The successful use of tools for Finnish professionals

Transkriptio

1 The successful use of tools for Finnish professionals Minna Kaila, MD, PhD, Pediatric Allergist Adjunct Professor /University of Tampere Senior Medical Officer /Finohta at STAKES minna.kaila(at)stakes.fi or (at)iki.fi mobile

2 Finnish Health Care System - publicly funded - NHS/Beveridge (van der Zee & Kroneman BMC Health Services Research 2007; 7:94) Doctors: Nurses: Population 5.3 million *homogenous OULU KUOPIO 5 University Hospitals and 21 Hospital Districts ~250 Primary Health Care Centers TURKU TAMPERE TAMPERE HELSINKI The ~400 municipalities are responsible for providing *Primary Health Care and * Specialized / Secondary Care

3 Finnish clinical practice guidelines since late 1980's EBM guidelines > Current Care guidelines > other guideline related material XML -format indexing involved in the development ~700 clinicians CC + ~300 EBMG implementation - hospitals & PHC the head of the board of CC is one hospital Medical Director

4 Portal for health care professionals

5 Portal DUODECIM for health care professionals Patient information Search engines Guidelines and evidence Dictionaries ICD-10 Drug information Specialist societies CME Kustannus Oy DUODECIM

6 Lääkärin käsikirja (YKT) 1218 Käypä hoito 278 Hoidon perusteet 247 Potilasohjeet 555 Sairaanhoitopiirien hoito-ohjelmat 631 Kuvat 2062 Aikakauskirja Duodecim 9328 Lääkärilehi Työterveyslääkäri 432 Laboratoriotutkimukset 6631 Näytönastekatsaukset 3596 Evidence summaries 3087 Matkailijan terveysopas 89 Rokottajan käsikirja 84 FinOHTA 132 Kela 131 Puolustusvoimat 52 Lääkärin etiikka 99 Äänet 77 Laskurit ja lomakkeet 26 Info 30 EBM Guidelines /concise & primary health care Current Care / thorough & all of health care National criteria for non-emergency care Patient information Hospital Districts localized guidelines /care pathways Pictures Finnish Medical Journal Duodecim Finnish Medical Journal Occupational physician (journal) Laboratory investigations Evidence summaries Travelers health guide Vaccinators hand book Social Insurance Institution s guidelines (reimbursement) Defense forces Physician s ethics Sounds Calculators and forms Information

7 Calculators Alkoholin käyttö Alcohol use Antikoagulanttiannostelu Anticoagulant dosing Ejektiofraktio Ejection fraction Energiankulutus Energy expentiture GFR-laskuri Glomerular filtration rate Haittaluokka ja prosentti Disability classification Kehon painoindeksi Body Mass Index Korjattu QT-aika QT time Kuivuman korjaus Rehydration LDL-laskuri LDL-cholesterol calculator PEF-laskuri PEF-calculator Reynolds Risk Score (naisille) SCORE-laskuri SCORE calculator Tavoitesyke Target rhythm UKPDS Veden vajaus hypernatremiassa Water deficit in hypernatremia

8 Lääkärin käsikirja (YKT) 1218 EBM Guidelines /concise & primary health care Käypä hoito 278 Current Care / thorough & all of health care Hoidon perusteet 247 National criteria for non-emergency care Potilasohjeet 555 Patient information Sairaanhoitopiirien hoito-ohjelmat 631 Hospital Districts localized guidelines /care pathways Kuvat 2062 Pictures Aikakauskirja Duodecim 9328 Finnish Medical Journal Duodecim Lääkärilehi All guidelines Finnish are Medical available Journal in Työterveyslääkäri 432 Occupational physician (journal) one search engine to Laboratoriotutkimukset 6631 Näytönastekatsaukset 3596 Evidence summaries 3087 Matkailijan terveysopas 89 Travelers health guide as a part of Physician s Database Rokottajan käsikirja 84 Vaccinators hand book FinOHTA 132 Laboratory investigations Evidence summaries 98 % of Finnish physicians Kela 131 Puolustusvoimat 52 Lääkärin etiikka 99 Äänet 77 Laskurit ja lomakkeet 26 Info 30 Social Insurance Institution s guidelines Defense forces Physician s ethics Sounds Calculators and forms Information

9 Use of EBMG, Current Care and related databases in the Terveysportti Health Portal Number of guideline documents opened 10 million/year Total number of documents opened >20 million/year

10 Current Care - 77 guidelines *in Finnish *also free direct access

11 Current Care 2006 & citizens' Health Library CC hits --> > 'the public' (ip addresses not in the client register)

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13 Current Care 2006 & citizens' Health Library CC hits --> > 'the public' (ip addresses not in the client register) In addition, the public accesses the patient versions of CC guidelines via the 'Health Library' - after official publication 2007: guideline hits.

