EHTO Trends in Health Telematics in the European Union
  
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Updated: Dec 19, 96
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FINLAND |
At the moment there is no one health telematics strategy in Finland. Rather it is being pursued by
several actors with partly overlapping and partly competing interests. The
main action lines are as follows:
Health Telematics in Finland
Finland has a health system with equal access to all citizens irrespective
of where they live or how much they earn. The community in which the person
resides is responsible for arranging for the availability of healthcare
services and for paying for these services. In this system GP's in the
primary health centres act as the gatekeepers to specialised care. Patients
can also elect to use private sector services. Private sector physicians
can refer patients to specialised care in the public sector. The cost is
financed through a combination of communal taxes, state taxes, the national
health insurance plan, and, in some cases, patient part-contributions.
Currently Finland spends nearly 10% of its GDP on health care.
Information and telematics systems have penetrated widely into healthcare
at both primary and secondary care levels and are used to support clinical
and administrative functions. MUMPS-based systems form the
core of clinical applications are the increasing trend. Most hospitals have
significant networking capability and EDI messages are coming into
widespread use. A wide consensus exists on migration towards systems integration, open interfaces
(APls) and object
orientation.
Health information strategies
During the nineties the development efforts in the Finnish Welfare and
Health sector have mainly been concentrated on cost reduction, a necessity
both at national and community level. Now that the immediate budget cuts
have been implemented a more comprehensive view is emerging, that the health
service systems needs re-engineering to meet the current and emerging needs
of the population.
Communities and service providers are seeking with ways to contain costs,
manage resources, and improve outcome and quality. Actions already taken
include:
- Combining social and primary healthcare services at the community level,
- Networking across institutional boundaries for seamless care (*) and
- Introducing total quality management (TQM), resource management, benchmarking
and business process
re-engineering techniques into the health service sector.
The major planks in developing IT solutions to support care providers and
payers are
- first, to focus on support for healthcare processes, i.e. a paradigm shift from date-centred to process-centred thinking; and
- second, to ensure input of clinical, administrative, and financial
data at the site only once and making that data available throughout the
system using filters to aggregate data into meaningful information to be
used both for clinical and management decision making.
This direction has been further fuelled by the Bangemann report on the
Information Society and the Information Superhighway. The Finnish
government decided last year to implement a special action in this area.
One of the domains where this concept is expected to have a major impact is
health.
The main actors in this field comprise the Ministry of Welfare and Health
together with STAKES; the care providers, i.e. hospitals, primary health
centres, and private sector care givers; the communities who are paying for
the major part of the cost; and industry, including the telecoms operators.
Ministry of Welfare and Health and STAKES
The Ministry of Welfare and Health's research and development work is
mainly in the area of information guidance. STAKES (National Research and
Development Agency for Welfare and Health) is maintaining a service based on
discharge summaries. It allows a crude comparison of outcomes and
performance. STAKES intends to develop this towards a system that enables
benchmarking between care providers. A similar service is currently
available from the Association of
Finnish Local Authorities. Within this service certain coding schemes
are enforced. From 1997 ICD-10 will be in full use together with some
other more detailed coding schemes.
Basis for the information systems strategy
The information strategy of an organisation must be based on its general
strategy, which will define how the organisation and its operations are to
be developed. From this will flow the strategic information, organisational
models, process models, roles of different actors, etc. that are needed to
build a consistent information systems strategy. At the national level the
information system strategy can only be based on general trends, generic
infrastructure and basic services needed.
As an example, a major theme at local and regional levels would be to
develop patient centred strategies. This will optimise clinical data flows
linking major diagnosis/treatment groups. The general practitioner (private
or public) with personal knowledge of the patient acts as the patient's
agent, looking after his/her interests in the process as well as following
the cost, whilst the local municipal organisations, as the service funders,
wish to be able to observe the costs and influence the decisions. As well as
supporting the improvement of clinical productivity this model could
facilitate continuity of care. It could also enhance decision-making and
improve quality management. The funding mechanism of healthcare means that
change management can only be done from the bottom up. In terms of
telematics applications this means that strong user orientation and the
commitment of local authorities are the crucial requirements if the results
of R&D are really to be
utilised.
Equality in access needs special attention and telemedicine
Compared to most of the rest of Europe, Finland is a very sparsely
populated country, thus Finnish strategies tend to stress equality of access
to high quality specialised services. Telemedicine has excellent potential
to realise a model where the general practitioner or other professional
health care workers working in the front line of care delivery can be
supported by the specialist clinicians at centres of excellence. This type
of virtual hospital is a reality already in some healthcare domains.
Although the cost savings are not dramatic, telemedicine is clearly
benefiting the streamlining of patient care and avoiding unnecessary
transfers of patients and travelling for specialists. In many sparsely
populated counties telemedicine is seen as the means of saving many small
health centres from closing down. It gives the general practitioner or
other health professional working in a remote location needs professional
support in terms of second opinion and access to continuous medical
education. For the national strategy the ability to get top level expertise
offered in a local surgery or even at home and the possibility of
competition between the units offering specialised services is probably the
major benefit from telemedicine. Telemedicine also fits well into the
patient centred and continuity of care views.
The home centred view
With the proportion of the elderly steadily increasing in the population,
home healthcare, home care and home support are an essential and growing
part of Finnish social and health services. Generally health and social
service management provides co-ordinated health care delivery. There is a
key role for non-invasive measuring technology, and technology to support
independent living, home security and communications.
Conclusion
With a highly developed telecommunication infrastructure, Finnish society
and industry has excellent prospects of prospering from the benefits of the
Information Society. The networks offer the capacity needed for a national
health network with high level of security and services available to all
having the basic equipment. The major problem is the lack of good
applications to make full use of the possibilities of modern telematics.
(*) The Finnish health system uses a unique
patient identifier. It has long been a requirement to combine all episodes
of care in the public sector into a "continues health record".
Consequently every citizen has a health record containing data of all health
related data. Visits to the private sector are not included .
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