Infostructure – ensuring a solid foundation

The strategic objectives for this area include:

 Interoperable and modular architecture

 Cooperation in development and procurement

Measures include the adoption of enterprise architecture, the development of standards and support for their use and dissemination, the ensuring of information security and data protection, and improving data connections of professionals and citizens

6.6.1 Availability

Interoperable and modular architecture: As discussed in the previous chapters, according to the 2014 survey most health information systems are still separate for hospital districts, healthcare centres and private service providers. The present use of regional HIEs is a partial remedy to this. While only a fifth of hospital districts have built a common system for public hospital and primary care, an even smaller subset of them (one sixth of hospital districts) had wider connectivity with social care information systems. The effects of national reference architecture are not yet seen in this survey, even though there are initiatives to increase modularity (Onion 2015).

Standards and classifications: The use of international interoperability standards like DICOM and HL7 has been on a high level already in our previous surveys and the implementation of the national Kanta services has augmented the positive development. In the same manner, the use of various classifications obtainable from the national code server has increased clearly compared to the 2011 survey. The availability of structured data content in Finnish healthcare information systems is thus steadily increasing. In discussions there have been proposals for how even the narrative texts could be entered in a structured form (Eskola 2014).

Information security and data protection: The use of professional ID cards has been solved when entering the national Kanta system, the strong authentication of personnel is now used throughout the Finnish health care system. Then next step is to facilitate secure authentication for citizens who are using various e-health and m-health services. Currently half of the hospital districts and a third of m-healthcare centres have used banking ID for patient authentication, though the new contenders

were an electronic citizen ID card (used by one third of healthcare providers) and a mobile ID (used by a tenth of healthcare providers). The traditional username and password was still used by a tenth of the healthcare providers. Even though the use of electronic authentication of the patient has increased since the previous surveys, there is still room for improvement in the light of anticipated extensive citizen services. Another question then is, how to ensure services to those citizens who are unable to obtain personal banking IDs. New survey targets will be patients´

electronic signatures and electronic identification within the healthcare institutions.

The general framework for organizing data protection and information security is well developed. All hospital districts and nearly all healthcare centres now have a written data protection policy, as well as a written data protection plan. With some exceptions, all public health care units have a designated privacy officer. In the next surveys, more emphasis could be placed in following the practical implementation of these tools. A new survey target was the readiness to react if serious disturbances in information system functionalities take place. A disaster recovery plan and business continuity plan were missing in many institutions, so a follow-up of these strategic components is needed. Finally, those organizations and systems that have joined the national Kanta services have been audited and certified respectively for their data protection and information security.

Improving data connections of professionals and citizens: The performance of data connections has not yet been included as a survey question in our studies. There is no dedicated network for healthcare services in Finland and the centralized services are heavily dependent on data connections. Therefore, it is essential to add new indicators for this purpose in forthcoming surveys.

6.6.2 Usability

Standards and classifications: Physicians experienced use of (structured) data entry as easier in the private sector than in the public sector – the situation was worst in hospitals, where the mean usability (scale 1-5) was 2.4. Usability of the nursing documentation has improved quite a lot in the public sector, especially in hospitals, but decreased in the private sector. The doctors agreed that the structured documentation does make searching and consolidating information from different sources easier.

Improving data connections of professionals and citizens: As stated in Chapter 6.1.2, physicians did not have much experience with electronic information exchange with patients, with the private sector being better adapted. Some 20% of physicians in the private sector compared to some 10% of physicians in the public sector have experienced that HISs supported physician-patient collaboration in 2014.

Patient-provided electronic data was not felt to have high impact on service quality.

6.6.3 Citizen views

A majority of the citizens felt that their personal health data is secure in electronic format, but a third of respondents to the citizen survey experienced the fear that their personal health data could be leaked to outsiders as a barrier to e-service use.

References

Ministry of Social Affairs and Health and the Association of Finnish Local and Regional Authorities (2015). Information to support well-being and service renewal. eHealth and eSocial Strategy 2020.

Edita Prima, Helsinki and http://www.julkari.fi/handle/10024/125955 (last checked 4.11.2015) Onion (2015) Internet pages, Onion project pages at Innokylä [in Finnish].

https://www.innokyla.fi/web/hanke1342710/etusivu?p_p_id=projects_WAR_projectsportlet&p_p_li

fecycle=0&p_p_state=normal&p_p_mode=view&p_p_col_id=column-1&p_p_col_count=1&_projects_WAR_projectsportlet_projectId=1532771&_projects_WAR_projec tsportlet_action=viewGeneral (last checked 4.11. 2015)

Eskola P (2014) Digitaalinen terveydenhuolto tulee muokkaamaan maailmaamme, FinJeHeW 2014;6(4) 217-219.