Finnish Journal of eHealth and eWelfare <p><em>Finnish Journal of eHealth and eWelfare (FinJeHeW)</em> is a scientific journal established by the Finnish Social and Health Informatics Association (FinnSHIA) and the Finnish Society of Telemedicine and eHealth (FSTeH).<strong><br></strong>ISSN 1798-0798</p> <p><strong><img src="/public/site/images/riaittam/VA_tunnus_tekstein_pieni_netti23.jpg" alt=""></strong></p> Finnish Social and Health Informatics Association en-US Finnish Journal of eHealth and eWelfare 1798-0798 <p>Authors transfer copyright to the Finnish Journal of eHealth and eWelfare (FinJeHeW). The CC-BY-NC-ND license allows users to copy and distribute the Article, provided this is not done for commercial purposes and further does not permit distribution of the Article if it is changed or edited in any way, and provided the user gives appropriate credit (with a link to the formal publication through the relevant DOI) and information about authors, title of the article, title of journal, journal volume and issue.</p> <p>Please read;</p> Sosiaali- ja terveydenhuollon tiedonhallinnan tutkimus kohdistuu sähköisen tiedonhallinnan strategian eri osa-alueisiin Kristiina Häyrinen ##submission.copyrightStatement## 2019-03-10 2019-03-10 11 1-2 1 2 10.23996/fjhw.79691 Research on social and health informatics focuses on various aspects of the Finnish Information Strategy for social and health care Kristiina Häyrinen ##submission.copyrightStatement## 2019-03-10 2019-03-10 11 1-2 3 4 10.23996/fjhw.79692 Turvallinen tiedonhallinta – vaikuttavat sähköiset palvelut. Odotettavissa koko maassa -seminaari 4.10.2018 <p>Itä-Suomen yliopistolla Kuopiossa 4.10.2018 järjestetyn "Odotettavissa koko maassa" -seminaarin aiheena oli turvallinen tiedonhallinta ja vaikuttavat sähköiset palvelut. Nyt kahdeksatta kertaa järjestetyssä sosiaali- ja terveydenhuollon tiedonhallinnan keskusteluforumissa kuultiin asiantuntijoiden esityksiä ajankohtaisista teemoista sosiaali- ja terveydenhuollon tiedonhallinnan näkökulmasta. Tänä vuonna teemoiksi valikoitui potilasturvallisuus, tietosuoja ja SoTe uudistuksen vaikutukset.&nbsp;</p> Anna Marika Kristiina Vahteristo ##submission.copyrightStatement## 2019-03-10 2019-03-10 11 1-2 5 6 Conferences Kristiina Häyrinen ##submission.copyrightStatement## 2019-03-10 2019-03-10 11 1-2 7 9 Osaamisen arviointi ammattikorkeakoulussa - Mittarin kehittäminen sähköisten sosiaali- ja terveydenhuollon palveluiden opetukseen <p>The purpose of this study was to validate a measurement tool to evaluate the competence of students at the University of Applied Sciences (UAS) in the development of digital health and social care services. The aim of this study was to describe the view of UAS teachers regarding the knowledge, skills and competences that all UAS social and health care students, information technology (IT) engineers, business and business economics students need to know about developing digital services after graduation. The International Medical Informatics Association (IMIA) has drawn up recommendations for the biomedicine and health information (BMHI) curriculum, and the service design skills descriptions had been used as a reference framework for assessing the competence of students that is now evaluated by Finnish, Estonian and Latvian teachers in an expert group (n = 17). The evaluation took place on a four-step Likert scale, from unimportant to important, as well as unsuitable to suitable. The measurement tool was in English. These included the sum of the content validity index of the entire form (S-CVI/Ave) and the competence content-validity indexes (I-CVI), whose acceptance limit was determined by 0.80 acording to the literature. After the evaluation, 82 competence sentences were omitted from 35 competence sentences to describe the students’ competence. The importance of the S-CVI/Ave was initially 0.84, and after removing the sentences, it was 0.94. The S-CVI/Ave was initially 0.72, and after removal, it was 0.91. The multidisciplinary team assessed the importance and suitability of the students’ competences in their own fields, which reduced the number of competence sentences based on the content validity index. Consequently, this research demonstrates that teachers do not require the same broad range of expertise as stated by international recommendations. The validation of the measurement tool will be continued by studying the views of the teachers of University of Applied Sciences at national level on the need for competence of students at the Bachelor level.