Teleradiology—changing radiological service processes from local to regional, international and mobile environment

Abstract The possibilities of teleradiology to modify the radiological service process in a regional, international and mobile setting were investigated by building new types of technical connections and then by evaluating their feasibility. First a teleradiology link based on low-end technology was built for primary care and hospital settings. On evaluation, the total diagnostic agreement between the transmitted images and the original films was 98%. Then, a work practice-oriented approach was used to gain an understanding of the relationship between the emerging teleradiology work practice and the newly implemented technology. Ethnographically informed fieldwork and cooperative workshops were utilized. According to findings, articulation work that supports the key tasks is mostly conducted at the receiving site, and radiologists have to rely on much less information in image interpretation. The decisions made at the sending site influence the outcome. To study the idea of consultations between different countries, a connection utilizing the Internet was built between university hospitals in Oulu, Reykjavik and Tromsø. After 131 images, a suitable image compression ratio was selected. Image quality and transfer time of the 80 clinical case readings were found to be adequate for teleradiology. A wireless image consultation system for radiological sub-specialist consultations based on a portable computer and a mobile phone with secure access to the hospital network was set up and tested. The transmitted images of 68 patients were acceptable for final diagnosis in 72% of the cases. The wireless link saved the senior radiologist a hospital visit in 24% of the cases. A smartphone was then used to communicate computed tomography scans in a feasibility study of 21 patient cases of brain attacks. All transmitted image series were suitable for giving a preliminary consultation to the clinic, and in one case even a final report could be made. In a real life clinical setting of the study with neuroradiological and neurosurgical emergencies, two different smartphone platforms with electronic patient record integration were built in European research projects and evaluated with sets of 115 and 150 patient cases. They were good for final diagnosis in 38% and 40% of the cases, respectively. The concept was found to be ready for clinical use. Finally a survey was made showing the status and trends of the usage of eHealth applications in Finland. The results from all the public health care providers and a representative sample of private providers showed that in 2005, teleradiology services were used by 18/21 hospital districts and the usage of all eHealth applications has progressed throughout the entire health care delivery system. Teleradiology services have become an integrated part of eHealth

Emergence of teleradiology, PACS, and other radiology IT solutions in Acta Radiologica

Abstract For this historical review, we searched a database containing all the articles published in Acta Radiologica during its 100-year history to find those on the use of information technology (IT) in radiology. After reading the full texts, we selected the presented articles according to major radiology IT domains such as teleradiology, picture archiving and communication systems, image processing, image analysis, and computer-aided diagnostics in order to describe the development as it appeared in the journal. Publications generally follow IT megatrends, but because the contents of Acta Radiologica are mainly clinically oriented, some technology achievements appear later than they do in journals discussing mainly imaging informatics topics

Lääketieteen alojen opetuksen digiloikka:MEDigi-hankkeen raportti

Tiivistelmä MEDigi — Lääketieteen alojen opetuksen digitoiminen ja harmonisointi (dnro OKM/270/523/2017) on opetus- ja kulttuuriministeriön (OKM) kärkihanke, jolle OKM on myöntänyt 3,2 miljoonan euron erityisavustuksen. Hanke toteutettiin 1.4.2018–31.12.2021 lääketieteellisten tiedekuntien yhteistyönä Helsingin, Itä-Suomen, Oulun, Tampereen ja Turun yliopistoissa. Hankkeen tavoitteena on ollut valtakunnallinen lääketieteen koulutuksen harmonisointi ja modernisointi hyödyntämällä digitalisaatiota lääketieteen ja hammaslääketieteen opetuksessa. Hankkeelle asetettiin sen alussa kuusi osatavoitetta. Hankkeen käynnistyttyä tunnistettiin tarve seitsemännelle tavoitteelle, joka koski juridisia asiakirjoja ja erilaisia ohjeistuksia kansallista opetusta, oppimateriaaleja ja verkostoyhteistyötä luotaessa. Englanninkielinen versio: isbn978-952-62-3245-

Digital transformation of medical education:MEDigi project report

Abstract MEDigi — Digitalisation and harmonisation of teaching in medical fields (record no. OKM/270/523/2017) is a key project of the Ministry of Education and Culture, to which the ministry has granted special funding in the amount of EUR 3.2 million. The project was conducted between 1 April 2018 and 31 December 2021 as cooperation of the medical faculties at the universities of Helsinki, Eastern Finland, Oulu, Tampere and Turku. The objective of the project has been to harmonise and modernise education in medical fields in Finland by utilising digitalisation in undergraduate medical and dentistry teaching. At the beginning of the project, six sub-objectives were set. Once the project was launched, the need for a seventh sub-objective was identified, which concerned legal documents and various guidelines for the creation of national teaching, study materials and network cooperation. Finnish version available: isbn978-952-62-3246-

