-3.10.2017

Digital Technologies Improving Patient Outcomes

Maritta Korhonen

Ministerial Counsellor

Ministry of Social Affairs and Health

Finland

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In theory, there is no differencebetween theory and praxis. In praxis, there is. (Yogi Berra)

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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

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Population densityin FinlandInhabitants / km2

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Finnish Public Healthcare System 2017

KUH

OUH

TUH

TUCH

HUCH

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

These are divided into hospital

districts, 20 altogether in Finland

Primary healthcare is provided by the

communs

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Objectives of the Finland’s social and health services reform 2020

Renewal of services

More expedientadministration

Better and more fluidfunctioning of services

Citizen participationEnhancement of economic growth

Cost-effectiveness

to promote and enhance the

activities of citizensand enterprises

Administrationas a service

OpennessCustomer-focus.

Interaction and dialogue

Reduced differences in health and social wellbeing

Improved equality, efficiency of fundamentalrights

Slowing of the expenditure growth(1.5 % to GDP)

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• 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

Public health work and structural social work into focus again

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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.

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Name

Surname10

Information to support wellbeing and servicerenewal (eHealth and eSocial strategy 2020)

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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 co-operation 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

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Architecture for eHealth

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2017

Name

Surname12

Public healthcare providers

Other national services

Kanta services

ePrescriptionservice

Dispensations

Patient data repository

Health records, structured

Consent and will managementConsents and

their restrictionsLiving wills and other wills

(organ donation, etc)

National code server Code systems and terminologies

Form structures

Pharmacies (~800)

Hospital districts (20)

Primary care org. (192)

Private healthcare providers (4000)

Patient summary management

Diagnoses Other summary dataRisks

eHealth DSI / CEF

Main standards• HL7 V3: CDA R2 L3 and Medical Records• HL7 FHIR DSTU2 (PHR)• JSON, XHTML (PHR and social services)• PDF/A (legacy data and social services)• IHE IT-I Profiles (Imaging and epSOS)• W3C XML DSig• WS Addressing, WS-I• TLS, X.509

Organization register

Radiology DICOM studies

Pharmacy register

Renewals

Prescriptions

Logs

Logs

Certification services HCP and SCP register

Pharmaceutical database

Health records, legacy

Health care professionals

My Kantapages

Citizens (> 5 000 000)

Web-GUIs for

HCPs

Kan

tam

ess

agin

g la

yer

Personal Health Record Customer’s mydata

Data repository for social services

Logs

Customer docs Customership and service item data

Pat

ien

t d

ata

man

age

me

nt

serv

ice

Summary managementLegacy data

Social care providers

ep

SO

S

NC

P

X-Road

Encounters

ORGANISATIONSUSING THE NATIONAL

SERVICES THROUGHTHEIR SYSTEMS

INTERNATIONAL CONNECTION(epSOS, CEF)

ACCESS FOR CITIZENS - TOP 3 WEB SERVICE IN

FINLAND

BASED ON INTERNATIONAL

STANDARDSSUPPORTING SERVICES

NATIONAL DATA STORE

E-PRESCRIPTION

PATIENT DATA(patient record)

SOCIAL CARE DATA

PERSONAL HEALTH AND WELLBEING DATA

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De facto: Electronic Prescription

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• 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 web-based service (HCP portal) for handling electronic prescriptions, to be used mainly by individual doctors and small organizations

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Electronic Prescriptions Promote PharmaceuticalSafety

• 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 paperformat

• 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

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0

50,000

100,000

150,000

200,000

250,0001 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

ElectronicPrescriptionRenewalRequests

20112010 20142012 2013

Electronic Prescription Renewal Service

2015

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208 232 (5/2017)

2016 2017

15

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Cross Border Exchange of Data and Services

• Exchange of electronic prescriptions between Finland and Estonia as a permanent reciprocal cross-border 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 e-prescriptions ready for dispensation in Estonian pharmacies

• 2019 Estonian e-prescription ready for dispensation in Finnish pharmacies

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Growing: Patient Data Repository

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• 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

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Benefits of the Patient Data Repository

• Provides access to individual medical records

• Previous test results can be utilised, which avoids unnecessarytreatment

• Encrypted data transfer, professional cards, monitoring of logdata 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

