From Big Data To Myhealth

S I T R A ST U D I E S 14 1 NOVEMBER 2 0 1 8
FROM BIG
DATA T O
M Y H E A LT H
– DATA ANALYTICS AS A TOOL FOR
HUMAN-DRIVEN WELL-BEING
ANDREW SIRKKA (ED.)
1
FROM BIG DATA TO MYHEALTH
Preface
Healthcare is undergoing profound change. Whole-genome sequencing and high-resolution
imaging technologies are key drivers of this rapid and crucial transformation. Big data in health
can be used to improve the efficiency and effectiveness of prediction and prevention strategies or
of health services. Exploiting data is key to value-based healthcare, personalised care, as well as
patient involvement.
Data is the primary component of building new health services in citizen-centric way. As the
world moves further into the digital age, generating vast amounts of data and born digital
content, there will be a greater need to deploy this information in the healthcare routines. Our
passion has been not only to find out but also to develop disruptive tools and methods to break
down barriers of accessibility for healthier life of future generations.
The potential of “big data” for improving health is enormous but, at the same time, we face a
wide range of challenges to overcome urgently. In healthcare, analytics and the use of collected
data is still in their infancy. We are very proud of some of our leading-edge projects; however, the
truth is that there is the big gap between these novel tools and the reality how they are deployed
in healthcare. Operational culture needs to change.
There is also a need for a citizen-centric, “my data” approach to improve healthcare services
in Europe. Instead of current volume-based healthcare we should concentrate on creating value
and better health outcomes for people by better understanding their needs and supporting them
towards healthy and happier living.
Unhealthy lifestyles are major public health issues in many European countries like Finland.
Unmet medical care needs are relatively high, especially among low-income people in Finland*.
For example, the amount of people seeking help for mental health problems has increased in
Finland in recent years. Despite those changes in customers’ needs, only minor improvements
have been successfully made in the care chain, access to care and the service system.
These findings were the start of the Health Analytics Programme (HEAP) in the autumn of
2017. The aim of the HEAP training on analytics was to advance analytical and technological
© Sitra 2018 competence in order to facilitate the innovative and proactive use of health data reserves in health
and social services. The project explored how the opportunities brought about by information
Sitra studies 141 technology could enhance the activity and engagement of clients in the service system.
The HEAP project was carried out in co-operation with Satakunta University of Applied
From Big Data to Myhealth
Sciences (SAMK), the Pori unit of Tampere University of Technology (TTY) and the eMed
laboratory of the Tallinn University of Technology (TalTech). I would especially like to thank Sari
ISBN 978-952-347-086-6 (paperback)
Merilampi, Doris Kaljuste and Andrew Sirkka for their invaluable work and encouragement, and
ISBN 978-952-347-087-3 (PDF) www.sitra.fi
the TTY and TalTech, under the leadership of Tarmo Lipping and Peeter Ross, for their ideas and
ISSN 1796-7104 (paperback)
ISSN 1796-7112 (PDF) www.sitra.fi support during the HEAP project.
Data analytics can be applied in healthcare in many forms and across all stages of the
Erweco, Helsinki 2018 healthcare service chain. It is of the utmost importance for decision-makers and management to
identify the need to educate new kinds of healthcare professionals. Finally, healthcare institutions
*State of Health in the EU should become learning and supporting organisations that are skilled at creating, acquiring and
SITRA STUDIES is a publication series which focuses on the
Finland, Country Health
transferring knowledge, and at modifying their behaviour to reflect new knowledge and insights,
Profile 2017, OECD and
conclusions and outcomes of Sitra’s future-oriented work. World Health Organization. together with their clients, citizens.
27.10.2018 Lappeenranta
TUULA TIIHONEN
Project director, Human-driven Health, Sitra
2 3
FROM BIG DATA TO MYHEALTH FROM BIG DATA TO MYHEALTH
Tiivistelmä Summary
Viime vuosina on puhuttu paljon big datan ja tekoälyn tuomista mahdollisuuksista. Niin myös In recent years there has been much talk about the opportunities offered by big data and artificial
terveydenhuollossa, missä kerätään ja tallennetaan päivittäin valtavat määrät tietoa. Näiden intelligence. This is also the case in healthcare, where large amounts of information are collected
tietomassojen älykkäässä hyödyntämisessä otamme kuitenkin vasta ensi askeleita. and stored every day. However, we are only taking the first steps in the smart use of this mass of data.
