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Riikka Vuokko

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Papers by Riikka Vuokko

Lääkehoidon tiedonhallinnan kokonaisarkkitehtuurin esiselvitys : Työryhmämuistio

Sidantal 89 Språk finska Nyckelord läkemedelsbehandling, läkemedelsförsörjning, informationshante... more Sidantal 89 Språk finska Nyckelord läkemedelsbehandling, läkemedelsförsörjning, informationshantering, övergripande arkitektur Referat Förstudien om övergripande arkitektur för informationshantering inom läkemedelsbehandling beskriver den helhet som utgörs av läkemedelsbehandling, läkemedelsförsörjning och läkemedelspreparat. I förstudien fokuseras det ur informationshanteringens synvinkel på bildandet av information om ett läkemedelspreparat och användningen av den informationen i administrativa processer och läkemedelsbehandlingens processer och den styrning och tillsyn som anknyter till dessa. Det fokuseras också på bildandet och användningen av information om läkemedelsbehandlingen i läkemedelsbehandlingens processer och den styrning, utveckling, forskning och utvärdering som gäller dessa. I förstudien definieras väsentliga begrepp som anknyter till helheten samt identifieras utmaningar i nuläget för informationshanteringen inom läkemedelsbehandlingen. På den principiella nivån av beskrivningen av den övergripande arkitekturen beskrivs den styrande lagstiftningen, strategier, anknutna arkitekturer och projekt, arkitekturprinciper och förmågor. I fråga om verksamhetsarkitekturen beskrivs intressentgrupper med anknytning till läkemedelspreparat och läkemedelsbehandling, dessa gruppers roller, växelverkan mellan grupperna samt de centrala processerna i fråga om läkemedelspreparat och läkemedelsbehandling genom beskrivningar av den övre nivån. I fråga om informationsarkitekturen beskrivs behoven av informationsutbyte mellan aktörerna, huvuddatagrupper och logiska informationsmängder. Förstudien om arkitekturen innehåller dessutom en utvecklingsväg på kort sikt och en på lång sikt samt åtgärdsförslag i fråga om dessa.

Systematized Nomenclature of Medicine–Clinical Terminology (SNOMED CT) Clinical Use Cases in the Context of Electronic Health Record Systems: Systematic Literature Review

JMIR medical informatics, Feb 6, 2023

Background: The Systematized Medical Nomenclature for Medicine-Clinical Terminology (SNOMED CT) i... more Background: The Systematized Medical Nomenclature for Medicine-Clinical Terminology (SNOMED CT) is a clinical terminology system that provides a standardized and scientifically validated way of representing clinical information captured by clinicians. It can be integrated into electronic health records (EHRs) to increase the possibilities for effective data use and ensure a better quality of documentation that supports continuity of care, thus enabling better quality in the care process. Even though SNOMED CT consists of extensively studied clinical terminology, previous research has repeatedly documented a lack of scientific evidence for SNOMED CT in the form of reported clinical use cases in electronic health record systems. Objective: The aim of this study was to explore evidence in previous literature reviews of clinical use cases of SNOMED CT integrated into EHR systems or other clinical applications during the last 5 years of continued development. The study sought to identify the main clinical use purposes, use phases, and key clinical benefits documented in SNOMED CT use cases. Methods: The Cochrane review protocol was applied for the study design. The application of the protocol was modified step-by-step to fit the research problem by first defining the search strategy, identifying the articles for the review by isolating the exclusion and inclusion criteria for assessing the search results, and lastly, evaluating and summarizing the review results. Results: In total, 17 research articles illustrating SNOMED CT clinical use cases were reviewed. The use purpose of SNOMED CT was documented in all the articles, with the terminology as a standard in EHR being the most common (8/17). The clinical use phase was documented in all the articles. The most common category of use phases was SNOMED CT in development (6/17). Core benefits achieved by applying SNOMED CT in a clinical context were identified by the researchers. These were related to terminology use outcomes, that is, to data quality in general or to enabling a consistent way of indexing, storing, retrieving, and aggregating clinical data (8/17). Additional benefits were linked to the productivity of coding or to advances in the quality and continuity of care. Conclusions: While the SNOMED CT use categories were well supported by previous research, this review demonstrates that further systematic research on clinical use cases is needed to promote the scalability of the review results. To achieve the best out-of-use case reports, more emphasis is suggested on describing the contextual factors, such as the electronic health care system and the use of previous frameworks to enable comparability of results. A lesson to be drawn from our study is that SNOMED CT is essential for structuring clinical data; however, research is needed to gather more evidence of how SNOMED CT benefits clinical care and patient safety.

Surveillance at workplace and at home

Journal of Information, Communication and Ethics in Society, Apr 4, 2008

PurposeThe purpose of this paper is to explore how surveillance facilitates new power relationshi... more PurposeThe purpose of this paper is to explore how surveillance facilitates new power relationships.Design/methodology/approachThis longitudinal qualitative study is predicated on observations of the home care workers interacting with their managers and clients. The emerging picture was complemented with interviews of the participants. The home care workers were chosen as being crucial in the construction of new everyday relationships, and their interpretations were given most value in presenting how surveillance and monitoring relationships are constructed as embedded mundane practices and as emerging from practical needs.FindingsThe paper discusses an implementation and use case of surveillance capable technology in a social home care setting. The findings suggest discrepancy of how surveillance is being interpreted by different participants depending on their positioning in the context of use.Originality/valueThe study presents a case study where surveillance issues emerge not only at the workplace but also in the domestic sphere. The paper explores the workers' role in defining surveillance at the workplace, and questions the limits of legitimate surveillance in the social care context concerning vulnerable citizens as clients.

Terveys- ja hoitosuunnitelman kehittäminen 2016 : Esiselvitysraportti

Potilastiedon suostumustenhallinta ja yhteisen potilastietorekisterin liittyminen Kantaan - Versio 2016

SNOMED CT Clinical Use Cases in the Context of Electronic Health Record Systems: A Systematic Literature Review (Preprint)

BACKGROUND The Systematized Medical Nomenclature for Medicine (SNOMED CT) is a clinical terminolo... more BACKGROUND The Systematized Medical Nomenclature for Medicine (SNOMED CT) is a clinical terminology system that provides a standardized and scientifically validated way of representing clinical information captured by clinicians. It can be integrated into electronic health records (EHRs) to increase the possibilities for effective data use and ensure a better quality of documentation that supports continuity of care, thus enabling better quality in the care process. Even though SNOMED CT consists of extensively studied clinical terminology, previous research has repeatedly documented a lack of scientific evidence of SNOMED CT in the form of reported clinical use cases in electronic health record systems. OBJECTIVE The aim of this study was to explore evidence in previous literature reviews of clinical use cases of SNOMED CT integrated into EHR systems or other clinical applications during the last 5 years of continued development. The study sought to identify the main clinical use purposes, use phases, and key clinical benefits documented in SNOMED CT use cases. METHODS The Cochrane review protocol was applied for the study design. The application of the protocol was modified to fit the research problem step-by-step by first defining the search strategy, identifying the articles for the review by isolating the exclusion and inclusion criteria for assessing the search results, and lastly, evaluating and summarizing the review results. The result categories were based on previous research. RESULTS In total, 17 research articles illustrating SNOMED CT clinical use cases were reviewed. The clinical domain or EHR in use was partially documented. The use purpose of SNOMED CT was documented in all the articles, with the terminology as a planned standard in EHR being the most common. The clinical use phase was documented in all the articles. The most common category of use phases was SNOMED CT in development. Core benefits achieved by applying SNOMED CT in a clinical context were identified by the research team. These were related to terminology use outcomes (i.e., to data quality in general or to enabling a consistent way of indexing, storing, retrieving, and aggregating clinical data). Additional benefits were linked to the productivity of coding or to advances in the quality and continuity of care. CONCLUSIONS While the SNOMED CT use categories were well supported by previous research, this review demonstrates that further systematic research on clinical use cases is needed to promote the scalability of the review results. To achieve the best out-of-use case reports, more emphasis is suggested on describing the contextual factors, such as the electronic health care system in use and the usage of previous frameworks to enable comparability of results. An important lesson to be drawn from our study is that SNOMED CT is essential for structuring clinical data; however, research is needed to gather more evidence of how SNOMED CT benefits clinical care and patient safety. CLINICALTRIAL na