CAF and CAMM analyses on the first 10 years of national Kanta services in Finland

Abstract We report the large-scale deployment, implementation and adoption of the nationwide centralized integrated and shared Kanta health information services by using the Clinical Adoption Framework (CAF). The meso and macro level dimensions of the CAF were incorporated early into our e-health evaluation framework to assess Health Information System (HIS) implementation at the national level. We found strong support for the CAF macro level model concepts in Finland. Typically, development programs were followed by government policy commitments, appropriate legislation and state budget funding before the CAF meso level implementation activities. Our quantitative data point to the fact that implementing large-scale health information technology (HIT) systems in practice is a rather long process. For HIT systems success in particular citizens’ and professionals’ acceptance are essential. When implementation of the national health information systems was evaluated against Clinical Adoption Meta-Model (CAMM), the results show that Finland has already passed many milestones in CAMM archetypes. According to our study results, Finland seems to be a good laboratory entity to study practical execution of HIT systems, CAF and CAMM theoretical constructs can be used for national level HIS implementation evaluation

Terveyskeskusten ja erikoissairaanhoidon sairaaloiden sähköisten potilaskertomusten markkinat olivat erittäin keskittyneet vuonna 2017 – onko syytä olla huolissaan?

Tiivistelmä Potilas- ja asiakastiedon käsittelyyn tarkoitetut ohjelmistot ovat kaupallisia sovelluksia, joiden tuotemerkit eroavat toisistaan esimerkiksi käytettävyyden perusteella. Aiemmat terveydenhuollon potilastiedon ja sosiaalihuollon asiakastiedon sähköisten tietojärjestelmien kertomusosioiden tuotemerkkien selvitykset ovat perustuneet kyselytutkimusten henkilö- tai organisaatiovastaajien otoksiin sekä erillisiin kyselyihin tai tietopyyntöihin. Selvitimme osana virkatyötä terveyskeskuksissa ja sairaanhoitopiirien sairaaloissa käytettyjen sähköisten potilaskertomusten markkinaosuudet vuonna 2017 sairaanhoitopiireittäin ja erityisvastuualueittain kaikissa kunnissa ja järjestämisen kuntayhtymissä. Vuonna 2017 terveyskeskuksissa oli käytössä kuusi potilaskertomusten tuotemerkkiä, kun luku oli yhdeksän vuonna 2002. Väestöjen perusteella markkinaosuus oli suurin Efficalla (43 %) ja Pegasoksella (36 %), kun se oli 7 % Lifecarella, 6 % Mediatrilla, 5 % Graafisella Finstarilla ja 1 % Abilitalla. Terveyskeskusten potilaskertomusten kuudella tuotemerkillä oli neljä valmistajaa. Sairaanhoitopiirin alueen terveyskeskukset käyttivät 1–5 potilaskertomusta. Yhtä potilaskertomusta käyttivät yhdeksän sairaanhoitopiirin alueen terveyskeskukset. Sairaaloissa oli käytössä viisi eri sähköistä potilaskertomusta (Abilita, Effica, ESKO, Mediatri ja Uranus) vuonna 2017, kun luku oli seitsemän vuonna 2001. Sairaanhoitopiirien potilaskertomusten viidellä tuotemerkillä oli viisi valmistajaa. Sama tuotemerkki oli käytössä yhdeksän sairaanhoitopiirin alueen terveyskeskuksissa ja sairaaloissa. Erityisvastuualueilla oli käytössä alueen terveyskeskuksissa 4–5 ja erikoissairaanhoidossa 2–4 eri potilaskertomusta. Sähköisten potilaskertomusten markkinat olivat erittäin keskittyneet (HHI=3300) vuonna 2017

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

A digital care pathway to access healthcare without time and place restrictions

Abstract A digital care pathway is a secure digital service channel for patients in a care relationship with a specialized health care hospital in Finland. It is part of the Health Village portal built in co-operation with the Virtual Hospital project by five Finnish university hospitals led by Helsinki University Hospital. Health Village services make healthcare services available to all Finns regardless of place of residence and income level, thus improving the equality of citizens

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