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5 554 753 persons5 080 679 informings2 550 179 consents

56 001 denials225 143 wills

181 831 Organ donation wills43 312 Living wills

Information Management Servicein Patient Data Repository (05/2017)

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All logins

Number of

Visitors

20112010 20142012 2013

Popular: My Kanta -pages

2015

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1 140 557 (5/2017)

514 969 (5/2017)

2016

2,02 Mill. Personshave used service

by 31 March 2017

2017

20

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My Kanta Pages for Citizens

• Citizens can view their own prescriptions and medicalrecords

• 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 owndata

• 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 10-years old can view the child´sprescriptions and patient records

• The information can be viewed as from the date when the organisation has joined the Kanta Services

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2014 2015 20161. Yle Areena Yle Areena Yle Areena2. Ilmatieteen laitos Ilmatieteen laitos Kanta.fi3. HSL Reittiopas Kanta.fi Ilmatieteen laitos4. HelMet Yle HelMet5. Yle HSL Reittiopas Yle6. Kanta.fi HelMet HSL Reittiopas7. Vero.fi Vero.fi Vero.fi8. Foreca Poliisi.fi Foreca9. OP/OP-Pohjola Foreca Kela.fi10. Poliisi.fi OP/OP-Pohjola OP/OP-Pohjola

Most Respected Finnish NetworkBrands 2014–2016

(Taloustutkimus Oy)

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-OPER 23

1st Phase:

PDF recording and availability of data for the register controller’s own use

2nd Phase:

Availability of data between registersand deployment of My Kanta Pages

3rd Phase:

Structured recording of documentsand expansion of My Kanta Pages’ functionalities

4th Phase:

Cooperation and reporting betweenservice providers

Production

Feb 2018

Integration: Social Welfare / Phases of Deployment in Kanta

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Started

29 Apr 2016

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Coming soon: Personal Health Record

• Using the PHR people will be able to enter in Kanta their own data relatedto health and wellbeing.

• Data can be entered through various web applications and apps. Examples of useare home monitoring, risk tests, smart diagnostics online, even fitnessapplications 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 caresolutions, a general trend and hot topic at the moment.

• Healthcare professionals will be able to access the data with patient’sconsent, 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.

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The TRUST of the citizens is crucial

for the development

of the data-based health care innovations

Source: Research with health data and biological material in Denmark, Danish Council of Ethics 2015

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THE VISION

THE TRADITIONAL

MODEL

THE NEW MODEL

CustomerReception

Paper Phone

Professionals

Official patient

data + mydata Value services

ProfessionalsNew service

channels

Customer

-Image: Visit HelsinkiJussi Hellsten

Digital primary care: What’s my problem? What can I do myself?

-2016 20172009

mentalhealth

weight

rarediseases

women’shealth

pain mgm

rehab

biobank

kids

peersupport

allergies

men’shealth

joints

arthritis Diabetes

cancerneuro

heart

allergies

Symptom navigators Service recommendations Self-help toolsInteractive therapeutic servicesTreatment paths

https://www.mielenterveystalo.fi/en/Pages/default.aspx”Healthvillage.fi”

Image: Visit Helsinki

Eetu Ahanen

Cost/client

Number of clients

Portion of digital services

Informing Selfcare eServices

F-to-F

primaryservices

F-to-F

secondaryservices

Demandingspecial

services

WebservicesWebservices

with login

Contact to

service

system

Health care

centerHospital

University

hospital

Kanta / Kansa

Regional and national systems

My Kanta

(Personal Health and Wellfare Record)Web pages

Providers directory and comparison

Digital primary care (ODA)

Virtual Hospital

Mental health house

Next-gen EHRs: Apotti / UNA

Health library

Self care path

Focus of development

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Ministry of Social Affairs and Healthwww.stm.fi/eng

Social and Healthcare Reformhttp://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/

E-health and e-welfare of Finland - Check point 2015http://urn.fi/URN:ISBN:978-952-302-563-9

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regionalreform.fi

MINISTRY OF SOCIAL AFFAIRS AND HEALTH ● MINISTRY OF FINANCE