Informing the product development of an mHealth solution for people with multiple sclerosis through early health technology assessment

Abstract The potential of mHealth is enormous for chronic conditions, yet the integration of these technologies into the clinical infrastructures and healthcare pathways remains an ongoing challenge. Digi-HTA has been developed to support health technology assessment activities for novel digital healthcare technologies. The use of Early Health Technology Assessment (EHTA) can help product development. The present study describes the way in which EHTA can guide the development of a product to anticipate future needs and market access

Implementation of a new Digi-HTA process for digital health technologies in Finland

Abstract Objectives: There has been a lack of health technology assessment (HTA) methods for novel digital health technologies (DHTs) such as mHealth, artificial intelligence, and robotics in Finland. The Digi-HTA method has been developed for this purpose. The aim of this study is to determine whether it would be possible to use Digi-HTA recommendations to support healthcare decision-makers. Secondly, from the perspective of companies offering different types of DHT products, this study assesses the suitability of using the Digi-HTA framework to perform HTAs for their products. Methods: Feedback about Digi-HTA recommendations was collected from healthcare professionals. DHT companies provided input about the Digi-HTA framework. Data were collected via a web-based survey and were analyzed using qualitative methods. Results: Of the twenty-four healthcare professional respondents, twenty said that the Digi-HTA recommendations contained all the necessary information, and twenty-one found them useful for their work. Respondents hoped that the Digi-HTA recommendations would be better integrated into the decision-making processes and healthcare professionals would be more informed about this new HTA process. The questions of the Digi-HTA framework were applicable for different DHT products based on the responses from DHT companies (n = 8). Conclusions: According to the study participants, although the Digi-HTA recommendations include clear and beneficial information, their integration into healthcare decision-making processes should be improved. Responses from DHT companies indicate that the Digi-HTA framework would be an appropriate tool for performing assessments for their products. To generalize the findings of this study, more comprehensive studies will be needed

Potilastietojärjestelmiin liitetyt erikoisalakohtaiset erillisjärjestelmät julkisessa erikoissairaanhoidossa 2014–2020

Tiivistelmä Terveydenhuollossa on käytössä useita erilaisia tietojärjestelmiä. Niistä keskeisimpänä voidaan mainita potilastietojärjestelmät, joita käytetään niin potilaiden hoitotietojen kirjaamiseen kuin palvelujen ja toimenpiteiden ajanvaraamiseenkin. Terveydenhuollon tietojärjestelmiin kuuluvat oleellisina myös erillisjärjestelmät, jotka ovat erityistä toimintaprosessia tai erikoisalaa varten hankittuja järjestelmiä. Erillisjärjestelmiä on Suomessa eri lähteiden ja määritelmien mukaan kymmenistä jopa tuhansiin, ja erilaisten tietojärjestelmien suuri määrä ja pirstaloitunut tietojärjestelmäkokonaisuus haittaavat muun muassa kliinisen työn sujuvuutta. Tämän tutkimuksen tavoitteena oli saada käsitys erillisjärjestelmien tuotemerkkien ja käytön tämänhetkisestä tilanteesta julkisessa erikoissairaanhoidossa sekä selvittää erillisjärjestelmien integraatioaste eli missä määrin ne ovat käytettävissä ydinpotilastietojärjestelmän