Sosiaali- ja terveyspalvelut Suomessa 2018 : Asiantuntija-arvio

From information to assessment: aiming for better service

E-health and e-welfare of Finland : Check Point 2022

The report provides an overview of progressive nationwide activities towards better e-services in Finland. The information system services of social welfare and health care are monitored by systematic gathering, analysis, and use of data, which allows the tracking of the progress of operations and the realisation of goals. In 2020 and 2021, six data collections were carried out to produce data for the monitoring of the Finnish ‘Information to support well-being and service renewal, eHealth and eSocial Strategy’. Some of the results presented in the report are also openly available in database cubes

eHealth and eWelfare of Finland - Checkpoint 2011

This eHealth and eWelfare report was produced by the National Institute for Health and Welfare (THL), Finland, and FinnTelemedicum, the Centre of Excellence for Telehealth at the University of Oulu, from the results of the national eHealth implementation survey commissioned by the Finnish Ministry of Social Affairs and Health and the eWelfare survey that was conducted as part of the SADe programme funded by the Ministry of Finance. The eHealth survey describes the status and trends in health care information and communication technology (ICT) and eHealth usage in Finland in 2011, comparing the results with earlier surveys carried out in 2003, 2005 and 2007. The eWelfare survey was a national review of the electronic social services and social welfare client information systems currently available in Finland and of how they function in the social services context. This report also includes current information on Finnish eHealth and eWelfare policies and other e activities such as reviews on the main results of two other surveys performed in Finland during the same time period. This report is produced for international readers and gives a comprehensive picture of the current eHealth and eWelfare situation in Finland

Large-scale implementation of the national Kanta Services in Finland 2010-2018 with special focus on electronic prescription