Impacts of structuring the electronic health record: Results of a systematic literature review from the perspective of secondary use of patient data

International Journal of Medical Informatics, 2017

The impact of various methods for structuring EHR content-incl. both at the time of care and post... more The impact of various methods for structuring EHR content-incl. both at the time of care and post hoc structuring approaches-were reviewed from the viewpoint of secondary use of data.  Information and system quality were commonly evaluated topics, however absence of common evaluation methods was revealed. Impacts and evaluation outcomes were structure-and contextsensitive.  Evaluation of NLP-applications and their potential in free text re-use in the secondary use context is the predominant research focus of an increasing number of studies after 2005. Parallel to NLPapplication evaluations, research of ad hoc structuring methods showed a clear increase in volume after 2000.  The benefits of standardized structured EHR data warrant further research, as potential benefits in the secondary use context are based on standardized and interoperable structured patient data.  Common evaluation methods would enhance comparable studies on structuring methods to generate more standardised results to be used in evidence-based policy making.

Sosiaali- ja terveydenhuollon kokonaisarkkitehtuurin kypsyysmallivertailu: näkökulmia kansalliseen ohjaukseen

Finnish Journal of eHealth and eWelfare, Feb 27, 2021

Sosiaali-ja terveydenhuollon alueella kokonaisarkkitehtuurin (KA) tuloksia ei ole vielä laajasti ... more Sosiaali-ja terveydenhuollon alueella kokonaisarkkitehtuurin (KA) tuloksia ei ole vielä laajasti arvioitu, vaikka menetelmää on sovellettu jo lähes parin vuosikymmen ajan. Tässä tutkimuksessa tarkastellaan tiettyjä keskeisiä kokonaisarkkitehtuurin kypsyysmalleja. Tutkimuksen lähtökohtana oli olettamus, että KA-kypsyyden kasvu parantaa julkishallinnon ohjausta. Tutkimusmenetelmänä käytettiin kuvailevaa kirjallisuuskatsausta. Tutkimus tuotti vertailun neljästä kypsyysmallista: EAMM, DyAMM, MIT CISR ja SAMM. Lisäksi tarkasteltiin kahden mallin, DyAMM ja SAMM arviointipiirteitä. Tämän tutkimuksen tulokset osoittavat, että KA-kypsyysmalleja on tutkittu vähän. Teoreettisen perustan heikkous onkin haaste KA-kehittämiselle ja kypsyysarvioinnille. Malleissa tunnistettuja ulottuvuuksia voitaisiin kuitenkin hyödyntää tehokkaammin julkishallinnon KA-ohjauksessa. Kypsyysmallien kehittäminen edellyttäisi jatkotutkimusta, jossa teoreettinen tutkimus yhdistettäisiin mallien testaamiseen tapausaineistolla. Malleja tulisi kehittää tutkimusnäyttöön perustuen eikä pelkästään yksittäisten hankkeiden perusteella. Tällä tavalla kypsyysmallit tuottaisivat luotettavaa ja paremmin kohteeseen soveltuvaa arviointia myös julkishallinnossa ja sen ohjauksessa.

Classification of Electronic Health Record–Related Patient Safety Incidents: Development and Validation Study (Preprint)

Background: It is assumed that the implementation of health information technology introduces new... more Background: It is assumed that the implementation of health information technology introduces new vulnerabilities within a complex sociotechnical health care system, but no international consensus exists on a standardized format for enhancing the collection, analysis, and interpretation of technology-induced errors. Objective: This study aims to develop a classification for patient safety incident reporting associated with the use of mature electronic health records (EHRs). It also aims to validate the classification by using a data set of incidents during a 6-month period immediately after the implementation of a new EHR system. Methods: The starting point of the classification development was the Finnish Technology-Induced Error Risk Assessment Scale tool, based on research on commonly recognized error types. A multiprofessional research team used iterative tests on consensus building to develop a classification system. The final classification, with preliminary descriptions of classes, was validated by applying it to analyze EHR-related error incidents (n=428) during the implementation phase of a new EHR system and also to evaluate this classification's characteristics and applicability for reporting incidents. Interrater agreement was applied. Results: The number of EHR-related patient safety incidents during the implementation period (n=501) was five-fold when compared with the preimplementation period (n=82). The literature identified new error types that were added to the emerging classification. Error types were adapted iteratively after several test rounds to develop a classification for reporting patient safety incidents in the clinical use of a high-maturity EHR system. Of the 427 classified patient safety incidents, interface problems accounted for 96 (22.5%) incident reports, usability problems for 73 (17.1%), documentation problems for 60 (14.1%), and clinical workflow problems for 33 (7.7%). Altogether, 20.8% (89/427) of reports were related to medication section problems, and downtime problems were rare (n=8). During the classification work, 14.8% (74/501) of reports of the original sample were rejected because of insufficient information, even though the reports were deemed to be related to EHRs. The interrater agreement during the blinded review was 97.7%. Conclusions: This study presents a new classification for EHR-related patient safety incidents applicable to mature EHRs. The number of EHR-related patient safety incidents during the implementation period may reflect patient safety challenges during the implementation of a new type of high-maturity EHR system. The results indicate that the types of errors previously identified in the literature change with the EHR development cycle.

Classification of Electronic Health Record–Related Patient Safety Incidents: Development and Validation Study

JMIR medical informatics, Aug 31, 2021

Background: It is assumed that the implementation of health information technology introduces new... more Background: It is assumed that the implementation of health information technology introduces new vulnerabilities within a complex sociotechnical health care system, but no international consensus exists on a standardized format for enhancing the collection, analysis, and interpretation of technology-induced errors. Objective: This study aims to develop a classification for patient safety incident reporting associated with the use of mature electronic health records (EHRs). It also aims to validate the classification by using a data set of incidents during a 6-month period immediately after the implementation of a new EHR system. Methods: The starting point of the classification development was the Finnish Technology-Induced Error Risk Assessment Scale tool, based on research on commonly recognized error types. A multiprofessional research team used iterative tests on consensus building to develop a classification system. The final classification, with preliminary descriptions of classes, was validated by applying it to analyze EHR-related error incidents (n=428) during the implementation phase of a new EHR system and also to evaluate this classification's characteristics and applicability for reporting incidents. Interrater agreement was applied. Results: The number of EHR-related patient safety incidents during the implementation period (n=501) was five-fold when compared with the preimplementation period (n=82). The literature identified new error types that were added to the emerging classification. Error types were adapted iteratively after several test rounds to develop a classification for reporting patient safety incidents in the clinical use of a high-maturity EHR system. Of the 427 classified patient safety incidents, interface problems accounted for 96 (22.5%) incident reports, usability problems for 73 (17.1%), documentation problems for 60 (14.1%), and clinical workflow problems for 33 (7.7%). Altogether, 20.8% (89/427) of reports were related to medication section problems, and downtime problems were rare (n=8). During the classification work, 14.8% (74/501) of reports of the original sample were rejected because of insufficient information, even though the reports were deemed to be related to EHRs. The interrater agreement during the blinded review was 97.7%. Conclusions: This study presents a new classification for EHR-related patient safety incidents applicable to mature EHRs. The number of EHR-related patient safety incidents during the implementation period may reflect patient safety challenges during the implementation of a new type of high-maturity EHR system. The results indicate that the types of errors previously identified in the literature change with the EHR development cycle.

