be viewed as from the date when the organisation has joined the Kanta Services 3.10.2017 21
Most Respected Finnish Network Brands 2014 2016 (Taloustutkimus Oy) 2014 2015 2016 1. Yle Areena Yle Areena Yle Areena 2. Ilmatieteen laitos Ilmatieteen laitos Kanta.fi 3. HSL Reittiopas Kanta.fi Ilmatieteen laitos 4. HelMet Yle HelMet 5. Yle HSL Reittiopas Yle 6. Kanta.fi HelMet HSL Reittiopas 7. Vero.fi Vero.fi Vero.fi 8. Foreca Poliisi.fi Foreca 9. OP/OPPohjola Foreca Kela.fi 10. Poliisi.fi OP/OPPohjola OP/OPPohjola 3.10.2017 22
Integration: Social Welfare / Phases of Deployment in Kanta 3.10.2017 1st Phase: PDF recording and availability of data for the register controller s own use 2nd Phase: Availability of data between registers and deployment of My Kanta Pages 3rd Phase: Structured recording of documents and expansion of My Kanta Pages functionalities 4th Phase: Started 29 Apr 2016 Cooperation and reporting between service providers Production Feb 2018 OPER 23 23
Coming soon: Personal Health Record Using the PHR people will be able to enter in Kanta their own data related to health and wellbeing. Data can be entered through various web applications and apps. Examples of use are home monitoring, risk tests, smart diagnostics online, even fitness applications and other data that patients want to follow. Kela is designing and building the data management platform. Third parties will develop services which produce, store and analyze the data. Many nationally and regionally coordinated projects are developing self care solutions, a general trend and hot topic at the moment. Healthcare professionals will be able to access the data with patient s consent, and put parts of it on the official patient health record. Currently being designed, first phase ready by end of 2017. Based on HL7 FHIR, OAuth etc.
The TRUST of the citizens is crucial for the development of the databased health care innovations Source: Research with health data and biological material in Denmark, Danish Council of Ethics 2015
THE VISION THE TRADITIONAL MODEL THE NEW MODEL Customer Reception Official patient data + mydata Value services Professionals Customer Paper Phone Professionals New service channels 26
Digital primary care: What s my problem? What can I do myself? Image: Visit Helsinki Jussi Hellsten
Symptom navigators Service recommendations Selfhelp tools Interactive therapeutic services Healthvillage.fi Treatment paths https://www.mielenterveystalo.fi/en/pages/default.aspx women s health joints kids allergies mental health weight rare diseases pain mgm rehab neuro heart peer support arthritis cancer Diabetes 2009 biobank 2016 2017 allergies men s health
Focus of development Webservices Webservices with login Contact to service system Health care center Hospital University hospital Informing Selfcare eservices FtoF primary services FtoF secondary services Demanding special services Cost/client Number of clients Portion of digital services Web pages My Kanta (Personal Health and Wellfare Record) Mental health house Kanta / Kansa Regional and national systems Health library Image: Visit Helsinki Eetu Ahanen Virtual Hospital Self care path Providers directory and comparison Digital primary care (ODA) Nextgen EHRs: Apotti / UNA
Ministry of Social Affairs and Health www.stm.fi/eng Social and Healthcare Reform http://alueuudistus.fi/en/ regionalreform.fi National services: www.kanta.fi/en ehealth strategy: http://www.julkari.fi/handle/10024/125955 Translations of Finnish legislation: https://www.finlex.fi/en/laki/kaannokset/ Ehealth and ewelfare of Finland Check point 2015 http://urn.fi/urn:isbn:9789523025639
regionalreform.fi MINISTRY OF SOCIAL AFFAIRS AND HEALTH MINISTRY OF FINANCE 3.10.2017