Finnish Journal of eHealth and eWelfare https://journal.fi/finjehew <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 https://creativecommons.org/licenses/by/4.0/legalcode&nbsp;</p> Verkostoidu terveysalan tiedonhallinnan yhteisössä https://journal.fi/finjehew/article/view/86088 Laura-Maria Peltonen Copyright (c) 2019 Finnish Journal of eHealth and eWelfare http://creativecommons.org/licenses/by-nc-nd/4.0 2019-11-02 2019-11-02 11 4 241 241 Konferenssit https://journal.fi/finjehew/article/view/86090 Kristiina Häyrinen Copyright (c) 2019 Finnish Journal of eHealth and eWelfare http://creativecommons.org/licenses/by-nc-nd/4.0 2019-11-02 2019-11-02 11 4 242–243 242–243 WIS 2018 Special issue "Fighting Inequalities” https://journal.fi/finjehew/article/view/86832 Reima Suomi Hongxiu Li Ágústa Pálsdóttir Roland Trill Copyright (c) 2019 Finnish Journal of eHealth and eWelfare http://creativecommons.org/licenses/by-nc-nd/4.0 2019-11-02 2019-11-02 11 4 244–245 244–245 10.23996/fjhw.86832 Empowering citizens through data interoperability - data federation applied to consumer-centric healthcare https://journal.fi/finjehew/article/view/82599 <p>During the era of open systems, healthcare services and related data are in a constant flux caused by digital transformation. The amount, sources and dimensionality of data grow rapidly, and solutions for data governance, integration and interoperability are urgently needed. At the same time, digital data and information technology–enabled healthcare services are offered as a means to empower citizens. The objective is for active citizens to take better care of their own health. It is possible to support empowerment in many ways, such as with easy-to-use information systems (IS) or personal health records (PHR), or by supporting citizens’ participation in health data creation. In this article, we first present the federative approach to data governance with data federation matrixes in order to show how data are made interoperable by combining data from different data storages. Federation matrixes define shared attributes with their technical, information-flow and socio-contextual metadata. We then contemplate how the federative approach can be deployed to citizens’ healthcare data empowerment. We propose that data ontologies, e.g., data federation matrixes, are useful in bridging gaps between the social contexts of citizens and healthcare professionals and, by doing so, to promote citizen empowerment. The present article contributes to research on the federative approach to data governance, its deployment to citizens’ healthcare empowerment, and to the practice-oriented further development of the federation matrix tools for this and other use cases.</p> Tiina Anneli Nokkala Tomi Dahlberg Copyright (c) 2019 Finnish Journal of eHealth and eWelfare http://creativecommons.org/licenses/by-nc-nd/4.0 2019-11-02 2019-11-02 11 4 246–257 246–257 10.23996/fjhw.82599 Skills and knowledge as a basis for safety competence in teacher education curriculum https://journal.fi/finjehew/article/view/80362 <p>Enhancing the safety culture in school context sets new challenges to prospective teachers, their need for safety skills, knowledge and competence. Based on the latest studies, the paper describes the factors of safety culture in the educational institutions. These factors are risks, processes, learning environments, learning, normative guidance, actors, target groups and tools. As a case study, further analysis is provided about the factor of learning. The data is teacher education curriculum text of one Finnish teacher education unit.</p> <p>In the content analysis, the data was first classified with themes in the context of safety. During the second round of analysis, special attention was paid to the verbs. Further, two groups, skills (S) and knowledge (K) were established.</p> <p>The analysis showed that there were more knowledge based (K) than skills based (S) meaning units. As the university studies are based on theoretical issues, this is understandable. Based on the analysis, it seems that the curriculum describes safety one-sided as the social issues and the interaction were in focus in both groups, knowledge and skills. This could mean that safety is valued in the teacher education. However, the results raise some concerns, whether the future teachers are able to provide decent education for their pupils in the various safety and security areas, such as traffic safety, injuries or occupational safety, or whether they are able to respond in the sudden crisis situations during the school day, for instance in case of violence or fire.