Tiedonhallintapalvelun periaatteet ja toiminnallinen määrittely - Versio 2016

Tiedonhallintapalvelun periaatteet ja toiminnallinen määrittely the document retrieved, which is ... more Tiedonhallintapalvelun periaatteet ja toiminnallinen määrittely the document retrieved, which is saved in the controller's system. Thereafter, the updated document will be available to other organisations and usable as a document template. The information management service puts together the compilations using diagnoses, risk data, procedures, imaging examinations entered by operation code, laboratory results, key physiological measurement data, vaccinations and medication. The maintained documents are generated using individual health and care plans, notes on information provided to the patient (concerning Kanta information and patient information registers shared by hospital districts), Kanta consent, bans on disclosure (concerning disclosure of information in Kanta and in patient information registers shared by hospital districts), organ donor status and living will.

Tiedonhallintapalvelun periaatteet ja toiminnallinen määrittely, versio 2015

Based on the Act on Electronic Processing of Client Data in Social and Health Care (159/2007), a ... more Based on the Act on Electronic Processing of Client Data in Social and Health Care (159/2007), a national health care archive service known as the National Archive of Health Information (Kanta) is being set up. The National Archive of Health Information will offer all health care organisations a nationwide, centralised repository for all patient information in electronic form. The system will allow health care professionals to access test and care data for any particular patient irrespective of institutional boundaries. The Act on Electronic Processing of Client Data in Social and Health Care was amended by Act 1227/2010, which entered into force on 1 January 2011. Section 14a of the Act as amended provides for a national patient information management service through which health care service providers will have access to information in and accessible through the service when organising or providing health care or medical care for a patient. Disclosure of information in the National Archive of Health Information will always require the currently valid consent of the patient. With the amendment, information on consent, events and services are also centrally stored in the patient information management service. A patient's consent for disclosing information concerning him/her, and any prohibitions imposed by the patient on such disclosure, will be entered in the information management service. The status of the consent has been changed to 'indefinitely valid', which means that once the patient has given his/her consent, his/her information may always be accessed by health care professionals with a current care relationship to the patient. The information management service will also include other entered information relevant for the patient's treatment, such as a living will or a ban on removing organs, tissue or cells to treat a disease or injury in another patient. Content expressing the will of the patient is one key element in the information management service; another is the information accessible through the service that is vital for the health care and medical care of the patient. The content of this vital data is provided for in more detail in the Ministry of Social Affairs and Health Decree on national health care IT system services (165/2012), known as the 'stagewise decree'. Patient information is entered in the National Archive of Health Information analysed by service event and controller. This makes it difficult for users to retrieve and maintain information important for treatment. The information management service will enable users to compile and maintain data independent of service events and controllers, using a patient-centred approach. This will make the information easier to access in treatment situations and to outline the general situation of the patient, while making it simpler to keep the patient information up to date. In order to leverage the benefits of the information management service, it is important that the principles of accessing the service, its information architecture and its privacy protection are respected in any changes made to patient information services and the eArchive. In order for the information management service to function properly, the information it provides must have been produced using nationally approved information structures and classifications. The information entered in and retrievable from the information management service may be divided into two categories by the way in which their information is used and in which they are handled: compilations and maintained documents. Compilations contain controller-specific information. The information management service brings together the principal items of controller-specific information at the time of the query to patient information systems, which in turn generate a compilation for the use of a health care professional. The compilation is regenerated for each query, ensuring that the information it contains is up to date. The maintained documents form part of the patient record and are stored by controller, as per normal patient document procedure. The information management service always retrieves the most recent version of any maintained document in the Kanta archive for the querying patient information systems, except if the document has restrictions imposed on it. Any new information to be maintained is entered in a copy of V a n h e n t u n u t Tiedonhallintapalvelun periaatteet ja toiminnallinen määrittely Sisällys

Handbok för strukturerad dokumentation inom hälso- och sjukvården - Dokumentation av de viktigaste journalstrukturerna i en elektronisk patientjournal, Del I, Version 2015

Virkkunen, Heikki, Päivi Mäkelä-Bengs and Vuokko, Riikka (eds.). Handbok för strukturerad dokumen... more Virkkunen, Heikki, Päivi Mäkelä-Bengs and Vuokko, Riikka (eds.). Handbok för strukturerad dokumentering inom hälsovården. Dokumentering av viktiga journalstrukturer i en elektronisk patientjournal-Del I. [Manual for structured data entry in health care. Entering essential patient record structures in the electronic patient record-Part I].

Tiedonhallintapalvelun periaatteet ja toiminnallinen määrittely

The European Cross-Border Health Data Exchange: Focus on Clinically Relevant Data

IOS Press eBooks, May 27, 2021

The eHealth Digital Service Infrastructure (eHDSI) is an infrastructure ensuring the continuity o... more The eHealth Digital Service Infrastructure (eHDSI) is an infrastructure ensuring the continuity of care for European citizens while they are travelling abroad in the EU. We present the Finnish readiness of implementing datasets of diagnosis, vaccinations and medication summary in a case study, and discuss challenges emerging from the national perspective. International harmonized standards are a key element in the smooth development of European information exchange.

Code service in social and health care - process description of the THL code service

Päivi Mäkelä-Bengs and Riikka Vuokko. Sosiaali-ja terveydenhuollon koodistopalvelutoiminta. THL:n... more Päivi Mäkelä-Bengs and Riikka Vuokko. Sosiaali-ja terveydenhuollon koodistopalvelutoiminta. THL:n Koodistopalvelun prosessikuvaus. [Code Service in social and health care. Process description of the THL Code Service]. National Institute for Health and Welfare (THL). Ohjaus [Directions] 19/2013. 55 pages. Helsinki, Finland 2013. ISBN 978-952-302-041-2 (printed); ISBN 978-952-302-042-9 (online publication). The National Institute for Health and Welfare (THL) maintains the national Code Service. The purpose of the Code Service is to maintain and distribute the national code sets, classifications, terms and other datasets used in social and health care client information systems. This publication describes the tasks and operating principles of the Code Service using the life cycle model, in compliance with the public administration architecture development. The description of the purpose and operations model of the Code Service includes modelling the operational environment and the content and core activities of the Code Service. The code service process is described from two perspectives: code set preparation and updating published code sets and data structures. Expert groups of the National Institute for Health and Welfare play a key role in the code service process in ensuring the correctness, quality and availability of code set content, and therefore also the operating principles and process of the work of the experts are described in the publication. In addition to process descriptions, the publication describes the steering and quality assurance of the code service process. This includes a presentation of the approval procedure for code sets at the National Institute for Health and Welfare from the officials' point of view. The publication describes the development goals for the Code Service, such as assigning an urgency rating for code set preparation, systematically compiling descriptions of code sets and expert groups, planning information management concerning code sets, and more efficient collecting and processing of client feedback. Lastly, the publication lists a number of development needs in the Code Service and in the THL.