kautta. Lisäksi tarkoituksena oli tehdä ajallista vertailua pyrkimyksenä muodostaa kuva siitä, mihin suuntaan erillisjärjestelmien käytössä ollaan menty ja mihin suuntaan mahdollisesti ollaan menossa. Tutkimus toteutettiin analysoimalla vuonna 2020 kerättyä terveydenhuollon organisaatiokyselyn osa-aineistoa sekä vertailemalla sitä vuoden 2017 ja 2014 aineistoihin vastaavilta osin. Tutkimuksen perusteella erillisjärjestelmien integraatioaste on kasvanut vuodesta 2017 ja voidaan olettaa, että sen suunta on vastaisuudessakin samanlainen. Kolmen viimeisimmän kyselyn aikana erillisjärjestelmien käyttö eri erikoisaloilla on kaikkiaan yleistynyt sairaanhoitopiirien keskuudessa, ja käytössä olevien tuotemerkkien määrä on niin ikään pääasiassa lisääntynyt. Niiden osalta valtakunnalliset uudistukset ja hankkeet terveydenhuollossa saattavat kuitenkin muuttaa kehityksen suunnan jatkossa. Tulosten perusteella erikoisalakohtaisten erillisjärjestelmien käytön yleisyys sairaanhoitopiireissä ei kulje käsi kädessä tuotemerkkien määrän tai integraatioasteen kanssa, ja erikoisalojen välillä oli havaittavissa isojakin eroja näiden muuttujien osalta. Erillisjärjestelmien runsaasta määrästä voidaan päätellä, että erikoisalakohtaisten järjestelmien kliininen tarve on yhä olemassa. Laaja järjestelmäkirjo aiheuttaa kuitenkin haasteita, mikä ilmeni ristiriitaisissa vastauksissa koskien erityisesti integraatioastetta.Abstract There are several different information systems in use in healthcare. The most important of these are electronic health records (EHRs), which are used both to record patient care information and to schedule services and procedures. Healthcare information systems also include auxiliary systems that are acquired for a specific operation or specialty. Depending on the source and definition, there are tens to thousands of auxiliary systems in Finland. The large number of different information systems as well as the fragmented system architecture hinder the clinical workflow, among other things. The aims of this study were to gain an understanding of the current situation of the brands and use of specialty specific auxiliary systems in public specialized healthcare as well as to determine the degree of integration of auxiliary systems, that is, the extent to which they are available through the EHR system. In addition, the purpose was to make a comparison over time in order to see whether there are some perceivable trends. The study was carried out by analyzing the sub-data of the Finnish health care organization survey collected in 2020 and comparing it with the data of 2017 and 2014, respectively. Based on the study, the degree of integration of specialty specific auxiliary systems has increased since 2017 and it can be assumed that its direction will continue to be similar in the future. In the last three surveys, the use of auxiliary systems in different specialties has become more common among Finland’s hospital districts, and the number of brands in use has also mainly increased. For those variables, however, national reforms and projects in healthcare may change the direction of development in the future. Based on the results, the prevalence of use of specialty specific auxiliary systems in hospital districts does not go hand in hand with the number of brands or the degree of integration. From the large number of auxiliary systems, it can be concluded that there is still a clinical need for them. However, a wide range of systems poses challenges, as evidenced by conflicting responses concerning particularly the degree of integration