</p> Brita Marianne Somerkoski Copyright (c) 2019 Finnish Journal of eHealth and eWelfare http://creativecommons.org/licenses/by-nc-nd/4.0 2019-11-02 2019-11-02 11 4 258–266 258–266 10.23996/fjhw.80362 Voices behind indicators for welfare and healthcare in Finland https://journal.fi/finjehew/article/view/80196 <p>The voices of different kinds (i.e., stated or unstated expectations of the entities) affect the functioning of the systems. Voices of authorities (VoA), processes (VoP) and shareholders (VoS) are seen in controls interacting with an environment. Therefore, control-related indicators are prescriptive, and they provide expectations for the functioning of the systems. In the study, the entity-related approach of the voices (VoA, VoP, and VoS) adapted to formalize rules for the evaluation metadata of the KUVA and SOTKANET indicators the meaning of which is to control welfare and health in Finland. The KUVA indicators are meant to control especially cost-effectiveness. The region classifications of the KUVA and SOTKANET indicators used to figure out whether responsible information providers (VoP) and information consumers (VoA and VoS) can be established. When 15 region classifications mapped within the voices by the nine rules the result of which was that nine region classifications mapped within VoA, three within VoS, and two within VoP. The main information providers are municipalities and hospital districts and municipalities. Despite our metadata-based KUVA and SOTKANET content research, without the deployment instructions of the indicators, the municipalities and other service providers do not get a complete picture of how the authorities and shareholders see them and what is expected of them, i.e., control-related cost-effectiveness will not be transparent.</p> Petteri Mussalo Virpi Hotti Hanna Mussalo Copyright (c) 2019 Finnish Journal of eHealth and eWelfare http://creativecommons.org/licenses/by-nc-nd/4.0 2019-11-02 2019-11-02 11 4 267–286 267–286 10.23996/fjhw.80196 Accessibility of TV media for the dual-sensory impaired in Finland and in the UK https://journal.fi/finjehew/article/view/79962 <p>One of the most used media is television. Almost all of us have a television set at home. Television is commonly thought also to be accessible, and for most of us, it seems to be so. However, there are people who cannot enjoy televised programmes without special measures. These measures include subtitling, audio description and sign language interpretation. All these are mentioned in the in-force EU Audiovisual Media Services Directive.</p> <p>In this article we look at how these are broadcast in different countries, what equipment is needed for receiving them, and how accessible the programme information (EPG) and menus to choose these accessibility options are, as they most often are not automatic, but have to be turned on in the accessibility options menu or the TV set or digital terrestrial receiver box (digibox). This article focuses on accessibility with special interest on the dual-sensory impaired perspective over four days comparing two countries: the UK where all three accessibility features mentioned above are well-established and Finland, where accessibility features concentrate mainly on subtitling.</p> Stina Ojala Russ Palmer Riitta Lahtinen Copyright (c) 2019 Finnish Journal of eHealth and eWelfare http://creativecommons.org/licenses/by-nc-nd/4.0 2019-11-02 2019-11-02 11 4 287–295 287–295 10.23996/fjhw.79962 #eHealth2019: Special issue - Data-driven Health https://journal.fi/finjehew/article/view/86888 Pirkko Kouri Jarmo Reponen Copyright (c) 2019 Finnish Journal of eHealth and eWelfare http://creativecommons.org/licenses/by-nc-nd/4.0 2019-11-02 2019-11-02 11 4 296–297 296–297 10.23996/fjhw.86888 Half of the Finnish population accessed their own data: comprehensive access to personal health information online is a corner-stone of digital revolution in Finnish health and social care https://journal.fi/finjehew/article/view/83323 <p>In Finland, the implementation of the national Kanta services’ second phase was carried out step by step from May 2010 to December 2017. My Kanta Pages, launched in 2010, is an online service where citizens can browse their own health information recorded in the Prescription Centre and the Patient Data Repository regardless of whether the healthcare services they had used were public or private. It is the patient accessible national electronic health records in Finland (PAEHR).</p> <p>The study objective was to investigate the use of the national PAEHR by using indicator data from 2010 to 2018.</p> <p>Cumulatively 2.8 million (M) persons (51% of the Finnish population, and 63% of the adults at least 18 year old) had accessed the PAEHR 23.2M times (49.2M sign-ins) by 31 December 2018. Altogether, 6.0M e-prescription renewal request were sent to healthcare via the PAEHR by 31 December 2018. Patient Data Management Service was implemented as part of the Patient Data Repository. By 31 December 2018, the Patient Data Management Service had records of 6.3M information notices, 3.3M consents and 93,732 refusals (consent restrictions). In addition, the Patient Data Management Service had records of 467,055 organ donation testaments and 93,484 living wills.</p> <p>Half of the Finnish population in general, and two out of three adults had used the national PAEHR by 31 December 2018. Since nine years after its launch, the adults’ use of the Finnish national PAEHR is still increasing and is approaching 50% annual use.