Lääkemerkinnän tekeminen ja tietosisältö 2016 - Toiminnallinen määrittely, versio 2015

Potilastiedon suostumustenhallinta ja yhteisen potilastietorekisterin liittyminen Kantaan - Versio 2014

Within a hospital district, a patient register, common for all the municipal health care units in... more Within a hospital district, a patient register, common for all the municipal health care units in the area (later a district register) is a shared register that was formed directly after the new Health Care Act (1326/2010) entered into force on May 1 st , 2011. Therefore a hospital district or a municipal health care unit needs no separate resolution to implement the register. The district register covers all patient records documented before and after the Health Care Act entered into force. All patient records regardless of the method of recording, such as on paper or in electronic format, belong to the register. Preparedness in hospital districts to implement the district register varies for example based on the use of local area patient information system. A regional patient information system has been in use only in some districts. In addition to these differences, the hospital districts have various forms and processes for handling patient information release and informing a patient of her or his rights concerning especially the electronic processing of patient information. Therefore, there are several alternative scenarios for implementing the district register as based on either regional patient information system integration or on national information system services or on combination of the both. Accessing patient information in the district register requires that the patient in question has been informed about operational principles of the register and about her or his right to refuse information release. The patient information from the district register can be released and used in various health care units when the patient hasn't refused the release and when there is an active health care relationship between the various participants. This means that no active release consent is required from the patient. The information release principles have been harmonized according to the Health Care Act regulating the information release from the district register and according to the act on electronic patient information processing in social and health care that regulates the information release from the national patient information archive Kanta. To harmonize the information release processes further, neither requires active information release consent from a patient before signing a release refusal form. Information release consent is described also from the viewpoints of electronic prescription and epSOS. After a hospital district has implemented the Kanta national archive services, handling the patient information release will be harmonized further as all the information release forms are to be filed into the Kanta archive. A patient can target release refusal on a service provider, a service event or a patient register. The release refusal concerns information release to other health care organizations than the one where the information was initially recorded. Furthermore, within Kanta archive services the information release requires an active information release consent form. At first, the Kanta implementation can be introduced with a limited set of patient information. For example, information release handling can be implemented with the national information services by filing the information release consent forms and the information release refusal forms into the Kanta archive. Kanta-implementation proceeds phase by phase so that by the end of the year 2016 all patient information will be filed into the Kanta archive. One Kanta-implementation objective is that in the future, all patient information release will be handled with the Kanta information services. As in several hospital districts there are local or area patient information systems with information release procedures already in use, the information release can be implemented initially also without the Kanta-services. Kanta-archive will act as a centralized long term register for all patient information. Local and area patient information systems will act as the main information systems for processing patient care information. Kanta will improve the functions of the local patient information systems with, for example, interface services. In this report, also a migration path for Kanta implementation is described from the viewpoint of the V a n h e n t u n u t THL-OHJAUS 20/2014 9 Potilastiedon suostumustenhallinta ja yhteisen potilastietorekisterin liittyminen Kantaan information release handling and, for example, how local release refusals can be converted to fit into the Kanta. After the Kanta-implementation, the information release handling concerning also the district register requires that the THL code server provides information of the health care registers and organizations. The use of the organization information is regulated by three classifications published in the THL code server. These are the classification for all social and health care organizations and units i.e. SOTE register, the classification for all health care registers and the classification of the hospital districts.

Preliminary Exploration of Main Elements for Systematic Classification Development: Case Study of Patient Safety Incidents (Preprint)

JMIR formative research, Dec 6, 2021

Background: Currently, there is no holistic theoretical approach available for guiding classifica... more Background: Currently, there is no holistic theoretical approach available for guiding classification development. On the basis of our recent classification development research in the area of patient safety in health information technology, this focus area would benefit from a more systematic approach. Although some valuable theoretical and methodological approaches have been presented, classification development literature typically is limited to methodological development in a specific domain or is practically oriented. Objective: The main purposes of this study are to fill the methodological gap in classification development research by exploring possible elements of systematic development based on previous literature and to promote sustainable and well-grounded classification outcomes by identifying a set of recommended elements. Specifically, the aim is to answer the following question: what are the main elements for systematic classification development based on research evidence and our use case? Methods: This study applied a qualitative research approach. On the basis of previous literature, preliminary elements for classification development were specified, as follows: defining a concept model, documenting the development process, incorporating multidisciplinary expertise, validating results, and maintaining the classification. The elements were compiled as guiding principles for the research process and tested in the case of patient safety incidents (n=501). Results: The results illustrate classification development based on the chosen elements, with 4 examples of technology-induced errors. Examples from the use case regard usability, system downtime, clinical workflow, and medication section problems. The study results confirm and thus suggest that a more comprehensive and theory-based systematic approach promotes well-grounded classification work by enhancing transparency and possibilities for assessing the development process. Conclusions: We recommend further testing the preliminary main elements presented in this study. The research presented herein could serve as a basis for future work. Our recently developed classification and the use case presented here serve as examples. Data retrieved from, for example, other type of electronic health records and use contexts could refine and validate the suggested methodological approach.

Features of COVID-19 applications and their impact on contact tracing: results of preliminary review

Finnish Journal of eHealth and eWelfare, Nov 10, 2021

Digital technologies and telehealth, specifically contact tracing applications can complement tra... more Digital technologies and telehealth, specifically contact tracing applications can complement traditional approaches for contact tracing of COVID-19 and overall COVID-19 control strategies. Despite the potential benefits of these novel approaches, concerns regarding privacy and basic rights have challenged application development and adoption. We explore the features of tracing applications, focusing on the trade-off between technical possibilities and privacy concerns. Our main objective is to map out central features of applied technology solutions that may prove as drivers or constrains for future development. Our secondary aim was to review how the effectiveness of tracing applications was being apprehended in research. We conducted a literature review of COVID-19 tracing applications and related privacy issues using the PubMed database. For analysis, we conceptualized contact tracing and data privacy. Our review identified various technologies with potential for contact tracing, with Bluetooth and GPS based solutions being the most common. Effectiveness of the applications is dependent on how widely these are adopted. However, technological approaches of the applications vary markedly, affecting their effectiveness for pandemic control. Privacy and trust are key limitations affecting application adoption. Existing privacy solutions are based on voluntary use, user consent, cryptographic data storage, minimum data collection, limited data usage, and transparency of the contact tracing applications and frameworks. Although evidence of applications' outcomes and benefits is yet tentative, the first evaluation frameworks for the applications are under development. In order to obtain maximum potential benefit from the applications, real-world evidence needs to be analyzed and evaluated carefully. However, along with contact tracing apps and comprehensive health programs, regulatory frameworks and safeguards are necessary to ensure that health information is not used for surveillance purposes and that app users' privacy is maintained.

