Overview of ehealth in Finland Visit of Norwegian ehealth network to Finland Jari Porrasmaa ministry of social affairs and health
Agenda Finnish healthcare system and on-going & upcoming reforms ehealth and ICT in Finland in comparison to other countries Overview of on-going ehealth and other national ICT-projects New national ehealth strategy (draft) 2 13.3.2014
Finland? population 5,4 million GDP per capita 47 000$ (US 64 000 $) Life expectancy M 77 / F 83 years Total fertility rate 1.85 Infant mortality 2.4/100 (US 6,5) 38% have tertiary education (US 41%) OECD 3 13.3.2014
Finnish health care system Key principles: residence-based, universal and equal right to health services Two tiers: local authorities are responsible for organising primary health care (municipalities/coalitions; approx.160) and specialised medical care (hospital districts; n=20) Public services are mainly funded by tax revenues collected by the state and municipalities. client charges are collected covering 5 10 % of costs in reality, there are 3 tax-supported service systems until now, public hospitals have taken care of serious morbidity funding and financing of the health sector are nor included in the ongoing municipality and service structure reform 4 13.3.2014
Private service providers & health insurance Supplement public health care services Private hc mainly provides outpatient treatments; a few private focus hospitals have emerged Health insurance reimburses at best 30 40 % of the charges of private doctors and dentists and of examinations and treatments prescribed by private doctors Private providers are mainstream in occupational health care private sector all together (occupation health + private hc) accounts for roughly 20-25% of healthcare 5 13.3.2014
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Population 1970 Population 2007 7 13.3.2014 16.3.2012
Municipal announcements on merger report areas by end of November 2013 Excemptions from the criteria can be applied for Local Government Reform Municipalities reports and proposals of municipal mergers by July 1st 2014 Municipal mergers in effect 2015-2017, Jan 1st 2017 at the latest State special reports on municipal boundaries divisions (exception) State special reports on municipal boundaries divisions Year 2013 Year 2014 Year 2015 Year 2016 Government evaluation on the progress of the reform New Local Government Act 1.1.2015 -> New State Grant Act 1.1.2015 -> Preliminary study on the metropolitan area structures, March 2013 Municipal Structure Act in effect, summer 2013 -> Studies on municipal structures, negotiations Implementation New Act on the Organization of Social and Health Services, new organization to start 1.1.2017 New municipalities 2015-2017 -> 8 13.3.2014
Trends in Health Care Expenditure 1995 2010 change mrd. euros % All 10,8 16,0 48 special care 3,8 5,5 46 primary care * 2,2 2,8 27 oral health 0,6 0,9 51 occupational care 0,3 0,6 99 pharmaceut 0,9 2,2 154 private (reimbursement) 0,7 1,0 31 * excluding occupational, student hc and oral care Data: http://www.thl.fi/tilastoliite/tilastoraportit/2012/tr05_12.pdf 9 13.3.2014
The parallel funding and provision arrangements in Finnish health care 10 13.3.2014 15.11.
Large reforms for Finnish healthcare are coming This government (re)organisation of healthcare, legislation 2014 strengthen primary care, unify health and social care broader shoulder for healthcare organizers into effect 1.1.2017 Next government scrap multichannel funding for healthcare, create single funding channel removes suboptimization, unhealthy competition within system etc. ICT eservices for citizen (NOT patient/customer) implement the shift from provider (doctor/org.) centric paradigm to citizen centric paradigm 11 13.3.2014
ICT and ehealth in Finland - outside and inside views 12 13.3.2014
OUTSIDE VIEW: General ICT and ehealth in Finland The global leaders Denmark, Finland, and Sweden have all implemented national-level strategies to drive and coordinate health IT adoption. Lähteet: Weaknesses and threats also identified Benchmarking ICT use among General Practitioners in Europe - Final Report, 2008, European Commision Explaining international IT application leadership: Health IT, september 2009, ITIF 13 13.3.2014 Peer Review ehealth Strategy and Action Plan of Finland in a European Context
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INSIDE VIEW ON EHEALTH HEALTH IT DISASTER!!! MONEY WASTED!!! 15 13.3.2014
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TOP 3 challenges: Very fragmented decision making, too many organizations with conflicting interests, small organizations do not have sufficient procurement power and know-how Political discussion on re-organising social and healthcare is on-going Health IT market is too centralized and controlled by a few vendors, many interoperability specifications exist but have steep learning curve (need to lower barrier of interoperability spefications to enable new innovative SMEs to enter the market) Culture of co-operation not strong enough, shared vision and commitment to work together needs work ( Sweden is an examplary country ) (ehealth strategy needs an update) (quite old and complicated data protection legislation) (focus on initial investment and unable to see the development potential of new solutions) 17 13.3.2014
TOP 3 enablers: Existing national infrastructure and services - enable change in way healthcare is delivered eprescription, national patient record archive and patient access to all information (Plan to start building a national Service Oriented Architecture - Look at what Estonia has done!!!) Citizens want ehealth, no-fear about ehealth - rather they demand that their information is accessible and shared with the care chain National services enforce interoperability standards and specifications on systems (international standards eg. CDA R2 and national IGs) - legislation mandating the use of national services (level of readiness and know-how within healthcare professionals is quite high) (fragmentation of ehealth field is recognized and plans to unify the field are being developed) (highly structured data, possibilities improving clinical process and decision support - secondary uses for research etc) 18 13.3.2014
ICT and ehealth deveploment in Finland 19 13.3.2014
