Finnish Journal of eHealth and eWelfare

Overview of Finnish national patient data repository for research on medical risk assessment

Viljami Männikkö — 2024-10-14

The Kanta Patient Data Repository (PDR) contains healthcare data from the population of Finland for more than a decade. The repository is a continuously expanding real world dataset produced by many information systems and healthcare service providers. Kanta data has been available for secondary uses such as scientific research since 2019. The data can be requested from the Finnish authority Findata. However, before a request has been accepted, it is difficult to assess if the accumulated data allows answering a specific research question. Publicly available descriptions of data structures in the Kanta PDR do not tell how much they are used in practice. This publication enables future data use cases by providing a view on the overall availability of types of structured health data in the Kanta PDR based on a sample of 96 200 medical histories of over 18-year-old patients. We conclude that the Kanta PDR is a promising source of real world data for development and evaluation of medical risk calculators within the Finnish population. The wide coverage of the Finnish population and timeliness of the data are its strengths as a source of research data also outside of Finnish context. However, the limitations on data availability in variable level need to be considered on a case-by-case basis. Main challenges in the use of data in the Kanta PDR are multiple code systems for laboratory results, short durations of recorded data for specific data types, and missing or very rarely used structured format e.g., in cases of tobacco and alcohol use.

Registered nurses' experiences of information systems at the beginning of wellbeing services counties in Finland

Tuulikki Vehko — 2024-10-14

Registered nurses' experiences of information systems have been studied as part of the monitoring of the implementation of the Finnish eHealth and eSocial 2020 Strategy theme ‘Smart Systems for Capable Users’. This evaluation study provides up-to-date information and a better understanding about experiences that registered nurses have related to client and patient information systems.

A modified electronic survey, based on previous data collections in 2017 and 2020 was sent by the Finnish Nurses Association and Tehy in the spring of 2023. After one reminder, 2,970 responses were received. Descriptive methods were used in the analyses of the survey conducted in the cross-sectional setting.

The majority (70%) of the registered nurses were highly experienced or experienced users in client and patient information systems (briefly systems). The systems support collaboration and information exchange was satisfactory level within respondents' own organisation but not between registered nurses in different organisations or between registered nurses and patients. At least half of respondents assessed that systems help to ensure continuity of care, and help in preventing errors and mistakes associated with medications, but the results were slightly lower level related to systems potential to avoid duplicate tests and systems potential to improve quality of care. The majority (76%) of the respondents assess that it is difficult to see the essential information from a considerable amount of data. The majority (75%) stated that the system takes too much time out of the nurse’s time with patients. In public health centres 29% used daily Kanta Services for obtaining patient data from another organisation, but the proportions were lower level at public hospitals (11%) and private sector (10%). In public health centres majority (58%) assess unsatisfactory situations related to inhouse training in system use, and similarly 59% point out that employers did not offer continuous training in systems use.

After the wellbeing counties have just started operating, the monitoring carried out did not have significant changes in the registered nurses’ experiences of the systems compare to the results of 2020. Obtaining patient data via Kanta Services increased between 2020 and 2023 and this development must be monitored. Organisations should provide adequate in-service training for staff in changing work processes.

Informed consent in the age of smart technologies

Jaana Leikas — 2024-10-14

Technology is increasingly being brought into the home care of older people. Digitalization is seen as an enabler for efficient and resource-saving operations. In the use of technology, informed consent is considered an ethical practice and part of a responsible home care service system. The aim of this article is to describe the problem of informed consent in situations where emerging technologies, such as artificial intelligence (AI) and mass data, are used as part of welfare services and home care for older people. The article discusses principles and ways to better integrate informed consent as an ethical practice into a responsible home care service system.

A qualitative study was carried out to gather the views of experts in the field of elderly care and ethics. A content analysis of a semi-structured focus group was used to explore perceptions of the changing nature of informed consent. According to our findings, the informed consent model requires updating. The key is to embrace the idea that consent is a living process designed to respect people's autonomous choices and protect them from risk. If the nature of the use of the data collected from individuals changes significantly in the future, the consent should also be updated to reflect this change. This aspect is important because new technologies will change the nature of the collection and use of the data. Mass data collection combines multiple databases so that the resulting data can be used even far from the original purpose or context in which it was collected. Therefore, consent should always be tailored to the context, allowing sufficient time for the person seeking and giving consent to clarify the content of the consent. This process highlights the importance of understanding the agency of the consent giver.