</p> Outi Maria Ahonen Ulla-Mari Kinnunen Kaija Saranto ##submission.copyrightStatement## 2019-03-10 2019-03-10 11 1-2 10 24 10.23996/fjhw.74411 Sähköiset terveyspalvelut osaksi potilaan arkea <p>Studies recently showed that interest in electronic healthcare services has increased, and there is a need to guide and inform patients and their families about the formats of such services. The purposes of this study were to determine what factors cause patients to accept electronic healthcare services and to determine what factors affect patients’ to use of such services by examining patients’ opinions of the services’ usefulness and ease of use. Sample data (n=113/150, 75%) was collected from the patients of six outpatient clinics at one university hospital for two weeks in April 2017. The patients and their escorts each completed a questionnaire that consisted of background variables (n=5) and questions (n=29). Statistical methods were used to describe and test the patients’ intentions to use electronic healthcare services. It was found that the participants were motivated to monitor their wellness with electronic healthcare services based on their experiences with such services, and the patients were confident about the effectiveness of such services. In fact, half the participants accessed electronic health assessment tools on the Internet and many participants were familiar with Kanta Services. As users’ experience with electronic services increased, perceptions of the services as useful increased. In particular, young participants (under 26 years) were dominant in the use of information technology (IT), and assessed their skills in using the services as good. In contrast, elderly participants (63 years and older) lacked confidence in their IT skills. Based on these results, it was concluded that participants’ perceptions of the usefulness and ease of use of electronic healthcare services are significant predictors of the participants’ attitudes and intentions to use such services.</p> Eija Kivekäs Pasi Kuosmanen Ulla-Mari Kinnunen Martti Kansanen Kaija Saranto ##submission.copyrightStatement## 2019-03-10 2019-03-10 11 1-2 25 37 10.23996/fjhw.69813 Sähköisen moniammatillisen kotiutuslistan kehittäminen sairaalasta kotiutuksen tueksi <p>To promote effective and safe patient discharge, it is necessary to harmonize discharge practices and improve the content of the electronic nursing discharge summary. The use of a discharge checklist can improve the continuity and quality of patient’s care. It helps to remind of the essential things that are relevant to the continuity of care during the care period and can used in, for example, the compilation of an electronic nursing discharge summary.</p> <p>&nbsp;</p> <p>In this article we describe the development of the content of a multiprofessional discharge checklist into the nursing documentation system in order to harmonize the recording of the patient’s admission and care period as a result of co-operation between literature and professionals (n = 82) working in specialized health care, primary care and social work.</p> <p>The discharge checklist included some of the key issues for safe patient discharge that emerged from the literature, the available paper discharge checking list examples and multiprofessional workgroups. The discharge checklist was piloted at Satakunta Hospital District. Piloting was carried out in three central hospital wards (lung diseases, internal medicine, neurology) and at the elderly psychiatry and rehabilitation wards in paper format, after which the information content was transferred into an electronic form into Efficais nursing documentation system as part of the patient’s clinical care plan.</p> Anne Maritta Kuusisto Anne Joensuu Minna Nevalainen Terhi Pakkanen Paula Ranne Juha Puustinen ##submission.copyrightStatement## 2019-03-10 2019-03-10 11 1-2 38 52 10.23996/fjhw.70465 Technologies for fall risk assessment and conceptual design in personal health record system <p>Falls among older people are a major economic and public health problem. Due to the demographic change and aging of populations, there is an urgent need for accurate screening tools to identify those at risk to target effective falls prevention strategies. Clinical fall risk assessments are costly and time-consuming and thus cannot be performed frequently. Technologies provide means for assessing fall risk during daily living, making self-evaluations and fast methods for fall risk assessment for professional use.