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The health and social services reform is an unprecedented IT system reform

Co-development is paving the way to the future

26 January 2022

The health and social services reform has generally been described as the largest IT system reform in Finnish history. Wellbeing services counties are built from very different starting points. There is no ready-made model; instead, the reform needs a holistic approach and collaboration. Co-development of systems brings more opportunities to make an impact and also transparency to the costs.

The establishment of wellbeing services counties could be compared to the time when digitalization entered the Finnish health care system in general. This is how Teemu Vähäkainu, Tietoevry's Head of Health, describes the scale of the reform from an IT systems perspective.

“The establishment of wellbeing services counties concerns the lifetime history of public health care and patient information for every Finnish citizen throughout their lifetime and the work of more than 200,000 professionals. Information on social and dental care, human resources, and financial administration, among others, will also be included in the same package. ”

Different starting points

Wellbeing services counties start developing from very different starting points. In some areas, the systems are very separate in different municipalities and associations of municipalities, while in others, large integrations have already taken place. The first group includes the county of Southwest Finland; for example, Kymsote, Siunsote, and Eksote have already made integrations.

In the country of South Karelia, health and social services were brought together in 2010. The situation was similar to that in many regions now: nine different municipalities, different patient information systems, customer information systems, all with different financial and HR management systems.

"I share the pain of other counties when facing this workload," says Mika Mitikka, CIO of Eksote, the social and health district of South Karelia.

The work at Eksote was significantly aided by a well-organized deployment program. "The program included several subprojects, and each project had its own manager."

Work for everyone

Regardless of the degree of readiness or integration, the establishment of wellbeing services counties requires a significant amount of work. A lot of work is already caused by the fact that the wellbeing services county has its own new organization, which operates with its own new business ID, Mitikka says.

“In practice, it’s like starting a new large company. This is reflected, among other things, in all the countless contracts that need to be updated manually.”

In the most challenging cases, there can be dozens of different systems from different suppliers within one wellbeing services county, which means that the amount of work is considerably higher than, for example, in Eksote.

What is changing in the first phase?

In the beginning, one of the most significant changes in the transition from several data registers to one register in each wellbeing services county. In the past, the registers have been in municipalities and associations of municipalities, but under the health and social services reform, they will be brought under the same roof.

"When looking at the timeline of the change, one has to ask how the resources of organizations or any IT provider across the country will be sufficient and what can be achieved by the beginning of 2023," says Marko Pyy, Lead Product Manager at Tietoevry.

In practice, the answer is first of all to ensure the availability of information and then bring different sources of information together into one manageable entity. At the same time, it must be ensured that the data is available to professionals.

“Tietoevry has extensive experience of similar projects, and it’s clear that they practically always require a considerable amount of work,” Pyy continues.

"The data needs to be available to professionals even they are located in separate registers" says Marko Pyy.

The continuation of accessing the data is the challenge

Before major system reconciliations and integrations can be made, it is essential to ensure that professionals have access to patients' or customers' information.

“System vendors need to make sure that professionals’ access to data is not made more difficult. We need to be able to solve things from the end user's point of view so that their work becomes easier and there is even more time for patient or customer work,” says Vähäkainu from TietyEvry.

In many wellbeing services counties, the data is in many different systems, which may be from different vendors. Even this cannot prevent accessing the data.

“There has to be an information system from which information is easily accessible. In practice, one user interface that gives you access to all the information you need for patient or customer work, without having to jump between numerous applications to understand the big picture,” describes Marko Pyy.

No functioning wellbeing services county without IT changes

The health and social services reform aims to secure high-quality healthcare and social welfare services and prevent an increase in costs. For a larger unit to be useful, IT systems and their data cannot be left in silos, according to Vähäkainu.

“The wellbeing services county must be able to care for the patient and serve the social welfare client as efficiently as possible. It’s only possible if the information flow within the wellbeing services county works. In addition, the systems need to produce data to support management.”

Pyy from Tietoevry estimates that systems must act as enablers of change. If the systems don’t allow the change and harmonization of the operating models, the benefits will largely be lost. Mitikka from Eksote agrees.

“There is no way the reform could happen without changes in information systems. Even at the administrative level, it is clear that one employer must have one system.”

New opening for development work

Healthcare information systems have traditionally been developed largely at the vendor organizations internally, and new features have been introduced through version updates at regular intervals.

Earlier this year, Tietoevry launched a new way of doing development work together with customers. According to Vähäkainu, customers have had a positive attitude towards co-development.

“In the beginning, many were quite surprised by this initiative. A new kind of openness in the development work is new for both parties,” he says.

"Customers have had a positive attitude towards co-development even it was something new for both parties" according to Teemu Vähäkainu.

Predictability and speed to health and social services reform by co-development

Seven hospital districts or joint municipal authorities for health and social services are now implementing a model in which Tietoevry's Lifecare patient information system is developed together. Eksote is one of seven participants.

“The development partnership has been an excellent opening. We are able to influence genuinely and in a new way what kind of features can be obtained for future publications and how the timeline looks,” says Mitikka from Eksote.

In the past, according to Mitikka, the new features came largely from a system vendor. Now the voice of the end-user is also heard.

"One of the best aspects of co-development is that it's possible to highlight the issues and desires that come from the practical work of our clinics; whether they were related to new features or electronic transactions."

Predictability to costs

The details of the distribution of state contributions between municipalities and wellbeing services counties for 2023 are still open. Those involved in the development partnership are committed to working together for five years.

“In this situation, it is good that we have cost transparency for the most important information system for the next five years. We know how much things will cost, and we get a new kind of transparency in the expenses,” says Mitikka from Eksote.

The co-development model has proven to work so well that, according to Mitikka, similar models are now being tried with other partners.

The path must be paved together

According to Marko Pyy, co-development enables the sharing of the workload between organizations and the system supplier.

“Not everyone has to do everything from scratch to finish alone. By working together, we can create a framework for easy division of labor. ”

Vähäkainu emphasizes that health and social services reform is a massive change from the IT systems perspective, and to be successful, it requires local experience, market knowledge, and presence.

"There is no ready-made highway, so the path to building the activities of the wellbeing services county must be cleared in close and open cooperation."

The article was originally published on MustRead-site in Finnish.

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