Major restructuring of health services is rarely possible without pervasive information infrastructure. Implementing and adopting a new nationwide health information system (HIS) is a risky mega-project: a large-scale, complex and costly endeavour, taking many years to develop and build, invoving multiple public and private stakeholders and impacting millions of people. This research aimed to assess the implementation and adoption of the Act on Electronic Prescription (61/2007) and the Act on Processing Customer Data in Health and Social Care (159/2007) from 2010 to 2018 in Finland. To achieve this, the study used the Clinical Adoption Framework (CAF) to provide an overarching conceptualö model for electronic HIS adoption and the Clinical Adoption Meta-Model (CAMM) to assess post-deployment of the national Kanta Services. This research revealed and documented the central building blocks of a large-scale nationwide development process established to implement electronic services based on national legislation in Finland and then described their implementation and adoption using rigorously log-based register data and specific indicators during the follow-up. In addition, this research was the first both to measure prescription volumes in Finland and to investigate the nationwide use of My Kanta Pages in public primary healthcare centres (PHCs), hospital districts and university hospital special catchment areas. The middle-out implementation approach employed in Finland proved an apt strategy for the nationwide adoption of the Kanta Services. It combines local consultation, locally driven investment and system choice, thus promoting a bottom-up approach, with central government support, leadership and resources and nationally agreed interopearbility standards and goals, which represent elements of a top-down apprach. The results of this research suggest that it is possible to create and adopt two large-scale nationwide HIS in 5.5 years covering public PHCs and pharmacies, hospitals and private healthcare providers in a counrty with 5.5 million inhabitants. The Prescription Centre services were implemented and adopted first, and thereafter the Patient Data Repository services. Public healthcare services providers implemented and adopted the Kanta Services first, and thereafter private healthcare service providers. Use of the Prescription Centre, the Patient Data Repository and My Kanta Pages increased continuously in an exponential fashion during the follow-up. The follow-up data of this research from May 2010 to December 2018 provide observations on the increasing availability of the nationwide Kanta Services, which led to increasing and ongoing use among citizens and professional users, in turn resulting in observable changes in clinical and health behaviours that may have resulted in improvements in measured outcomes. Based on the results of this Kanta Services infrastructure research (log register data, registered implementation start dates, and a large population survey), long-term follow-up observations point towars the 'Adoption with Benefits' archetype of the CAMM.Terveyspalvelujen uudelleen järjestäminen on harvoin mahdollinen ilman läpitunkevaa tiedonhallinnan infrastruktuuria. Uuden maanlaajuisen terveydenhuollon tietojärjestelmän käyttöönoton suurprojekti sisältää paljon riskejä: se on laaja-alainen, monimutkainen ja kallis, sen kehittämiseen ja rakentamiseen kuluu vuosia, sidosryhmiin kuuluu useita julkisen ja yksityisen sektorin toimijoita ja muutosprojektilla on vaikutuksia miljooniin ihmisiin. Tämän tutkimuksen tavoitteena oli tutkia ja selvittää, kuinka Eduskunnan hyväksymät lait Laki sähköisestä lääkemääräyksestä (61/2007) sekä Laki sosiaali- ja terveydenhuollon asiakastietojen sähköisestä käsittelystä (159/2007) toimeenpantiin ja valtakunnalliset tietojärjestelmät otettiin käyttöön Suomessa vuosina 2010-2018 soveltamalla teoreettista viitekehystä Clinical Adoption Framework (CAF) käyttöönottoihin sekä viitekehystä Clinical Adoption Meta-Model (CAMM) valtakunnallisten tietojärjestelmien käyttöönoton jälkeiseen seurantaan. Tutkimuksessa selvitettiin ja dokumentoitiin Suomessa lakisääteisten terveydenhuollon sähköisten palvelujen kansallisen kehittämisprosessin toimeenpanon keskeisiä piirteitä sekä kahden Kanta-palvelun käyttöönottoa, niiden etenemistä ja seurantaa tietojärjestelmien lokitiedoista tuotetuilla indikaattoreilla ja aikasarjoilla. Lisäksi tässä tutkimuksessa mitattiin ensimmäisen kerran lääkemääräysten volyymi Suomessa. Tutkimuksessa selvitettiin myös ensimmäisen kerran valtakunnallisen potilaan terveystietojen portaalin (Omakanta) käyttöä Suomessa alueellisesti terveyskeskuksittain, sairaanhoitopiireittäin ja yliopistosairaaloiden erityisvastuualueittain. Kanta-palvelujen toimeenpanon ja käyttöönoton strategiaksi valittu välimuoto (middle-out) toimi hyvin valtakunnallisissa käyttöönotoissa. Välimuoto yhdistää näkökulman alhaalta ylös (bottom-up) painottamia paikallisia tarpeita ja investointeja sekä tietojärjestelmien valintoja yhteen näkökulmassa ylhäältä alas (top-down) painottuvien keskushallinnon tuen, johtamisen, resurssien ja kansallisiin sopimuksiin perustuvien yhteen toimivuuden standardien ja tavoitteiden kanssa. Tulosten perusteella on mahdollista ottaa 5,5 vuoden aikana käyttöön kaksi terveydenhuollon valtakunnallista tietojärjestelmää Suomen terveyskeskuksissa, apteekeissa, sairaaloissa sekä yksityisessä terveydenhuollossa (5,5 miljoonaa asukasta). Kanta-palveluissa Reseptikeskus otettiin käyttöön ensin ja sen jälkeen Potilastiedon arkisto. Julkisen terveydenhuollon toimijat ottivat valtakunnalliset tietojärjestelmät käyttöön ensin ja sen jälkeen yksityisen terveydenhuollon toimijat. Reseptikeskuksen, Omakannan ja Potilastiedon arkiston käyttö kasvoivat jatkuvasti ja eksponentiaalisesti seurannan aikana. Tämän tutkimuksen tulokset toukokuusta 2010 seurattuina joulukuun loppuun 2018 viittaavat siihen, että Kanta-palveluiden saatavuus oli edistynyt ja niiden käyttö oli kasvanut kansalaisten ja ammattilaisten keskuudessa, mikä puolestaan näyttäisi johtaneen kliinisiin ja käyttäytymisen muutoksiin, mitkä puolestaan ovat saattaneet parantaa mitattavissa olleita lopputuloksia. Kanta-palvelujen infrastruktuurin tutkimustiedot (lokitiedot, rekisteröidyt käyttöönottojen aloitusten päivämäärät sekä väestökyselyn tulokset) pitkäaikaisessa seurannassa viittaavat CAMM-viitekehyksen arkkityyppiin 'Adoption with Benefits' (käyttöönotto hyötyjen kera)