</p> <p>This study collects and evaluates existing technological solutions for fall risk assessment including various different sensor technologies. The study also presents one easy to use solution for assessing fall risk and suggests a concept-design for integrating sensor-based solutions into the Finnish national Kanta Personal Health Record.</p> <p>The optimal solution for technological fall risk assessment is still unclear. A wide implementation still requires extensive validation studies, adoption to health care processes and novel IoT -solutions for collecting large amounts of sensor data. Thorough methods should be utilised in designing the privacy and security aspects of fall risk assessment solutions, as well as different user profiles, to allow suitable interfaces and visualisations to users. It should always be clear what kind of data are collected from users and how the data are utilised. The consent of the users should also always be collected.</p> Milla Sinikka Immonen Heidi Similä Mikko Lindholm Raija Korpelainen Timo Jämsä ##submission.copyrightStatement## 2019-03-10 2019-03-10 11 1-2 53 67 10.23996/fjhw.73258 Validation of consumer wearable activity tracker as step measurement in free-living conditions <p>Different generations of consumer wearable activity trackers are prevalent with the increasing demands in health and physical activity monitor. This pilot study aims to validate one of the consumer wearable activity trackers, the Mi band 2 as a step measurement in free-living conditions.</p> <p>Thirty-one healthy volunteers, aged 23 to 45 with 16 female (52%), wore both Mi band 2 and ActiGraph GT9X Link on their dominant hand’s wrist for seven consecutive days. The validity of the electronic activity devices was assessed objectively by average steps/day using i) Paired sample t-tests; ii) Pearson correlation. In addition, Bland-Altman plots were constructed to visually inspect the data and to assess agreement with the ActiGraph accelerometer.</p> <p>There was a high correlation in steps/day between the reference device, Actigraph accelerometer and Mi Band 2 (r = 0.97, p &lt; 0.001). No significant mean different in steps/ day and no apparent systematic biases in the Bland-Altman plots between step count measurements obtained using the Mi Band 2. Xiaomi Mi Band 2 provided valid step count measurement in the free-living conditions.</p> Man Ka Tam Siu Yin Cheung ##submission.copyrightStatement## 2019-03-10 2019-03-10 11 1-2 68 75 10.23996/fjhw.76673 Manual annotation of narrative patient charts – Finnish experiences related to a multilingual text corpus <p>ASSESS CT project evaluated SNOMED CT use for patient information exchange in EU. Finland was one of the six participating EU states. The Finnish part of the research was conducted in the National Institute for Health and Welfare. The Finnish experiences and results are interesting from the perspective of a minority language.</p> <p>Research purpose was to compare SNOMED CT to two alternative terminology scenarios, a UMLS terminology set and a value set of national codes. The Finnish research team participated in the UMLS scenario. Clinical text samples were gathered from the six states resulting in a corpus of 60 texts. All texts were translated to six research languages. The annotators’ task was to identify clinically relevant concepts of a corpus text, add respective codes using a term browser, and evaluate concept and term coverages. The Finnish team conducted annotations as two pairs. The annotators chunked text samples covering 23 % of corpus texts by the first annotator and 35 % by the second. For clinical concepts, the annotators added 818 codes in total, of which 270 (33 %) were exact matches and 548 (66 %) different ones. Main issues affecting the Finnish results were corpus translation quality in a multilingual context and vagueness of annotation guidelines contributing to different interpretations of included semantic groups. Consequently, limited terminology content in Finnish affected results. However, the annotation bridges a path towards more comparable evaluation results of international reference terminologies such as SNOMED CT. The experiences can be used to inform a national level implementation decisions.</p> Päivi Mäkelä-Bengs Päivi Hämäläinen Virpi Kalliokuusi Riikka Vuokko ##submission.copyrightStatement## 2019-03-10 2019-03-10 11 1-2 76 85 10.23996/fjhw.70241 Health care and cyber threats <p>Finland’s cyber security strategy states that Finland has to be capable of protecting the vital functions of society, such as health care, against cyber threats. Currently, health care heads the TOP-5 list of cyber attacks because of the value of patient data in dark markets. In this article, we describe actual cyber threats, cyber vulnerabilities, and cyber attacks covering different dimensions of the cyber world.