</p> Vesa Jormanainen Kimmo Parhiala Anu Niemi Marina Erhola Ilmo Keskimäki Minna Kaila Copyright (c) 2019 Finnish Journal of eHealth and eWelfare http://creativecommons.org/licenses/by-nc-nd/4.0 2019-11-02 2019-11-02 11 4 298–310 298–310 10.23996/fjhw.83323 Combining end-user recruitment methods for usability testing of eTriage Service https://journal.fi/finjehew/article/view/82596 <p>The Finnish national eHealth and eSocial strategy emphasizes citizens’ active role in promoting their own well-being by improving information management and implementing self-management and online services. In the Emergency Hub, part of the Finnish online health portal (Health Village), an eTriage Service is being developed by ICT experts and healthcare professionals. To make the eTriage Service available to the public, the user interface must comply with relevant quality and safety regulations. The aim of this paper is to describe the recruitment methods used for eTriage Service usability testing and the feasibility of those methods. The results of the actual usability testing are not discussed in this article. Two different recruiting methods were combined: online recruiting with remote testing and organized on-site testing occasions. A total of 219 volunteer end-users were recruited and 115 (52.5%) of them performed the usability testing. A better participation rate was achieved with organized on-site testing occasions, but the method consumed significantly more time and effort on the part of developers. A sufficient number and variety of end-users were recruited by combining different recruiting methods. Online recruiting with remote usability testing helps reduce the costs and effort of developers but may require a longer period of time to achieve a sufficient number of testers. A complex or highly novel, self-performing test process without any support might affect negatively the number of testers available by the online recruitment. It also seems that usability testing for digital health services can be more attractive to healthcare professionals than to persons with no healthcare education background.</p> Marja Helmi Ylilehto Eini Saarivesi Jarmo Reponen Pia Liljamo Copyright (c) 2019 Finnish Journal of eHealth and eWelfare http://creativecommons.org/licenses/by-nc-nd/4.0 2019-11-02 2019-11-02 11 4 311–319 311–319 10.23996/fjhw.82596 Adoption of diagnostic digital pathology in Finland https://journal.fi/finjehew/article/view/82550 <p>Digital pathology (DP) means digitizing histological glass slides for the assessment on a computer screen. In clinical diagnostics, DP is expected to reduce costs due to improved pathologist productivity with the aid of image analysis, workload distribution, and more accurate subspecialty-based diagnoses. The digital workflow also provides many advantages to research and education. However, the adoption of DP into clinical diagnostics has been slow. In this study, the current state and attitudes of the adoption of DP were explored with a questionnaire sent to the persons in charge of digitalization in all public pathology laboratories in Finland.</p> <p>Most of the respondents (75.0%) considered that there is a sufficient amount of validation studies about the safety of DP. The benefits of DP were seen in e.g. tumor boards (64.3%), logistics (64.3%), diagnostic quality (50.0%), and consultations (64.3%). All but one (92.9%) expected the level of digitalization to reach 100% in the following 12 years. The price of digitalization, specifically the cost of storage, was considered to be the most important barrier to a large-scale adoption of DP.</p> <p>The results suggest that there is a need for a substantial governmental financing: the virtual slide images could be stored in a central national image archive (e.g. Kvarkki) after diagnostics, leading to a remarkably reduced cost of local storage and an accelerated large-scale adoption of DP in the Finnish pathology laboratories. This would lead to improved diagnostic efficacy and quality by enabling better workload management locally and nationally. A central DP repository could serve as an invaluable database for e.g. biobank research</p> Juha Näpänkangas Teemu Tolonen Copyright (c) 2019 Finnish Journal of eHealth and eWelfare http://creativecommons.org/licenses/by-nc-nd/4.0 2019-11-02 2019-11-02 11 4 320–325 320–325 10.23996/fjhw.82550 Digi-HTA: Health technology assessment framework for digital healthcare services https://journal.fi/finjehew/article/view/82538 <p>Health technology assessment (HTA) refers to the systematic evaluation of the properties, effects, and/or impacts of health technology. The main purpose of the assessment is to inform decisionmakers in order to better support the introduction of new health technologies. New digital healthcare solutions like mHealth, artificial intelligence (AI), and robotics have brought with them a great potential to further develop healthcare services, but their introduction should follow the same criteria as that of other healthcare methods. They must provide evidence-based benefits and be safe to use, and their impacts on patients and organizations need to be clarified.</p> <p>The first objective of this study was to describe the state-of-the-art HTA methods for mHealth, AI, and robotics. The second objective of this study was to evaluate the domains needed in the assessment. The final aim was to develop an HTA framework for digital healthcare services to support the introduction of novel technologies into Finnish healthcare.