How to improve communication using technology in emergency medical services?:a case study from Finland

Abstract The field of emergency medical services (EMS) is a challenging environment for ensuring fluent information exchange between stakeholders because several different kinds of organizations are involved in EMS missions. Solutions for information and communication technology can vary significantly depending on the organization. This study aims to identify current communication bottlenecks between EMS professionals, understand the technological challenges behind them, and describe technologies that can improve EMS communication in the future. Information for the study about current EMS processes, technologies, and technology needs was collected from EMS professionals during three workshops, five personal interviews, and one email questionnaire. All surveyed health care professionals were working in the county of Northern Ostrobothnia. Information about proposed technologies for EMS was obtained from literature and interviews with five technology companies. The principal problem in EMS communication is scattered health data. This leads to a lack of common situational awareness for professionals and incomplete medical histories for patients. The reasons behind those problems are different information systems which do not communicate with each other and the lack of a common electronic patient care record (ePCR) for use by stakeholders. Personal health measurements, sensors, telemedicine, and artificial intelligence will create opportunities for further improving the flow of communication in EMS, provided those tools can be integrated into decision-making systems

National development and regional differences in eHealth maturity in Finnish public health care:survey study

Abstract Background: eHealth increasingly affects the delivery of health care around the world and the quest for more efficient health systems. In Finland, the development of eHealth maturity has been systematically studied since 2003, through surveys conducted every 3 years. It has also been monitored in several international studies. The indicators used in these studies examined the availability of the electronic patient record, picture archiving and communication system, health information exchange, and other key eHealth functionalities. Objective: The first aim is to study the national development in the maturity level of eHealth in primary health care and specialized care between 2011 and 2020 in Finland. The second aim is to clarify the regional differences in the maturity level of eHealth among Finnish hospital districts in 2020. Methods: Data for this study were collected in 2011, 2014, 2017, and 2020, using web-based questionnaires from the Use of information and communication technology surveys in Finnish health care project. In total, 16 indicators were selected to describe the status of eHealth, and they were based on international eHealth studies and Finnish eHealth surveys in 3 areas: applications, regional integration, and data security and information and communications technology skills. The indicators remain the same in all the study years; therefore, the results are comparable. Results: All the specialized care organizations (21/21, 100%) in 2011, 2014, 2017, and 2020 participated in the study. The response rate among primary health care organizations was 86.3% (139/161) in 2011, 88.2% (135/153) in 2014, 85.8% (121/141) in 2017, and 95.6% (130/136) in 2020. At the national level, the biggest developments in eHealth maturity occurred between 2011 and 2014. The development has since continued, and some indicators have been saturated. Primary health care lags behind specialized care organizations, as measured by all the indicators and throughout the period under review. Regionally, there are differences among different types of organizations. Conclusions: eHealth maturity has steadily progressed in Finland nationally, and its implementation has also been promoted through various national strategies and legislative changes. Some eHealth indicators have already been saturated and achieved an intensity of use rate of 100%. However, the scope for development remains, especially in primary health care. As Finland has long been a pioneer in the digitalization of health care, the results of this study show that the functionalities of eHealth will be adopted in stages, and deployment will take time; therefore, national eHealth strategies and legislative changes need to be implemented in a timely manner. The comprehensive sample size used in this study allows a regional comparison in the country, compared with previous country-specific international studies

Finnish e-health services intended for citizens:national and regional development

Abstract Electronic health care (e-health) services intended for Finnish citizens have been recently developed nationally, regionally, and locally through several projects and programs. This study aimed to investigate the development and availability of e-health services for Finnish citizens in specialized and primary health care and private medical service providers from 2011 to 2020. In addition, the differences between the availability of services in different sectors and regional differences between hospital districts were investigated. Data were collected using web-based questionnaires in 2011, 2014, 2017, and 2020 from “Use of information and communication technology surveys in Finnish health care”. This study covers all 21 hospital districts, nearly all primary health care centers, and a sample of private medical service providers. Quantitative data were analyzed using SPSS software (version 25). The availability of an e-health service was calculated as a percentage of all respondents in each sector. The results of this study show that public and private health care organizations extensively offered health care services on their websites. Almost all organizations had information on well-being, provided services, contact methods, and locations, as well as options to send electronic feedback. Remote consultation, electronic appointment booking services, and telephone counseling were also extensively offered. This study revealed that the volume of e-health services increased from 2011 to 2020. For instance, remote consultation services and information exchange through encrypted email increased rapidly during follow-up periods in all service sectors. Comparing service sectors revealed that specialized health care covers e-health services more extensively than do primary health care and private service providers. According to this study, there are also clear differences in the availability of services between hospital districts and no hospital district offered all studied services. These results suggest the need to clarify national and regional development responsibilities and standardize the availability of e-health services within and between hospital districts

Teknologian hyödyntämiseen liittyvä yksityisyydensuoja, tietoturva ja -suoja ikääntyneiden kotipalveluissa:kyselytutkimus johtajille