The power of architecture towards better hospital buildings

The physical qualities of a hospital building can in the best case indicate a high level of development and humanity in a given society. The academic purpose of this doctoral dissertation is to articulate the accumulated knowledge and dynamics of these qualities as well as other know-how deemed relevant to the primary quest of improving the current state of our hospitals. Its pragmatic purpose is to facilitate analysis and to assist in the development of conceptual tools meant to improve the design processes and practices, thereby creating conditions more conducive to high quality architecture. The widely held view is that recent hospital buildings have not responded to modern demands in a satisfactory manner. The hypothesis is made that this view is well-founded, and that the main reason for it is that the architectural quality of the vast majority of these hospitals has not reached the level that should be expected of major public buildings. This study claims, and attempts to show, that the underlying reasons for this lack of quality are the shortcomings in the actual design process and in the way design services are procured, as well as in an excessive emphasis on specialisation. A historic overview is presented in which the recurring themes of the study are highlighted. Four historic periods are taken up in more detail. These eras are seen by the author to be particularly relevant when creating strategies aimed at producing better buildings for health care. The examples from these past eras are analysed through drawings, old and new photographic material, site visits and discussions with present users. The study claims that only through combining lessons learnt from the past with a thorough knowledge and insight into the topical discourse can administrators, medical professionals and other user-clients, but above all architects, achieve the design quality that should be expected of our future health care facilities. The present discourse and trends have been examined through research projects and case studies, as well as discussions with major international authorities. Recommendations are made on how improvements could be achieved. Present best practices are referred to, while some topics prominent in the present discourse are critically analysed. The study concludes with a conceptual physical synthesis that consists of the presentation of two successful entries for major international architectural design competitions for health care facilities of the future. In the latter case the task was to design a city, a health care system for that city, as well as conceptual designs for the buildings serving that system. These competition entries were based on the knowledge accumulated during the process of writing this dissertation as well as experience from previous and concurrent professional practice. They provide models where lessons learnt are combined with the latest ideas on creating health care facilities that could actually become attractive places to use and visit, and would display an architectural quality of the highest order

Final report of the regional government, health and social services reform: Experiences of the preparatory work, lessons and conclusions

The aim of the regional government, health and social services reform that started in 2015 was to provide people with services on a more equal basis than before, level out differences in health and wellbeing and curb cost increases. The reform sought to reinforce basic services and utilise digital services better than before. The reform also aimed at bridging a large part of the sustainability gap in general government finances. The Government's aim was to save EUR 10 billion, of which approximately EUR 3 billion was meant to be covered through the reform in healthcare and social services by 2029. The large reform involved sizeable legislative drafting work and preliminary national and regional preparation for the implementation. The implementation work for the reform was carried out in the ministries, agencies and institutions in different administrative branches, regional projects and service centres. The preparatory work for the regional government, health and social services reform was implemented in cross-ministry and intersectoral cooperation and close interaction with people engaged in the preparation in the counties. The scale of the regional government, health and social services reform, its social significance and engagement in people's everyday services made the reform an exceptional project for the Government. The objectives of the reform were ambitious and the size of the reform was unprecedented in Finnish administrative history. Preparations for the regional government, health and social services reform continued until 8 March 2019. At the time, Prime Minister Juha Sipilä’s Government resigned and preparations concerning the regional government, health and social services reform could no longer be continued