Users’ perceptions of electronic patient safety incident reporting software

Saija Koskiniemi — 2024-10-14

Incident reporting is a central part of the continuing development work on client and patient safety, although incidents are under-reported. At the general level, it is known that incident reporting systems themselves can be one of the many reporting barriers. Nevertheless, users’ perceptions of incident reporting systems and their features, in addition to users’ knowledge regarding incident reporting, have not been widely studied.

This study describes users’ perceptions and knowledge of patient safety incident reporting software and incident reporting. The results can be used when planning and developing incident reporting processes and systems.

The study was conducted as a cross-sectional electronic survey. The questionnaire was sent to all potential incident software users in two wellbeing service counties in Finland in January 2024. From the data, HaiPro and Laatuportti systems’ users’ (n=729) background questions and structured responses were analysed. The results were presented as frequencies, percentages, means, and standard deviations. Differences between HaiPro and Laatuportti users’ satisfaction were investigated using the Mann-Whitney-U-test.

The results showed that the respondents were satisfied with their knowledge related to incident reporting and reporting software. Respondents were the most dissatisfied with the features of incident reporting software for handling the reports. There were no statistical differences between HaiPro and Laatuportti users’ responses. However, HaiPro users were often more satisfied with the software’s features than Laatuportti users. Altogether, respondents were similarly satisfied and dissatisfied with the reporting software’s features, regardless of the software used.

In Finland, incident reporting software reform is planned based on the national Client and Patient Safety Strategy and its Implementation Plan. In this development, attention to end-users’ perceptions is central to achieving improved software acceptance and effective implementation.

Preventing patient falls – introduction of research-based Fall T.I.P.S. model in special medical care departments

Tarja Kansanen — 2024-10-14

The prevention of falls requires the identification of the factors underlying the incidents leading to falls and the strengthening of the factors that maintain safety. The organization is responsible for drawing up client and patient safety guidelines, but all staff members are responsible for their implementation. The Fall Tailoring Intervention for Patient Safety (Fall T.I.P.S.) model has been developed for fall risk assessment workflow, emphasizing the importance of preventive measures. This qualitative register study aims to identify precipitating factors related to patients` falls at the early stage of introducing the fall T.I.P.S. model in hospital wards.

The research data consisted of reports to the HaiPro reporting system for dangerous adverse events (N = 224) at a university hospital after one year of the introduction of the Fall T.I.P.S. model. The data were grouped with Atlas. - ti software. Entries describing the elements of the fall T.I.P.S. model and the factors contributing to the fall were selected and grouped from the event descriptions. Content analysis was used in data analysis.

According to the results, patients` functional capacity, diseases (86%), pharmacotherapy (14%) and mobility aids (12%) were identified as precipitating factors (n=202) to in hospital falls. According to the Fall T.I.P.S. model, a personal management plan (72%), consistent intervention and maladministration (18%) and risk assessment (9%) were recorded as measures to prevent (n=124) the recurrence of risk events. The Fall T.I.P.S. model was found to support the prevention of falls. The notifications also highlighted training support, introduced the Fall T.I.P.S. model, and identified personnel's information needs. Identifying information needs, multiprofessional competence, and utilizing evidence-based information are essential to developing safe operating practices. With the help of comparison data, the organization can monitor the results of the same type of units and thus support the development of quality and patient safety.

Terveydenhuollon työntekijöiden eri sukupolvien välinen digitaalinen osaaminen

Reetta-Maria Uljas — 2024-10-14

The current reform of social and healthcare services and structure aims to limit the growth of costs and promote access to services. Social and healthcare services are increasingly being developed to be more customer-oriented, timely, effective and efficient through digitalization. The changes have a particular impact on the working methods and content of healthcare workers, as digitalization of services requires digital competence. Previous research suggests that a worker's age and year of graduation affect their ability to use digital systems, with digital competence declining from the age of 45 onwards. The purpose of this study was to explore the generational differences in the digital competence of healthcare workers.