Lääkehoidon tiedonhallinnan kokonaisarkkitehtuurin esiselvitys : Työryhmämuistio

Sidantal 89 Språk finska Nyckelord läkemedelsbehandling, läkemedelsförsörjning, informationshante... more Sidantal 89 Språk finska Nyckelord läkemedelsbehandling, läkemedelsförsörjning, informationshantering, övergripande arkitektur Referat Förstudien om övergripande arkitektur för informationshantering inom läkemedelsbehandling beskriver den helhet som utgörs av läkemedelsbehandling, läkemedelsförsörjning och läkemedelspreparat. I förstudien fokuseras det ur informationshanteringens synvinkel på bildandet av information om ett läkemedelspreparat och användningen av den informationen i administrativa processer och läkemedelsbehandlingens processer och den styrning och tillsyn som anknyter till dessa. Det fokuseras också på bildandet och användningen av information om läkemedelsbehandlingen i läkemedelsbehandlingens processer och den styrning, utveckling, forskning och utvärdering som gäller dessa. I förstudien definieras väsentliga begrepp som anknyter till helheten samt identifieras utmaningar i nuläget för informationshanteringen inom läkemedelsbehandlingen. På den principiella nivån av beskrivningen av den övergripande arkitekturen beskrivs den styrande lagstiftningen, strategier, anknutna arkitekturer och projekt, arkitekturprinciper och förmågor. I fråga om verksamhetsarkitekturen beskrivs intressentgrupper med anknytning till läkemedelspreparat och läkemedelsbehandling, dessa gruppers roller, växelverkan mellan grupperna samt de centrala processerna i fråga om läkemedelspreparat och läkemedelsbehandling genom beskrivningar av den övre nivån. I fråga om informationsarkitekturen beskrivs behoven av informationsutbyte mellan aktörerna, huvuddatagrupper och logiska informationsmängder. Förstudien om arkitekturen innehåller dessutom en utvecklingsväg på kort sikt och en på lång sikt samt åtgärdsförslag i fråga om dessa.

Systematized Nomenclature of Medicine–Clinical Terminology (SNOMED CT) Clinical Use Cases in the Context of Electronic Health Record Systems: Systematic Literature Review

JMIR medical informatics, Feb 6, 2023

Background: The Systematized Medical Nomenclature for Medicine-Clinical Terminology (SNOMED CT) i... more Background: The Systematized Medical Nomenclature for Medicine-Clinical Terminology (SNOMED CT) is a clinical terminology system that provides a standardized and scientifically validated way of representing clinical information captured by clinicians. It can be integrated into electronic health records (EHRs) to increase the possibilities for effective data use and ensure a better quality of documentation that supports continuity of care, thus enabling better quality in the care process. Even though SNOMED CT consists of extensively studied clinical terminology, previous research has repeatedly documented a lack of scientific evidence for SNOMED CT in the form of reported clinical use cases in electronic health record systems. Objective: The aim of this study was to explore evidence in previous literature reviews of clinical use cases of SNOMED CT integrated into EHR systems or other clinical applications during the last 5 years of continued development. The study sought to identify the main clinical use purposes, use phases, and key clinical benefits documented in SNOMED CT use cases. Methods: The Cochrane review protocol was applied for the study design. The application of the protocol was modified step-by-step to fit the research problem by first defining the search strategy, identifying the articles for the review by isolating the exclusion and inclusion criteria for assessing the search results, and lastly, evaluating and summarizing the review results. Results: In total, 17 research articles illustrating SNOMED CT clinical use cases were reviewed. The use purpose of SNOMED CT was documented in all the articles, with the terminology as a standard in EHR being the most common (8/17). The clinical use phase was documented in all the articles. The most common category of use phases was SNOMED CT in development (6/17). Core benefits achieved by applying SNOMED CT in a clinical context were identified by the researchers. These were related to terminology use outcomes, that is, to data quality in general or to enabling a consistent way of indexing, storing, retrieving, and aggregating clinical data (8/17). Additional benefits were linked to the productivity of coding or to advances in the quality and continuity of care. Conclusions: While the SNOMED CT use categories were well supported by previous research, this review demonstrates that further systematic research on clinical use cases is needed to promote the scalability of the review results. To achieve the best out-of-use case reports, more emphasis is suggested on describing the contextual factors, such as the electronic health care system and the use of previous frameworks to enable comparability of results. A lesson to be drawn from our study is that SNOMED CT is essential for structuring clinical data; however, research is needed to gather more evidence of how SNOMED CT benefits clinical care and patient safety.

Surveillance at workplace and at home

Journal of Information, Communication and Ethics in Society, Apr 4, 2008

PurposeThe purpose of this paper is to explore how surveillance facilitates new power relationshi... more PurposeThe purpose of this paper is to explore how surveillance facilitates new power relationships.Design/methodology/approachThis longitudinal qualitative study is predicated on observations of the home care workers interacting with their managers and clients. The emerging picture was complemented with interviews of the participants. The home care workers were chosen as being crucial in the construction of new everyday relationships, and their interpretations were given most value in presenting how surveillance and monitoring relationships are constructed as embedded mundane practices and as emerging from practical needs.FindingsThe paper discusses an implementation and use case of surveillance capable technology in a social home care setting. The findings suggest discrepancy of how surveillance is being interpreted by different participants depending on their positioning in the context of use.Originality/valueThe study presents a case study where surveillance issues emerge not only at the workplace but also in the domestic sphere. The paper explores the workers' role in defining surveillance at the workplace, and questions the limits of legitimate surveillance in the social care context concerning vulnerable citizens as clients.

Terveys- ja hoitosuunnitelman kehittäminen 2016 : Esiselvitysraportti

Potilastiedon suostumustenhallinta ja yhteisen potilastietorekisterin liittyminen Kantaan - Versio 2016

SNOMED CT Clinical Use Cases in the Context of Electronic Health Record Systems: A Systematic Literature Review (Preprint)

BACKGROUND The Systematized Medical Nomenclature for Medicine (SNOMED CT) is a clinical terminolo... more BACKGROUND The Systematized Medical Nomenclature for Medicine (SNOMED CT) is a clinical terminology system that provides a standardized and scientifically validated way of representing clinical information captured by clinicians. It can be integrated into electronic health records (EHRs) to increase the possibilities for effective data use and ensure a better quality of documentation that supports continuity of care, thus enabling better quality in the care process. Even though SNOMED CT consists of extensively studied clinical terminology, previous research has repeatedly documented a lack of scientific evidence of SNOMED CT in the form of reported clinical use cases in electronic health record systems. OBJECTIVE The aim of this study was to explore evidence in previous literature reviews of clinical use cases of SNOMED CT integrated into EHR systems or other clinical applications during the last 5 years of continued development. The study sought to identify the main clinical use purposes, use phases, and key clinical benefits documented in SNOMED CT use cases. METHODS The Cochrane review protocol was applied for the study design. The application of the protocol was modified to fit the research problem step-by-step by first defining the search strategy, identifying the articles for the review by isolating the exclusion and inclusion criteria for assessing the search results, and lastly, evaluating and summarizing the review results. The result categories were based on previous research. RESULTS In total, 17 research articles illustrating SNOMED CT clinical use cases were reviewed. The clinical domain or EHR in use was partially documented. The use purpose of SNOMED CT was documented in all the articles, with the terminology as a planned standard in EHR being the most common. The clinical use phase was documented in all the articles. The most common category of use phases was SNOMED CT in development. Core benefits achieved by applying SNOMED CT in a clinical context were identified by the research team. These were related to terminology use outcomes (i.e., to data quality in general or to enabling a consistent way of indexing, storing, retrieving, and aggregating clinical data). Additional benefits were linked to the productivity of coding or to advances in the quality and continuity of care. CONCLUSIONS While the SNOMED CT use categories were well supported by previous research, this review demonstrates that further systematic research on clinical use cases is needed to promote the scalability of the review results. To achieve the best out-of-use case reports, more emphasis is suggested on describing the contextual factors, such as the electronic health care system in use and the usage of previous frameworks to enable comparability of results. An important lesson to be drawn from our study is that SNOMED CT is essential for structuring clinical data; however, research is needed to gather more evidence of how SNOMED CT benefits clinical care and patient safety. CLINICALTRIAL na