14 Implementation /hospital districts & PHC Why What How Where By whom When Systematic review or study (National) guideline (National) guideline Localised guideline /care pathway Localised guideline /care pathway Localised guideline /care pathway Treatment plan/appointment Treatment plan/appointment I Kunnamo

15 3rd National seminar on care pathways May 2007

16 Lääkärin käsikirja (YKT) 1218 Käypä hoito 278 Hoidon perusteet 247 Potilasohjeet 555 Sairaanhoitopiirien hoito-ohjelmat 631 Kuvat 2062 Aikakauskirja Duodecim 9328 Lääkärilehi Työterveyslääkäri 432 Laboratoriotutkimukset 6631 Näytönastekatsaukset 3596 Evidence summaries 3087 Matkailijan terveysopas 89 Rokottajan käsikirja 84 FinOHTA 132 Kela 131 Puolustusvoimat 52 Lääkärin etiikka 99 Äänet 77 Laskurit ja lomakkeet 26 Info 30 EBM Guidelines /concise & primary health care Current Care / thorough & all of health care National criteria for non-emergency care Patient information Hospital Districts localized guidelines /care pathways Pictures Finnish Medical Journal Duodecim Finnish Medical Journal Occupational physician (journal) Laboratory investigations Evidence summaries Travelers health guide Vaccinators hand book Social Insurance Institution s guidelines Defense forces Physician s ethics Sounds Calculators and forms Information

17 HUS PSHP PPSHP PSSHP VSSHP KHSHP SATshp EPSHP KPSHP EKSHP ESSHP LSHP KSSHP VSHP not frontpage not frontpage frontpage not frontpage not frontpage frontpage not frontpage not frontpage frontpage frontpage not frontpage frontpage not frontpage not frontpage search: + search: 1 publication link to TERVEYSPORTTI search: 2?? search?? minutes from a known project search: care pathways lnks to CC & EBMG search + alaotsikon alta: terveyskeskuksille (muuta pääasiassa) (lasten ra ja astma ) search + /need a password? search + search + need a password search + search + /need a password PHSOTEY PKSSK Kainuu SOSTERI not frontpage not frontpage not frontpage not frontpage terveyspiiri sosiaalipalvelut yhdistetty terveyspiiri terveyspiiri (Itä-Savon SHP) MISSING: LPSHP, KymSHP, Ahvenanmaa

18 National Criteria for Non-emergency Care ( care guarantee ) Pediatrics Internal Medicine Psychiatry Surgery ORL... in all ~ implementation? Current Care Guideline Evidence Criteria for treatment Care Pathway Evaluation, follow-up, indicators?

19 Centre for Pharmacotherapy Development *care pathways /house rules *multiprofessional *not only pharmacotherapy *Current Care Guidelines etc. when applicable more: Risto Mäkinen

20 Promotion of acceptance and wide use of guidelines in Finland 1. Homogeneity of health care (culture and value basis) 2. Municipal ownership of all (public) health care facilities 3. Lack of any significant competition in health care 4. Practically identical university curricula in the 5 medical faculties; 5. High national penetration of the internet technology and high computer proficiency; and 6. One respected medical scientific society responsible of the service, physicians producing guidelines for physicians

21 Integrating patient data with evidence: Clinical Decision Support EPR DS Global Scripts DS Service Database Data Data Data DS Interactions DS Contraindications DS Component Feedback Web Server Feedback DS Core DS Routines DS Indications Feedback DS Guideline Links Work station DS Local Scripts Evidence Based Medicine electronic Decision Support EBMeDS Kunnamo, Komulainen, Kaila, Mäntyranta & al

22 5th annual G-I-N Network meeting October 2008, Helsinki, Finland Implementation in practice Thank you for your attention!

23 Metathesaurus Translation of MeSH into Finnish (FinMeSH) was first completed in 1989 FinMeSH II with synonyms in terms synonyms National metathesaurus (Metathesaurus Rex) in 2003 Number of terms soon exceeds Based on UMLS (which contains nearly 3 million character strings) Identifiers (CUIs) link Finnish terms to a number of vocabularies and classifications Searching in Finnish e.g. from PubMed

24 Evidence-based Health Care Current Care EBM Guidelines FinOHTA Centre for Pharmacotherapy Development -ROHTO National Health Project Electronic Patient Record Core information Managed Uptake of Medical Methods MUMM National Criteria for Non-emergency care EBMeDS Clinical Decision Support ----? 's 2010 Basis: *Personal Identification Code 1970's --> *National statistics & registries by Social Insurance Institution, National Research and Development Centre for Welfare and Health, National Public Health Institute, etc.

25 ICD-10 search engine Search term: uti Searching for the code of urinary tract infection synonyms and search terms have been added from the metathesaurus I Kunnamo

26 Exact hit Selection of essential ICD-10 codes All ICD-10 codes I Kunnamo

27 Care pathway There are guidelines (to be implemented) There is a need (measured?) to develop (clinical) practices (are there guidelines?) Top-down Bottom-up Provider Problem / Input Process Service / Product Customer