The study followed a cross-sectional study design. The survey data (n=817) was collected through an electronic questionnaire from healthcare professionals in nine healthcare organizations nationwide. The survey included background questions and questions about the respondent's self-assessed digital competence and factors affecting digital competence on a four-point scale. The data was statistically analyzed using the SPSS software.

Based on the results, it can be concluded that the Z and Y generations experience stronger digital competence than the X generation and older generations. The older generations rate the support of factors influencing digital competence as more significant than the younger generations. In health care, it would be important in the future to target competence development methods, considering the differences in digital competence between generations. Organizations and work communities should therefore work actively and systematically to identify the digital competence needs of different generations, so that digital services and solutions can be adopted more openly in the future.

The association between depression and cannabis use with technology multitasking among Finnish university students – a pilot study

Krista Hylkilä — 2024-10-14

Multitasking with technology – the simultaneous use of two or more media devices – has increased in recent years. However, to date, little research has been done on the subject, and it is therefore important to gain more information on its effects. The aim of this preliminary study was to examine associations between technology multitasking, depression symptoms and cannabis use among Finnish university students; background factors which affect technology multitasking were also considered.

The study was a cross-sectional study. Participants were Finnish university students (n = 260) and the data were gathered through a survey. The data were analyzed using descriptive statistics, independent t-test, correlation coefficient and linear regression analysis.

The results demonstrated that specific background variables are associated with technology multitasking, whereas there was no significant association between depression symptoms and cannabis use with technology multitasking. It transpired that female gender, age and daily mobile phone use related significantly to technology multitasking.

The study identified certain background factors which affect technology multitasking; technology multitasking was more common among girls and younger participants. There were no significant associations between technology multitasking and depression symptoms or cannabis use, but the results should be interpreted with caution due to the small study population. Instead, higher daily internet use was significantly associated with increased depression symptoms. Technology multitasking is a very recent subject for research, so it is important to improve our knowledge and gain new insights. The results can be used to design various health promotion projects, and multiple actors such as municipalities or organizations can use the data to e.g., plan targeted interventions.

Midwives’ account of virtual reality childbirth education

Marjaana Siivola — 2024-10-14

In Finland, prenatal clinics and birthing hospitals struggle with resources to provide expectant parents with childbirth education (CBE) and a tour of the hospital birthing unit. Not preparing for birth is common, and not knowing how and where to give birth causes parents unnecessary stress during pregnancy. One new possibility to complement CBE is using virtual reality (VR) to deliver content.

The aim of this study is to describe midwives' views of the status of parents' preparation for birth and provide information on the VR CBE program's advantages and challenges from the midwife's perspective. The study consisted of two focus group sessions with seven participants. Participants were midwives with experience from a hospital birthing ward and had provided childbirth education. The data was analysed using a thematic content analysis approach.

According to the midwives, the parents do not prepare for birth well enough. Preparing for birth affects the parents' knowledge about childbirth, their cooperation with the healthcare personnel, and how they trust the birthing process, themselves, and the healthcare personnel. Preparation can also have adverse effects if the birthing person is trying to give birth with a detailed plan or has false expectations. Parents should focus on knowledge, attitude, and mental and physical exercise in preparing for childbirth. By preparing from trusted sources, parents can make informed decisions. They have the skills to stay calm, relaxed, and open-minded during labour and birth. Physical and mental exercise will help them cope with labour and relax their mind and bodies during birth.

Midwives see VR as offering great potential for concrete, realistic, and flexible childbirth education that can address current challenges. They were also worried that VR could replace face-to-face contact. However, since there is minimal such contact in the current CBE, VR could enhance childbirth education and offer a realistic and concrete image of birth and a hospital tour.

Midwives want families to prepare better for birth and work on their knowledge, attitude, and exercise. By preparing, parents understand childbirth, trust themselves, the birthing process, and the midwives; cooperation works better. Midwives see VR as an excellent addition to childbirth education by offering realistic and concrete online childbirth education. VR should not replace face-to-face contact.

Tietoon perustuva suostumus ja tiedonhallinta osana osaamisen varmistamista

Pia Liljamo — 2024-10-14

Lectio praecursoria, Tietojärjestelmät osana sosiaalityön tiedonmuodostusta

Samuel Salovaara — 2024-10-14

Announcements and conferences

Pia Liljamo — 2024-10-14