Comparability, availability and use of medication eHealth services in the Nordic Countries

Abstract— A prescription and medication service that is optimised to protect against unnecessary harm is an essential component of a safer healthcare system. To this means, the Nordic countries have put considerable efforts in digitizing their prescription and dispensing processes and making medication related eHealth services available for clinicians, pharmacists and patients. As these e-services are being established and applied, there is a need to monitor and learn from their use. This paper reports from a sub-study of a larger activity on developing indicators for monitoring eHealth services in the Nordic countries. We describe different medication eHealth services and compare their availability to professionals and patients in the Nordic countries and the usage rates. We found that an ePrescription service is available for clinicians and patients in all Nordic countries, but services that enable renewal or viewing of prescriptions by patients are not commonly available yet. The usage rate of the e-services was not systematically registered in all the Nordic countries at the time of the study, so a comparison between the countries was impossible. A major challenge when comparing medication eHealth services is the fact that definitions of the service itself as well as the indicators used to monitor it vary between countries. The main output is a knowledge-based discussion from the Nordic context on indicators for monitoring eHealth services, evaluated by the potential outcome in terms of comparability and benchmarking

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 First 25 Years of the Bled eConference: Themes and Impacts

The Bled eConference is the longest-running themed conference associated with the Information Systems discipline. The focus throughout its first quarter-century has been the application of electronic tools, migrating progressively from Electronic Data Interchange (EDI) via Inter-Organisational Systems (IOS) and eCommerce to encompass all aspects of the use of networking facilities in industry and government, and more recently by individuals, groups and society as a whole. This paper reports on an examination of the conference titles and of the titles and abstracts of the 773 refereed papers published in the Proceedings since 1995. This identified a long and strong focus on categories of electronic business and corporate perspectives, which has broadened in recent years to encompass the democratic, the social and the personal. The conference\u27s extend well beyond the papers and their thousands of citations and tens of thousands of downloads. Other impacts have included innovative forms of support for the development of large numbers of graduate students, and the many international research collaborations that have been conceived and developed in a beautiful lake-side setting in Slovenia

Information Technology's Role in Global Healthcare Systems

Over the past few decades, modern information technology has made a significant impact on people’s daily lives worldwide. In the field of health care and prevention, there has been a progressing penetration of assistive health services such as personal health records, supporting apps for chronic diseases, or preventive cardiological monitoring. In 2020, the range of personal health services appeared to be almost unmanageable, accompanied by a multitude of different data formats and technical interfaces. The exchange of health-related data between different healthcare providers or platforms may therefore be difficult or even impossible. In addition, health professionals are increasingly confronted with medical data that were not acquired by themselves, but by an algorithmic “black box”. Even further, externally recorded data tend to be incompatible with the data models of classical healthcare information systems.From the individual’s perspective, digital services allow for the monitoring of their own health status. However, such services can also overwhelm their users, especially elderly people, with too many features or barely comprehensible information. It therefore seems highly relevant to examine whether such “always at hand” services exceed the digital literacy levels of average citizens.In this context, this reprint presents innovative, health-related applications or services emphasizing the role of user-centered information technology, with a special focus on one of the aforementioned aspects

ERP implementation methodologies and frameworks: a literature review

Enterprise Resource Planning (ERP) implementation is a complex and vibrant process, one that involves a combination of technological and organizational interactions. Often an ERP implementation project is the single largest IT project that an organization has ever launched and requires a mutual fit of system and organization. Also the concept of an ERP implementation supporting business processes across many different departments is not a generic, rigid and uniform concept and depends on variety of factors. As a result, the issues addressing the ERP implementation process have been one of the major concerns in industry. Therefore ERP implementation receives attention from practitioners and scholars and both, business as well as academic literature is abundant and not always very conclusive or coherent. However, research on ERP systems so far has been mainly focused on diffusion, use and impact issues. Less attention has been given to the methods used during the configuration and the implementation of ERP systems, even though they are commonly used in practice, they still remain largely unexplored and undocumented in Information Systems research. So, the academic relevance of this research is the contribution to the existing body of scientific knowledge. An annotated brief literature review is done in order to evaluate the current state of the existing academic literature. The purpose is to present a systematic overview of relevant ERP implementation methodologies and frameworks as a desire for achieving a better taxonomy of ERP implementation methodologies. This paper is useful to researchers who are interested in ERP implementation methodologies and frameworks. Results will serve as an input for a classification of the existing ERP implementation methodologies and frameworks. Also, this paper aims also at the professional ERP community involved in the process of ERP implementation by promoting a better understanding of ERP implementation methodologies and frameworks, its variety and history

Front-Line Physicians' Satisfaction with Information Systems in Hospitals

Day-to-day operations management in hospital units is difficult due to continuously varying situations, several actors involved and a vast number of information systems in use. The aim of this study was to describe front-line physicians' satisfaction with existing information systems needed to support the day-to-day operations management in hospitals. A cross-sectional survey was used and data chosen with stratified random sampling were collected in nine hospitals. Data were analyzed with descriptive and inferential statistical methods. The response rate was 65 % (n = 111). The physicians reported that information systems support their decision making to some extent, but they do not improve access to information nor are they tailored for physicians. The respondents also reported that they need to use several information systems to support decision making and that they would prefer one information system to access important information. Improved information access would better support physicians' decision making and has the potential to improve the quality of decisions and speed up the decision making process.Peer reviewe

mHealth Innovation in Asia: Grassroots Challenges and Practical Interventions

This book offers a detailed account of a range of mHealth initiatives across South, Southeast and East Asia. It provides readers with deep insights into the challenges such initiatives face on the ground, and a view of the diverse cultural contexts shaping strategies for overcoming these challenges. The book brings together various discussions on the broader mHealth literature, and demonstrates how a research focus on diverse Asian contexts influences the success and/or failure of current mHealth initiatives. It also highlights the important roles social scientists can play in advancing theoretical approaches, as well as planning, implementing and evaluating mHealth initiatives. The book is a valuable resource for project planners, policy developers in NGOs and government institutions, as well as academics, researchers and students in the fields of public health, communications and development studies