Impacts of structuring the electronic health record: Results of a systematic literature review from the perspective of secondary use of patient data

International Journal of Medical Informatics, 2017

The impact of various methods for structuring EHR content-incl. both at the time of care and post... more The impact of various methods for structuring EHR content-incl. both at the time of care and post hoc structuring approaches-were reviewed from the viewpoint of secondary use of data.  Information and system quality were commonly evaluated topics, however absence of common evaluation methods was revealed. Impacts and evaluation outcomes were structure-and contextsensitive.  Evaluation of NLP-applications and their potential in free text re-use in the secondary use context is the predominant research focus of an increasing number of studies after 2005. Parallel to NLPapplication evaluations, research of ad hoc structuring methods showed a clear increase in volume after 2000.  The benefits of standardized structured EHR data warrant further research, as potential benefits in the secondary use context are based on standardized and interoperable structured patient data.  Common evaluation methods would enhance comparable studies on structuring methods to generate more standardised results to be used in evidence-based policy making.

Sosiaali- ja terveydenhuollon kokonaisarkkitehtuurin kypsyysmallivertailu: näkökulmia kansalliseen ohjaukseen

Finnish Journal of eHealth and eWelfare, Feb 27, 2021

Sosiaali-ja terveydenhuollon alueella kokonaisarkkitehtuurin (KA) tuloksia ei ole vielä laajasti ... more Sosiaali-ja terveydenhuollon alueella kokonaisarkkitehtuurin (KA) tuloksia ei ole vielä laajasti arvioitu, vaikka menetelmää on sovellettu jo lähes parin vuosikymmen ajan. Tässä tutkimuksessa tarkastellaan tiettyjä keskeisiä kokonaisarkkitehtuurin kypsyysmalleja. Tutkimuksen lähtökohtana oli olettamus, että KA-kypsyyden kasvu parantaa julkishallinnon ohjausta. Tutkimusmenetelmänä käytettiin kuvailevaa kirjallisuuskatsausta. Tutkimus tuotti vertailun neljästä kypsyysmallista: EAMM, DyAMM, MIT CISR ja SAMM. Lisäksi tarkasteltiin kahden mallin, DyAMM ja SAMM arviointipiirteitä. Tämän tutkimuksen tulokset osoittavat, että KA-kypsyysmalleja on tutkittu vähän. Teoreettisen perustan heikkous onkin haaste KA-kehittämiselle ja kypsyysarvioinnille. Malleissa tunnistettuja ulottuvuuksia voitaisiin kuitenkin hyödyntää tehokkaammin julkishallinnon KA-ohjauksessa. Kypsyysmallien kehittäminen edellyttäisi jatkotutkimusta, jossa teoreettinen tutkimus yhdistettäisiin mallien testaamiseen tapausaineistolla. Malleja tulisi kehittää tutkimusnäyttöön perustuen eikä pelkästään yksittäisten hankkeiden perusteella. Tällä tavalla kypsyysmallit tuottaisivat luotettavaa ja paremmin kohteeseen soveltuvaa arviointia myös julkishallinnossa ja sen ohjauksessa.

Classification of Electronic Health Record–Related Patient Safety Incidents: Development and Validation Study (Preprint)

Background: It is assumed that the implementation of health information technology introduces new... more Background: It is assumed that the implementation of health information technology introduces new vulnerabilities within a complex sociotechnical health care system, but no international consensus exists on a standardized format for enhancing the collection, analysis, and interpretation of technology-induced errors. Objective: This study aims to develop a classification for patient safety incident reporting associated with the use of mature electronic health records (EHRs). It also aims to validate the classification by using a data set of incidents during a 6-month period immediately after the implementation of a new EHR system. Methods: The starting point of the classification development was the Finnish Technology-Induced Error Risk Assessment Scale tool, based on research on commonly recognized error types. A multiprofessional research team used iterative tests on consensus building to develop a classification system. The final classification, with preliminary descriptions of classes, was validated by applying it to analyze EHR-related error incidents (n=428) during the implementation phase of a new EHR system and also to evaluate this classification's characteristics and applicability for reporting incidents. Interrater agreement was applied. Results: The number of EHR-related patient safety incidents during the implementation period (n=501) was five-fold when compared with the preimplementation period (n=82). The literature identified new error types that were added to the emerging classification. Error types were adapted iteratively after several test rounds to develop a classification for reporting patient safety incidents in the clinical use of a high-maturity EHR system. Of the 427 classified patient safety incidents, interface problems accounted for 96 (22.5%) incident reports, usability problems for 73 (17.1%), documentation problems for 60 (14.1%), and clinical workflow problems for 33 (7.7%). Altogether, 20.8% (89/427) of reports were related to medication section problems, and downtime problems were rare (n=8). During the classification work, 14.8% (74/501) of reports of the original sample were rejected because of insufficient information, even though the reports were deemed to be related to EHRs. The interrater agreement during the blinded review was 97.7%. Conclusions: This study presents a new classification for EHR-related patient safety incidents applicable to mature EHRs. The number of EHR-related patient safety incidents during the implementation period may reflect patient safety challenges during the implementation of a new type of high-maturity EHR system. The results indicate that the types of errors previously identified in the literature change with the EHR development cycle.

Classification of Electronic Health Record–Related Patient Safety Incidents: Development and Validation Study

JMIR medical informatics, Aug 31, 2021

Background: It is assumed that the implementation of health information technology introduces new... more Background: It is assumed that the implementation of health information technology introduces new vulnerabilities within a complex sociotechnical health care system, but no international consensus exists on a standardized format for enhancing the collection, analysis, and interpretation of technology-induced errors. Objective: This study aims to develop a classification for patient safety incident reporting associated with the use of mature electronic health records (EHRs). It also aims to validate the classification by using a data set of incidents during a 6-month period immediately after the implementation of a new EHR system. Methods: The starting point of the classification development was the Finnish Technology-Induced Error Risk Assessment Scale tool, based on research on commonly recognized error types. A multiprofessional research team used iterative tests on consensus building to develop a classification system. The final classification, with preliminary descriptions of classes, was validated by applying it to analyze EHR-related error incidents (n=428) during the implementation phase of a new EHR system and also to evaluate this classification's characteristics and applicability for reporting incidents. Interrater agreement was applied. Results: The number of EHR-related patient safety incidents during the implementation period (n=501) was five-fold when compared with the preimplementation period (n=82). The literature identified new error types that were added to the emerging classification. Error types were adapted iteratively after several test rounds to develop a classification for reporting patient safety incidents in the clinical use of a high-maturity EHR system. Of the 427 classified patient safety incidents, interface problems accounted for 96 (22.5%) incident reports, usability problems for 73 (17.1%), documentation problems for 60 (14.1%), and clinical workflow problems for 33 (7.7%). Altogether, 20.8% (89/427) of reports were related to medication section problems, and downtime problems were rare (n=8). During the classification work, 14.8% (74/501) of reports of the original sample were rejected because of insufficient information, even though the reports were deemed to be related to EHRs. The interrater agreement during the blinded review was 97.7%. Conclusions: This study presents a new classification for EHR-related patient safety incidents applicable to mature EHRs. The number of EHR-related patient safety incidents during the implementation period may reflect patient safety challenges during the implementation of a new type of high-maturity EHR system. The results indicate that the types of errors previously identified in the literature change with the EHR development cycle.