</p> <p>In this study, the state-of-the-art HTA methods were evaluated using a literature review and interviews. It was noted that some good practices already existed, but the overall picture showed that further development is still needed, especially in the AI and robotics fields. With the cooperation of professionals, key aspects and domains that should be taken into account to make fast but comprehensive assessments were identified. Based on this information, we created a new framework which supports the HTA process for digital healthcare services. The framework was named Digi-HTA.</p> Jari Haverinen Niina Keränen Petra Falkenbach Anna Maijala Timo Kolehmainen Jarmo Reponen Copyright (c) 2019 Finnish Journal of eHealth and eWelfare http://creativecommons.org/licenses/by-nc-nd/4.0 2019-11-02 2019-11-02 11 4 326–341 326–341 10.23996/fjhw.82538 Potential direct secondary care cost benefits of HealthyWeightHub - Virtual Hospital 2.0 digital lifestyle intervention https://journal.fi/finjehew/article/view/82457 <p>HealthyWeighHub (HWH) is a 12-month coaching and education service designed to help patients with obesity make permanent life changes, launched and expanded gradually in Helsinki University Hospital (HUS) Healthvillage since 2016.</p> <p>We examined the direct secondary care cost benefits of HWH, measured with potential capacity freed (PCF) compared to conventional group coaching (CGC). Costs included health care, patient co-payments and travelling expenses. First, we evaluated the PCF actualized in the first two years from 2016 to 2018 in the HUS Specific Catchment Area (HUS ERVA). Then, we predicted the PCF at Finnish national level, if HWH was implemented gradually over the five years from 2018 to 2022, aimed at treating 1 % of adults with obesity annually in 2022.</p> <p>HWH’s actualized PCF was €2.69 million compared to CGC in the first two years in HUS ERVA. If the patients who received CGC had been treated with HWH instead, total PCF could have been €3.71 million. At Finnish national level, providing CGC to 1 % of adults with obesity was predicted to cost €28.0 million (€5.08 per capita) annually in 2022. With HWH predicted cost was €7.31 million (€1.33 per capita), meaning an annual PCF of €20.7 million (€3.75 per capita) in 2022 and cumulative five-year PCF of €57.5 million (€10.43 per capita). Compared to CGC, HWH is estimated to enable treatment of approximately 3.8-times more patients with obesity at the same cost.</p> <p>HWH can be more affordable than CGC and a potentially efficient tool to combat the obesity epidemic. Future evaluations should examine HWH’s effectiveness and impact on the indirect costs associated with weight loss and long-term illness.</p> Saku Väätäinen Erkki Soini Sirpa Arvonen Laura Suojanen Kirsi Pietiläinen Copyright (c) 2019 Finnish Journal of eHealth and eWelfare http://creativecommons.org/licenses/by-nc-nd/4.0 2019-11-02 2019-11-02 11 4 342–356 342–356 10.23996/fjhw.82457 National MEDigi project: systematic implementation of digitalization to undergraduate medical and dental education in Finland https://journal.fi/finjehew/article/view/83309 <p>MEDigi is a nationwide Finnish project that aims to develop and implement digital teaching, learning and assessment solutions and to provide possibilities for national harmonization of undergraduate medical and dental education in Finland. The MEDigi project will investigate the options and feasibility of a common national digital online platform and produce digital content and solutions for medical education. Furthermore, tools and support system for digital pedagogy training will be created to ensure that the teaching staff will achieve and retain appropriate digipedagogical skills. The project aims also to increase the competence related to the digital tools used in clinical practice (eHealth, digital health) of physicians and dentists. Furthermore, academic research will be carried out on various aspects of the project. All the universities in Finland that offer the Licentiate Degree in Medicine and Dentist programmes are involved: Universities of Eastern Finland, Helsinki, Oulu, Tampere and Turku. The project is coordinated by the University of Oulu. The project is carried out in close collaboration with the Finnish Medical Society Duodecim and the Finnish Dental Society Apollonia. The project lifespan is until the end of May 2021. MEDigi project is financed by the Finnish Ministry of Culture and Education and its total budget is over 4 million euros.</p> Anna Reetta Levy Petri Kulmala Jussi Merenmies Jarmo Jääskeläinen Outi Kortekangas-Savolainen Juhani Jääskeläinen Seppo Nikkari Anne Remes Jarmo Reponen Copyright (c) 2019 Finnish Journal of eHealth and eWelfare http://creativecommons.org/licenses/by-nc-nd/4.0 2019-11-02 2019-11-02 11 4 357–361 357–361 10.23996/fjhw.83309 Lectio praecursoria, Työkykytietoja voidaan kirjata potilaskertomukseen kansallisesti yhtenevällä tavalla https://journal.fi/finjehew/article/view/79321 Sari Päivikki Nissinen Copyright (c) 2019 Finnish Journal of eHealth and eWelfare http://creativecommons.org/licenses/by-nc-nd/4.0 2019-11-02 2019-11-02 11 4 362–364 362–364 10.23996/fjhw.79321