12 January 2021
Finnish healthcare and the healthcare information systems suffer from the same basic problem: fragmentation. When there are multiple service providers, data processing is also fragmented says Joona Pylkäs, Head of Strategy and Business Development at TietoEVRY Healthcare.
“Different areas use dozens of different systems; the data are spread all over different systems and communication across systems is limited. Caring for the population is made difficult, when care personnel have to use many siloed systems to obtain a comprehensive picture”, says Pylkäs.
The problems in the social welfare and healthcare system are to be solved with the reform, but will the information system fragmentation be fixed at the same time?
Many of the new social welfare and healthcare districts or regions or whatever they will be called in future, are considering a new client and patient information system, one that would replace the numerous existing systems and applications. This solution also comes with problems, however.
“As the reform is approaching, service production will be consolidated in a number of areas, and the social welfare and healthcare providers will also want a consolidated IT solution for the entire sector. This will raise the question of what to do with the old systems and the data they contain”, says Pylkäs.
This autumn, a major system introduction takes place when Apotti replaces the final 30 percent of various patient data systems used by HUS. There are about ten systems in all: the largest system, Uranus, as well as dedicated systems for different areas such as surgery, anesthesia, intensive care and imaging.
Over a long career, HUS ICT Development Director Mikko Rotonen has observed that patient data systems have a life cycle of about 15 years. Over that period, technical requirements change, and Apotti is the third-generation patient data system during his time.
HUS DataLake is the largest healthcare data platform in Finland. It contains 800 million laboratory tests and about one million imaging opinions, for instance, says ICT Development Director Mikko Rotonen.
“The data structure model of Apotti is very different, and that is why we need a flexible way of looking at old data. It was not possible to transfer all old data to the structured system”, Rotonen says.
HUS has tackled the problem with a solution they developed together with TietoEVRY. It entails moving the data from previous systems to a cloud-based data lake system. The data is then available through one single application, 360° Patient.
”360° Patient complements Apotti, as it has a direct link to Apotti at the touch of one button. The end-user benefit is a comprehensive view of the information on a patient. It also offers the benefits of modern technology: the application is quick to use and has a comprehensive search function”, says Rotonen.
Speed is important, as HUS is the largest healthcare unit in Finland with almost 27 000 employees providing specialized care for more than 3 million citizens in four healthcare districts.
Consequently, an enormous amount of data is generated, and the HUS DataLake is the largest healthcare data platform in Finland. It contains about 800 million laboratory tests and one million imaging opinions, for instance. The new data from Apotti is also continuously being transferred to the data lake.
“We are able to create and visualize views rapidly when planning patient care. An anesthesiologist may, for instance, wish to review earlier anesthesia records in order to calculate the risk score of the patient. By combining old data, you can create an individual care path”, says Rotonen.
The aim is to terminate the production and history use of the old patient data systems with the help of the HUS DataLake and 360° Patient, which in Rotonen’s view would be a major financial advantage.
The recently appointed Administrative Chief Physician of HUS, Veli-Matti Ulander, was still doing patient work, when 360° Patient was introduced last summer. As an obstetrician he had to look for patient data in several systems: he accessed the delivery report in the Obstetrics system, but other patient data could be found in the Uranus patient data system.
HUS Chief Physician Veli-Matti Ulander describes the patient data system 360° Patient: ”This is a well-functioning tool for the intermediate stage, when we move from the old system to the new”.
”Access to data is faster when using 360° Patient than if you opened the old patient systems. This is a well-functioning tool for the intermediate stage, when we move from the old system to the new. I have used this myself, when, for instance, looking for data on the previous pregnancies and deliveries of the patient”, Ulander says.
Ulander notes that you also need to access health records that are several years old, for an accurate reconstruction of care events, in the event of a patient claim or complaint.
The complete care history data of a patient is basically available in the Kanta system as well, but in Ulander’s opinion Kanta is a very cumbersome tool.
“Given a choice, this is where I would look for information – certainly not in the Kanta system.”
Introducing a new Electronic Health Record, EHR system is a cumbersome, slow and expensive process. With the tendering process and introduction, the entire process may well take five years and cost tens of millions of euros. It makes economic sense to look at several suppliers in the buying process, but then there may be problems with reaching an agreement on the priority of various features.
“Not only is the tendering stage challenging, but with several actors, everyone has a strong opinion on what exactly is required. 360° Patient is a lighter solution that allows more time to implement the tendering processes”, says Tiina Tauru, Head of Regions at TietoEVRY.