Tiedonhallintapalvelun periaatteet ja toiminnallinen määrittely - Versio 2016

Tiedonhallintapalvelun periaatteet ja toiminnallinen määrittely the document retrieved, which is ... more Tiedonhallintapalvelun periaatteet ja toiminnallinen määrittely the document retrieved, which is saved in the controller's system. Thereafter, the updated document will be available to other organisations and usable as a document template. The information management service puts together the compilations using diagnoses, risk data, procedures, imaging examinations entered by operation code, laboratory results, key physiological measurement data, vaccinations and medication. The maintained documents are generated using individual health and care plans, notes on information provided to the patient (concerning Kanta information and patient information registers shared by hospital districts), Kanta consent, bans on disclosure (concerning disclosure of information in Kanta and in patient information registers shared by hospital districts), organ donor status and living will.

Tiedonhallintapalvelun periaatteet ja toiminnallinen määrittely, versio 2015

Based on the Act on Electronic Processing of Client Data in Social and Health Care (159/2007), a ... more Based on the Act on Electronic Processing of Client Data in Social and Health Care (159/2007), a national health care archive service known as the National Archive of Health Information (Kanta) is being set up. The National Archive of Health Information will offer all health care organisations a nationwide, centralised repository for all patient information in electronic form. The system will allow health care professionals to access test and care data for any particular patient irrespective of institutional boundaries. The Act on Electronic Processing of Client Data in Social and Health Care was amended by Act 1227/2010, which entered into force on 1 January 2011. Section 14a of the Act as amended provides for a national patient information management service through which health care service providers will have access to information in and accessible through the service when organising or providing health care or medical care for a patient. Disclosure of information in the National Archive of Health Information will always require the currently valid consent of the patient. With the amendment, information on consent, events and services are also centrally stored in the patient information management service. A patient's consent for disclosing information concerning him/her, and any prohibitions imposed by the patient on such disclosure, will be entered in the information management service. The status of the consent has been changed to 'indefinitely valid', which means that once the patient has given his/her consent, his/her information may always be accessed by health care professionals with a current care relationship to the patient. The information management service will also include other entered information relevant for the patient's treatment, such as a living will or a ban on removing organs, tissue or cells to treat a disease or injury in another patient. Content expressing the will of the patient is one key element in the information management service; another is the information accessible through the service that is vital for the health care and medical care of the patient. The content of this vital data is provided for in more detail in the Ministry of Social Affairs and Health Decree on national health care IT system services (165/2012), known as the 'stagewise decree'. Patient information is entered in the National Archive of Health Information analysed by service event and controller. This makes it difficult for users to retrieve and maintain information important for treatment. The information management service will enable users to compile and maintain data independent of service events and controllers, using a patient-centred approach. This will make the information easier to access in treatment situations and to outline the general situation of the patient, while making it simpler to keep the patient information up to date. In order to leverage the benefits of the information management service, it is important that the principles of accessing the service, its information architecture and its privacy protection are respected in any changes made to patient information services and the eArchive. In order for the information management service to function properly, the information it provides must have been produced using nationally approved information structures and classifications. The information entered in and retrievable from the information management service may be divided into two categories by the way in which their information is used and in which they are handled: compilations and maintained documents. Compilations contain controller-specific information. The information management service brings together the principal items of controller-specific information at the time of the query to patient information systems, which in turn generate a compilation for the use of a health care professional. The compilation is regenerated for each query, ensuring that the information it contains is up to date. The maintained documents form part of the patient record and are stored by controller, as per normal patient document procedure. The information management service always retrieves the most recent version of any maintained document in the Kanta archive for the querying patient information systems, except if the document has restrictions imposed on it. Any new information to be maintained is entered in a copy of V a n h e n t u n u t Tiedonhallintapalvelun periaatteet ja toiminnallinen määrittely Sisällys

Handbok för strukturerad dokumentation inom hälso- och sjukvården - Dokumentation av de viktigaste journalstrukturerna i en elektronisk patientjournal, Del I, Version 2015

Virkkunen, Heikki, Päivi Mäkelä-Bengs and Vuokko, Riikka (eds.). Handbok för strukturerad dokumen... more Virkkunen, Heikki, Päivi Mäkelä-Bengs and Vuokko, Riikka (eds.). Handbok för strukturerad dokumentering inom hälsovården. Dokumentering av viktiga journalstrukturer i en elektronisk patientjournal-Del I. [Manual for structured data entry in health care. Entering essential patient record structures in the electronic patient record-Part I].

Tiedonhallintapalvelun periaatteet ja toiminnallinen määrittely

The European Cross-Border Health Data Exchange: Focus on Clinically Relevant Data

IOS Press eBooks, May 27, 2021

The eHealth Digital Service Infrastructure (eHDSI) is an infrastructure ensuring the continuity o... more The eHealth Digital Service Infrastructure (eHDSI) is an infrastructure ensuring the continuity of care for European citizens while they are travelling abroad in the EU. We present the Finnish readiness of implementing datasets of diagnosis, vaccinations and medication summary in a case study, and discuss challenges emerging from the national perspective. International harmonized standards are a key element in the smooth development of European information exchange.

Code service in social and health care - process description of the THL code service

Päivi Mäkelä-Bengs and Riikka Vuokko. Sosiaali-ja terveydenhuollon koodistopalvelutoiminta. THL:n... more Päivi Mäkelä-Bengs and Riikka Vuokko. Sosiaali-ja terveydenhuollon koodistopalvelutoiminta. THL:n Koodistopalvelun prosessikuvaus. [Code Service in social and health care. Process description of the THL Code Service]. National Institute for Health and Welfare (THL). Ohjaus [Directions] 19/2013. 55 pages. Helsinki, Finland 2013. ISBN 978-952-302-041-2 (printed); ISBN 978-952-302-042-9 (online publication). The National Institute for Health and Welfare (THL) maintains the national Code Service. The purpose of the Code Service is to maintain and distribute the national code sets, classifications, terms and other datasets used in social and health care client information systems. This publication describes the tasks and operating principles of the Code Service using the life cycle model, in compliance with the public administration architecture development. The description of the purpose and operations model of the Code Service includes modelling the operational environment and the content and core activities of the Code Service. The code service process is described from two perspectives: code set preparation and updating published code sets and data structures. Expert groups of the National Institute for Health and Welfare play a key role in the code service process in ensuring the correctness, quality and availability of code set content, and therefore also the operating principles and process of the work of the experts are described in the publication. In addition to process descriptions, the publication describes the steering and quality assurance of the code service process. This includes a presentation of the approval procedure for code sets at the National Institute for Health and Welfare from the officials' point of view. The publication describes the development goals for the Code Service, such as assigning an urgency rating for code set preparation, systematically compiling descriptions of code sets and expert groups, planning information management concerning code sets, and more efficient collecting and processing of client feedback. Lastly, the publication lists a number of development needs in the Code Service and in the THL.