Tiivistelmä Tutkimuksen tarkoituksena on kuvata johtajien näkemyksiä teknologian hyödyntämiseen liittyvästä yksityisyydensuojasta, tietoturvasta ja -suojasta, niihin liittyvistä haasteista ja ratkaisuista sekä teknologisten ratkaisujen hankkimatta jättämiseen liittyvistä tekijöistä ikääntyneiden kotipalveluissa. Tutkimus on poikkileikkausasetelmassa tehty survey-tutkimus. Aineisto kerättiin syksyllä 2022 sähköisellä kyselyllä iäkkäiden kotipalvelujen johtajilta (n=68) viidestä sosiaali- ja terveydenhuollon kuntayhtymästä ja viidestätoista kunnasta tai kaupungista eri puolilta Suomea. Kyselylomake sisälsi neljä strukturoitua ja kaksi avointa kysymystä. Aineisto analysoitiin kuvailevilla tilastomenetelmillä ja induktiivisen sisällön analyysin periaatteilla. Tulosten mukaan teknologisten ratkaisujen käyttöönotossa huomioidaan Digi-HTA-arviointien asioita tietoturvasta ja -suojasta pääasiallisesti hyvin, mutta tässä tunnistettiin myös kehitettävää. Johtajien arvioiden mukaan teknologian hankintaprosesseissa huomioidaan tietosuojaan liittyvät tekijät hyvin, ja prosesseihin on luotu tietoturvaan liittyvät kriteerit. Teknologisten ratkaisujen hankkimatta jättämiseen arvioitiin vaikuttavan erityisesti se, että ratkaisut eivät vastanneet asiakkaiden tarpeisiin tai niiden ei nähty tehostavan toimintaa. Johtajien näkemykset teknologian hyödyntämiseen liittyvän yksityisyydensuojan ja tietoturvan ja -suojan haasteista liittyivät toimintaympäristöön, digitaalisiin ratkaisuihin, toimintatapoihin ja osaamiseen sekä organisaation käytäntöihin haasteiden ehkäisyssä. Näiden haasteiden ratkaisuiksi nähtiin viestintä ja vuorovaikutus, yksityisyydensuojaa, tietoturvaa ja -suojaa koskevien prosessien määrittäminen sekä toimintatapojen muuttaminen ja osaamisen kehittäminen. Yksityisyydensuojaan, tietoturvaan ja -suojaan liittyvien tekijöiden huomioiminen toteutuu ikääntyneiden kotipalveluissa pääasiallisesti hyvin, mutta toisaalta niihin liittyvät haasteet koetaan moninaisiksi. Tutkimuksessa tunnistettiin selkeä tarve koko henkilöstön laaja-alaiseen koulutukseen, konkreettisiin näyttöön perustuviin suosituksiin ja selkeisiin toimintaohjeisiin. Huomiota tulisi kiinnittää etenkin ikääntyneiden itsemääräämisoikeuden toteutumiseen ja tietoisen suostumuksen varmistamiseen.Abstract The purpose of this study was to describe managers’ perceptions of privacy protection, data security and protection in technology utilization, related challenges, and solutions, and factors related not acquiring technological solutions in home care services for the older people. This cross-sectional survey study was conducted by electronic survey in Autumn 2022. The data was collected from the managers of home care services (n=68) from five public social and healthcare joint municipal authorities and fifteen municipalities or cities located in different parts of Finland. The questionnaire included four structured and two open questions. The data was analyzed using descriptive statistical methods and the principles of inductive content analysis. According to results, the issues raised by the Digi-HTA evaluations regarding data security and protection are mainly adequately considered when implementing technological solutions, but areas for development were also identified. According to managers’ evaluations, factors related to data protection are adequately considered in the technology acquisition processes, and criteria related to data security have been created for the processes. Not acquiring technological solutions was estimated to be especially influenced by the fact that the solutions did not meet the clients’ needs or were not seen to make operations more efficient. The managers’ perceptions of the challenges of privacy protection and data security and protection in technology utilization, were related to the operating environment, digital solutions, procedures, competence, and the organization’ practices in the prevention of challenges. The solutions to these challenges were seen as communication and interaction, defining processes of privacy protection, data security and protection, changing procedures, and developing competence. Taking account of factors related to privacy protection, data security and protection is mainly adequately implemented in home care services, though the challenges associated with them are perceived as diversified. The research identified a clear need for comprehensive training of all personnel, concrete evidence-based recommendations, and clear instructions of procedures. Particularly, attention should be paid to realizing the older people’s right to self-determination and ensuring informed consent

Current use of combined hormonal contraception is associated with glucose metabolism disorders in perimenopausal women

Abstract Objective: The use of combined hormonal contraceptives (CHCs) worsens glucose tolerance, but the risk for glucose metabolism disorders remains controversial. Design: The study is a prospective longitudinal population-based cohort study. Methods: The study was based on a cohort population that comprised 1879 women born in 1966. At age 46, the women answered a questionnaire on contraceptive use and underwent an oral glucose tolerance test. Glucose metabolism indices were evaluated in current CHC (n = 153), progestin-only contraceptive (POC, n = 842), and non-hormonal contraceptive users (n = 884). Results: In the entire study population, current CHC use was significantly associated with prediabetes (OR: 2.0, 95% CI: 1.3–3.2) and type 2 diabetes (OR: 3.3, 95% CI: 1.1–9.7) compared to non-hormonal contraceptive use. After 5 years of use, the prediabetes risk increased 2.2-fold (95% CI: 1.3–3.7) and type 2 diabetes risk increased 4.5-fold (95% CI: 1.5–13.5). Compared with the current POC use, current CHC use was significantly associated with prediabetes (OR: 1.9, 95% CI: 1.2–3.0). Current POC use was not associated with any glucose metabolism disorders. The results prevailed after adjusting for BMI and socioeconomic status. Conclusions: CHC use in perimenopausal women was associated with a significantly increased risk of glucose metabolism disorders. This association should be considered in women with increased metabolic risk