</p> <p>In this study, we use a five-layer cyber world network-model including physical, syntactic, semantic, service, and cognitive layers. The model covers widely the devices and networks from the physical layer to the human problem solving and interpretation environments in the cognitive layer. Also, the vulnerabilities of e.g. device-specific or human factor-related and realised attacks like phishing can be classified with the help of the model. Ransomwares, affecting the semantic layer, have received a lot of publicity lately.</p> <p>There are many ways to take safeguards against cyber threats in different layers. The starting point is that each organisation takes care of their cyber security in collaboration with other actors in recognising threats and in taking action against them. Creating cyber security is actually about managing the system. It is vital to focus on systems as a whole instead of individual devices. The target of the collaboration is that comprehensive know-how supports the facilities of each actor against a common threat. The continuous improvement of cyber security in health care, increasing awareness, and educating staff should be an essential part of the cyber strategy of any organisation.</p> Teija Norri-Sederholm Tiina Laitinen Martti Lehto Martti J Kari ##submission.copyrightStatement## 2019-03-10 2019-03-10 11 1-2 86 99 10.23996/fjhw.74183 NoTeb: NORDIC exploration of an early assessment framework in health care <p>Nordic Test Beds (NoTeB) is a Nordic Innovation funded project to strengthen Nordic health care cooperation. By joining Nordic university hospitals and innovation centers, its aim has been to provide a Nordic test bed cooperation ecosystem that includes templates and tools for early decisional support.</p> <p>The objective of this study was to describe how the partners in the Nordic collaboration developed and agreed upon an early assessment framework in health care. The framework was also presented as a user guide with the aim of providing advisory guidelines accessible to health care institutions to support early assessment of health innovation. A co-creation process comprising all collaborating Nordic partners initiated by a workshop, sharing current practice and aligning needs and content of for a decision support tool.</p> <p>Large Nordic variation in value assessment approaches were found. For the decision-making tools, two important features were emphasized; the need for a decision support rather than a decision-making tool and that the tool should be based on valid measures; HTA- methodology. For the user guide, it was emphasized that it should be easily available in an easy-to-read report format.</p> <p>In conclusion, NoTeB was successful in uniting Nordic countries in a common objective to develop a decision-making tool and a user guide to assess health innovations. Although the tools and the guide are still to be tested, this is a first step in developing a standardized tool for innovation assessment among the Nordic countries.</p> Kari Jorunn Kvaerner Linn N. Støme ##submission.copyrightStatement## 2019-03-10 2019-03-10 11 1-2 100 108 10.23996/fjhw.75011 Highly concentrated markets of electronic health records data systems in public health centres and specialist care hospitals in 2017 in Finland <p>Data systems for EHR and social care client data processing are usually commercial products, the trademarks of which differ from each other, for example, by usability. Previously conducted research on EHR and client data system trademarks in Finland have been based on survey responses of samples of professionals and organisations. Our study objective was to investigate market shares of EHR data systems used in public primary health care (health centres) and hospitals in 2017 in all municipalities, hospital districts and specific catchment areas in 2017. Health centres used six EHR trademarks in 2017 whereas nine in 2002. Based on populations covered, the market share was the highest for Effica (43%) and 36% for Pegasos, 7% for Lifecare, 6% for Mediatri, 5% for Graafinen Finstar and 1% for Abilita. These trademarks were produced by 4 data system providers. The number of different EHR trademarks used by health centres varied between 1–5 by hospital district. Only one EHR was used by health centres in 9 hospital districts. Public hospitals used five EHR data systems (Abilita, Effica, ESKO, Mediatri and Uranus) in 2017 whereas seven in 2001. These trademarks were produced by five data system providers. The same EHR trademark was used by health centres and hospitals in nine hospital district areas. The number of EHRs used by health centres varied between 4–5 and by hospitals between 2–4 in specific catchment areas. EHR data systems’ markets were highly concentrated in 2017 (Herfindahl-Hirschman Index was 3300).