Recent ICT / ehealth developments in Finland Whole Finland is (soon) connected to national ICT services, production use increases, Kanta EHR service grows content wise (e.g. dental records, imaging) Kanta: eprescription, sharing/archive of EHR, patient access, details in coming presentations Create national service oriented architecture (120M) collaboration with Estonia Biobank legislation came into effect in 9/2013 5+1 large banks Renewal of EHR systems and other health/hospital/patient acccess systems is moving forward (details in coming presentations) Apotti (Helsinki region), others starting as well Enterprise architecture: national and regional work on-going Ministry of Social affairs and Health is creating a new strategy for information management and ICT ready by summer, create execution plans for the set actions during fall National genome strategy is under preparation 20 13.3.2014
The aim of the KEJO project Develop and build costeffectively a software for multiagency emergency field operations system for: Emergency medical services Social services Police Rescue services Border Guard Custom Defense Forces Photo: yle.fi 21 13.3.2014
What is KEJO? (Multiagency Command & Control System) Enterprise Architecture 22 13.3.2014
System s main functions Field management tool, command & control Situational awareness Resource management and control Communication tools Communication inside EMS Communication with other authorities Map services Destination information Navigation Registry queries domain systems vehicle, populatio, etc registries Integration and interfaces mission details: 112 or domain specific data stored in domain systems, eg. Kanta for healthcare integration into devices used in different domains Data entry and forms simple data entry & store sophisticated app: devices, registries, business logic example: emergency care record Administration Accounting (emergency care report) Reporting of shifts Support multi agency workflows Offline functionality (keep on working even if mobile connection is lost) Photo: PHPela Photo: IltaSanomat 23 13.3.2014
Social services Legislation about documents to be created Legislation about national IT services Relationship to national SOA PKI solution, identity Lot of specification work done between 2005-2011 Start implementing after the legislation work 24 13.3.2014
eservices for social and healthcare (SADe program) Development partners Mental health house eservices for the citizen (Hyvis) Purchase services / service bill (public/private co-operation) National services and specifications scheduling service directory secure messaging structure / free feedback general health information 25 13.3.2014
New ehealth strategy Work started in autumn 2013 Broad participation from national level, from social and healthcare organizations, from associations of professionals etc. Work transparently and allow larger participation through web questionaires, social media (linkedin) and interactive tools Aim to have strategy ready by summer Create implementation road map in autumn 2014 26 13.3.2014
Vision: Wellbeing, health and service information is in good use, social and health services are renewed to be citizen centric and cost effective 1. CITIZEN - YES I CAN! 2. PROFESSIONAL - CAPABLE USERS AND SMART SYSTEMS Luotettava hyvinvointitieto auttaa kansalaista elämänhallinnassa - Reliable info -Power Palveluiden laatu- to choose ja saatavuustieto auttaa kansalaista palvelujen valinnassa support choices Kansalainen voi hyödyntää ja päättää itseään koskevien tietojen käytöstä -Capability lainsäädännön to use määrittelemissä rajoissa and create health Kansalaisella on mahdollisuus tuottaa itse data tietoa sähköisesti omaan ja sote-ammattilaisten käyttöön - National PHR? and information to -Ownership of data Sosiaali- ja terveydenhuollon ammattilaisilla on käytössään työtä tukevat tietojärjestelmät sekä riittävät ja toimintavarmat -systems to support work - usability - overviews - DSS tiedonsiirto-yhteydet 3. SERVICE SYSTEM, SMARTER USE OF DIMINISHING RESOURCES -better accessibility Palvelujen saatavuutta ja esteettömyyttä parannetaan sähköisten and availablity ratkaisujen avulla through Sosiaali- ja terveydenhuollon eservices tiedot ovat käytössä riippumatta organisaatiorakenteiden, - information palveluiden ja tietojärjestelmien independent on muutoksista Sähköisen organization tiedonhallinnan ratkaisut lisäävät palvelujärjestelmän structure vaikuttavuutta ja kustannustehokkuutta - ehealth increases effectiveness and reduces costs 4. SOCIETY - KNOW BEFORE LEADING! Tietoaineistot tukevat reaaliaikaisesti yhteiskunnallista päätöksentekoa sekä tutkimus- -data ja is in innovaatiotoimintaa realtime Vaikuttavien, use for kustannustehokkaide decisions, n ja laadukkaiden research toimintamallien and ja niitä tukevien sähköisten välineiden innovation levittämistä ja -vaikuttavuuden Big data arviointia ohjataan kansallisesti ja alueellisesti 5.INFOSTRUCTURE AND GUIDING OF ORGANIZATIONS monikanavaiset ja mobiilit palvelut tavoitettavuuden ja liikkuvuuden tukena luotettava ja koeteltu tietoturva ja tietosuoja palvelu-, laatu- ja saatavuustiedot avoimesti saataville Toimiva tuotanto: luotettavat ja riittävät tietoliikenneyhteydet Kansalliset sotetietovarannot kattavasti käytössä -multichannel -mhealth -interoperability - HL7, IHE, Continua - 27 13.3.2014 tietojen valtakunnallinen yhtenäisyys ja tiedonkulku tietojärjestelmien alueellinen yhtenäisyys ja kansallinen yhteistyö innovatiiviset hankinnat kehittämisessä, konsolidointi ja laaja hankintayhteistyö levittämisessä Luodaan kansallinen infostruktuuri modulaarinen ja joustava palveluarkkitehtuuri Yhteentoimivuus kansainvälisten standardien kautta kehittämisen palveluekosysteemit - National ICT services - regional unification and national specifications -flexible SOA - ecosytems for development
Other misc thoughts Strengthen Nordic co-operation? One possible area would be interoperability specifications? Global leaders, small market place common voice to international SDOs, more influence Organize joint tracking and analysis of emerging standards work Share implementation experience IHE meeting in Stockholm 11.3.2014 - Finnish experience One area of interest for Finland is Continua / mhealth deployment Balance gadget geeks vs. health benefit Learn from Denmark s experience Anything relevant going on in other countries? 28 13.3.2014