Lääkemerkinnän tekeminen ja tietosisältö 2016 - Toiminnallinen määrittely, versio 2015

Potilastiedon suostumustenhallinta ja yhteisen potilastietorekisterin liittyminen Kantaan - Versio 2014

Within a hospital district, a patient register, common for all the municipal health care units in... more Within a hospital district, a patient register, common for all the municipal health care units in the area (later a district register) is a shared register that was formed directly after the new Health Care Act (1326/2010) entered into force on May 1 st , 2011. Therefore a hospital district or a municipal health care unit needs no separate resolution to implement the register. The district register covers all patient records documented before and after the Health Care Act entered into force. All patient records regardless of the method of recording, such as on paper or in electronic format, belong to the register. Preparedness in hospital districts to implement the district register varies for example based on the use of local area patient information system. A regional patient information system has been in use only in some districts. In addition to these differences, the hospital districts have various forms and processes for handling patient information release and informing a patient of her or his rights concerning especially the electronic processing of patient information. Therefore, there are several alternative scenarios for implementing the district register as based on either regional patient information system integration or on national information system services or on combination of the both. Accessing patient information in the district register requires that the patient in question has been informed about operational principles of the register and about her or his right to refuse information release. The patient information from the district register can be released and used in various health care units when the patient hasn't refused the release and when there is an active health care relationship between the various participants. This means that no active release consent is required from the patient. The information release principles have been harmonized according to the Health Care Act regulating the information release from the district register and according to the act on electronic patient information processing in social and health care that regulates the information release from the national patient information archive Kanta. To harmonize the information release processes further, neither requires active information release consent from a patient before signing a release refusal form. Information release consent is described also from the viewpoints of electronic prescription and epSOS. After a hospital district has implemented the Kanta national archive services, handling the patient information release will be harmonized further as all the information release forms are to be filed into the Kanta archive. A patient can target release refusal on a service provider, a service event or a patient register. The release refusal concerns information release to other health care organizations than the one where the information was initially recorded. Furthermore, within Kanta archive services the information release requires an active information release consent form. At first, the Kanta implementation can be introduced with a limited set of patient information. For example, information release handling can be implemented with the national information services by filing the information release consent forms and the information release refusal forms into the Kanta archive. Kanta-implementation proceeds phase by phase so that by the end of the year 2016 all patient information will be filed into the Kanta archive. One Kanta-implementation objective is that in the future, all patient information release will be handled with the Kanta information services. As in several hospital districts there are local or area patient information systems with information release procedures already in use, the information release can be implemented initially also without the Kanta-services. Kanta-archive will act as a centralized long term register for all patient information. Local and area patient information systems will act as the main information systems for processing patient care information. Kanta will improve the functions of the local patient information systems with, for example, interface services. In this report, also a migration path for Kanta implementation is described from the viewpoint of the V a n h e n t u n u t THL-OHJAUS 20/2014 9 Potilastiedon suostumustenhallinta ja yhteisen potilastietorekisterin liittyminen Kantaan information release handling and, for example, how local release refusals can be converted to fit into the Kanta. After the Kanta-implementation, the information release handling concerning also the district register requires that the THL code server provides information of the health care registers and organizations. The use of the organization information is regulated by three classifications published in the THL code server. These are the classification for all social and health care organizations and units i.e. SOTE register, the classification for all health care registers and the classification of the hospital districts.

Preliminary Exploration of Main Elements for Systematic Classification Development: Case Study of Patient Safety Incidents (Preprint)

JMIR formative research, Dec 6, 2021

Background: Currently, there is no holistic theoretical approach available for guiding classifica... more Background: Currently, there is no holistic theoretical approach available for guiding classification development. On the basis of our recent classification development research in the area of patient safety in health information technology, this focus area would benefit from a more systematic approach. Although some valuable theoretical and methodological approaches have been presented, classification development literature typically is limited to methodological development in a specific domain or is practically oriented. Objective: The main purposes of this study are to fill the methodological gap in classification development research by exploring possible elements of systematic development based on previous literature and to promote sustainable and well-grounded classification outcomes by identifying a set of recommended elements. Specifically, the aim is to answer the following question: what are the main elements for systematic classification development based on research evidence and our use case? Methods: This study applied a qualitative research approach. On the basis of previous literature, preliminary elements for classification development were specified, as follows: defining a concept model, documenting the development process, incorporating multidisciplinary expertise, validating results, and maintaining the classification. The elements were compiled as guiding principles for the research process and tested in the case of patient safety incidents (n=501). Results: The results illustrate classification development based on the chosen elements, with 4 examples of technology-induced errors. Examples from the use case regard usability, system downtime, clinical workflow, and medication section problems. The study results confirm and thus suggest that a more comprehensive and theory-based systematic approach promotes well-grounded classification work by enhancing transparency and possibilities for assessing the development process. Conclusions: We recommend further testing the preliminary main elements presented in this study. The research presented herein could serve as a basis for future work. Our recently developed classification and the use case presented here serve as examples. Data retrieved from, for example, other type of electronic health records and use contexts could refine and validate the suggested methodological approach.

Features of COVID-19 applications and their impact on contact tracing: results of preliminary review

Finnish Journal of eHealth and eWelfare, Nov 10, 2021

Digital technologies and telehealth, specifically contact tracing applications can complement tra... more Digital technologies and telehealth, specifically contact tracing applications can complement traditional approaches for contact tracing of COVID-19 and overall COVID-19 control strategies. Despite the potential benefits of these novel approaches, concerns regarding privacy and basic rights have challenged application development and adoption. We explore the features of tracing applications, focusing on the trade-off between technical possibilities and privacy concerns. Our main objective is to map out central features of applied technology solutions that may prove as drivers or constrains for future development. Our secondary aim was to review how the effectiveness of tracing applications was being apprehended in research. We conducted a literature review of COVID-19 tracing applications and related privacy issues using the PubMed database. For analysis, we conceptualized contact tracing and data privacy. Our review identified various technologies with potential for contact tracing, with Bluetooth and GPS based solutions being the most common. Effectiveness of the applications is dependent on how widely these are adopted. However, technological approaches of the applications vary markedly, affecting their effectiveness for pandemic control. Privacy and trust are key limitations affecting application adoption. Existing privacy solutions are based on voluntary use, user consent, cryptographic data storage, minimum data collection, limited data usage, and transparency of the contact tracing applications and frameworks. Although evidence of applications' outcomes and benefits is yet tentative, the first evaluation frameworks for the applications are under development. In order to obtain maximum potential benefit from the applications, real-world evidence needs to be analyzed and evaluated carefully. However, along with contact tracing apps and comprehensive health programs, regulatory frameworks and safeguards are necessary to ensure that health information is not used for surveillance purposes and that app users' privacy is maintained.