</p> Vesa Jormanainen Kimmo Parhiala Jarmo Reponen ##submission.copyrightStatement## 2019-03-10 2019-03-10 11 1-2 109 124 10.23996/fjhw.75554 Social care client information systems in Finnish municipality social services in 2017 <p>Various types of data systems technology has become part of current working environments, also in social care and social work. In Finland, social care information systems were used in almost all the municipalities in the end of 1990s. Previous enquiries in Finland that have focused on client data systems’ trademarks were carried out among social care organisations in national questionnaire studies in 2001, 2011, 2014 and 2017. However, a major problem in these studies has been a remarkable rate of withdrawals (over 50%). In this study, we investigated the trademarks of social care client data systems used in social care in every municipality in 2017 in Finland (100% coverage). In highly concentrated (HHI&gt;2500) markets in municipality social care client data systems in Finland, three data systems manufacturers provided five trademarks for 294 municipalities in 2017, whereas no electronic social care client data systems was used in 17 municipalities. The two market leader providers’ (Tieto and CGI) total market share was 90% by municipality and 95% by population calculations. Tieto’s Effica Sosiaalihuolto and CGI’s Pro Consona Sosiaalitoimi total market share together varied 73–82% by municipality or population calculations. Helsinki and Vantaa towns used ATJ/VATJ electronic social care client data system, the mean population of which was 427,000 (mean population per municipality). Market leader Effica was used in municipalities with larger numbers of inhabitants (27,600) whereas Pro Consona in smaller municipalities (9,600). Municipality social care used mainly one client data systems’ trademark in five hospital district areas, whereas two trademarks in 13 and 3–4 trademarks in three hospital district areas in 2017 in Finland.</p> Vesa Jormanainen Maarit Rötsä Kimmo Parhiala ##submission.copyrightStatement## 2019-03-10 2019-03-10 11 1-2 125 138 10.23996/fjhw.76835 Future connected health technology opportunities in non-urgent emergency care actions <p>The need of emergency care services increases due to health and social services reformation and the ageing of the population. Mobile technologies, virtual communication technologies, sensor solutions and data analytics help to organize services and to develop care paths. The described patient case in this study, concentrated on the ageing woman of home care who suffered from repeated urinary tract infections. The present situation of patient case and the future care path was described and analyzed together with the healthcare professionals, technology suppliers, researchers, and patients. Based on the collected material the care paths of patient cases can be improved by increasing health knowledge, by utilizing better the remote meters, home measurement results, connected health solutions and available information, and by enabling the quicker beginning of the required medical treatments. Additionally, it was found that the existing solutions and information can be better utilized by developing the consultation center of the healthcare professionals, the real-time follow-up system of care institutions, the common user interface of different systems that centralized directs the identification and the access of the professionals to the defined systems.</p> Mia Hautala Mari Ervasti Minna Pikkarainen Jarmo Reponen Iita Daavittila Lasse Raatiniemi Matti Martikainen Johanna Tuukkanen Juha Korpelainen ##submission.copyrightStatement## 2019-03-10 2019-03-10 11 1-2 139 149 10.23996/fjhw.70242 Kliinisen ja hallinnollisen hoitotiedon vastaavuus. Hoitoisuustiedon luotettavuus ja rakenteisen hoitokertomustiedon toisiokäytön mahdollisuudet hoitoisuuden määrittämisessä Pia Lijamo ##submission.copyrightStatement## 2019-03-10 2019-03-10 11 1-2 150 153 10.23996/fjhw.79456