The social welfare and healthcare reform means challenges concerning both new routines and costs for the healthcare districts. Besides, COVID-19 has given rise to extra costs and reduced income that is normally obtained. In a situation like this, extra efforts, such as a new EHR system, are not all that welcome. Data still have to be transferred between systems, however.
”We have paid special attention to data security and privacy when designing and developing this solution, says Joona Pylkäs, Head of Strategy and Business Development at TietoEVRY Healthcare.
“This solution supports the primary systems over the several years of the transition phase, while operations are being harmonized”, Pylkäs says.
The social welfare and healthcare reform will not automatically mean that a given district only uses one patient data system. It is probable that the HUS district, for instance, will continue to use several systems. It is also possible that the healthcare sector and the social welfare sector will each keep their own patient data systems.
“If active use of several patient data systems continues in a district, we can offer 360° Patient as a regional solution. It provides a regional view of patient data without requiring changes to existing systems: they continue to exist, and this solution is added on top, as an umbrella solution”, Pylkäs tells us.
The TietoEVRY solution works as a common platform, pooling data from different sources in the social welfare systems and healthcare patient data systems and harmonizes them.
“Our solution is based on cloud-based solutions and related tools, offering the latest technology and cutting-edge tools for data transfer and processing. This allows us to process data more efficiently than before”, says Pylkäs.
The Vastaamo data breach, which has upset the public in Finland, shows how important data security is in systems related to patient data. It is TietoEVRY’s view that data is better stored in the extremely secure and audited cloud environment.
“In our design and development work we have given special attention to data security and privacy. Data and connections are invariably encrypted, for instance. Besides, the solution as a whole has been comprehensively evaluated by external data security experts”, Pylkäs tells us.
The patient display of 360° Patient has been developed together with HUS’s clinics and the development work continues. The display introduced in June is still a new product.
“We are actively further developing this application together with HUS. We add features needed by the end-users, and the application will have several new sources of information. The solution is designed to allow flexible introduction of new sources of information, both ours and software from other vendors within social care and healthcare”, Pylkäs explains.
Tiina Tauru agrees that the patient display is easy to develop and that the design cycle is much faster than in patient data systems.
Ulander at HUS, for instance, notes that the way in which 360° Patient presents data could be improved: a useful feature would be a display that allows the user to see different laboratory test value histories without having to search for each one separately.
“The time perspective is important when we look at patient data, and it is also important that we can combine diagnostic tests and health records chronologically. A positive feature of 360° Patient is that you can search information using keywords”, Ulander says.
HUS and TietoEVRY have also worked together on developing digital healthcare for a long time. The HUS Health Village concept provides the public with information on health questions and digital care paths that can be more specifically personalized in the future.
“The Health Village is both a provider of data to the DataLake and a user of data available in it. The DataLake is an important hub that sends data in different directions”, says Mikko Rotonen.
Renewing a patient data system, including tendering, is a cumbersome, slow and expensive process. 360° Patient allows you more time to complete the process, says Tiina Tauru at TietoEVRY.
Surely the social welfare and healthcare reform won’t impair digital development?
Although the advantages provided by digitalization for better and more efficient healthcare are acknowledged by politicians as well, it does not always seem to be clear what reforms will entail in practical terms.
In the case of the Uusimaa district, for instance, the reform will pose a threat in that the number of controllers of healthcare data may increase, says Mikko Rotonen. The transfer of information between different controllers will always mean extra work.
“We are having discussions about ways to make data transfers as smooth as possible, when people move within Uusimaa, for instance. The Kanta service is not the solution. We need a more accurately designed solution to gain more flexible data access. Instead, we can offer 360° Patient, which has a better search engine”, Rotonen points out.
Tiina Tauru of TietoEVRY would like to have a public debate about ways to have a balanced reform of the social welfare and healthcare legislation: professional and secure processing of patient data without forgetting support to further digitalization.
“A number of digital healthcare development projects are never carried out. Even though they are technically viable, the regulatory requirements complicate things, and the price tag grows out of control”, says Tauru.
“It is important that all the data concerning a patient can be used in the services. Only then can the digital solution provide the maximum benefit to both the patient and the care personnel. At the same time, we must make sure that “agile” applications are not quickly and cheaply built on quality systems, which may possibly endanger data security.”