Tässä julkaisussa arvioidaan, kuinka hyvin osaamme hyödyntää terveys- ja hyvinvointidataa This publication evaluates how well we currently use data on health and well-being,
tällä hetkellä, esitellään hyvinvointianalyytikkojen koulutusohjelman (HEAP) pilottihankkeen presenting the experiences and teachings of the Health Analytics Programme (HEAP) pilot
kokemuksia ja oppeja sekä kerrotaan käytännön tapausesimerkkien avulla, miten tietoa hyödyn- project and using practical examples of cases to illustrate how data is already being used in new
netään aivan uudenlaisissa terveyspalveluissa jo nyt. HEAP-pilottiprojekti toteutettiin yhteis- forms of healthcare services. The HEAP project was a co-operation between Satakunta University
työssä Satakunnan ammattikorkeakoulun, Tampereen teknillisen yliopiston Porin yksikön ja of Applied Sciences (SAMK), the Pori unit of Tampere University of Technology (TTY) and the
Tallinnan teknillisen yliopiston kanssa. eMed laboratory of the Tallinn University of Technology (TalTech).
Kuten professori Tarmo Lipping kirjoittaa, hyvinvointianalytiikka voidaan nähdä lukutai- According to Professor Tarmo Lipping, data analytics can be seen as a kind of literacy, whose
tona, jonka arvo kasvaa jatkuvasti, varsinkin terveydenhuollon kaltaisessa monimutkaisessa value becomes greatest in complex environments such as healthcare. It is also an important way
ympäristössä. Niin ikään se on tärkeä keino parantaa ihmisten osallisuutta omassa hoidossaan. to improve people’s participation in their own care.
Tulevaisuudessa tätä lukutaitoa tarjoavat yhä useammin tekoäly ja algoritmit, mutta sitä In future, this literacy will increasingly be offered by artificial intelligence and algorithms,
odotellessamme terveydenhuollon arjessa tarvittaisiin data-analyysin ammattilaisia, jotta tietova- but until then professional health analysts could enhance the day-to-day operations of the
rantomme saataisiin hyötykäyttöön. Hyvinvointianalyytikot voisivat toimia erilaisissa rooleissa eri healthcare system, maximising the value of our existing knowledge reserves. Health analysts
osissa terveydenhuoltojärjestelmää ja esimerkiksi tuottaa hyödynnettävää tietoa hoitotiimin tai could operate in many different roles in various parts of the healthcare system and, for example,
johdon päätöksenteon tueksi. Analyytikko voisi koostaa ja analysoida mm. potilasdataa sekä provide information that improves treatment or supports administrative decision-making. An
asiakastietoa palveluohjauksen ja asiakaskokemuksen kehittämiseksi. Analyytikko voisi myös analyst could compile and analyse information such as patient data and customer information for
tukea yksilöllistä terveys- ja hyvinvointisuunnittelua ja -valmennusta datan avulla. the development of service counselling and the customer experience. An analyst could also
support individual planning for health and well-being and for coaching with the help of data.
Pilottihankkeen tulos: matka on vasta alussa mutta paljon on
tehtävissä jo nyt Pilot project outcome: the journey is just beginning but much
HEAP-pilottihankkeesta saadut kokemukset ovat rohkaisevia mutta alleviivaavat myös sitä, että more can be done now
tehtävää on vielä paljon. Asiakasrajapintaa hoidetaan edelleen pääosin manuaalisesti The experiences of the HEAP pilot project are encouraging, but they also underscore the fact that
terveydenhuollon arjessa. Toiminta- ja prosessiautomaatio on vasta aivan alkuvaiheessa moniin much remains to be done. The customer interface continues to be primarily handled manually as
muihin toimialoihin verrattuna. a part of healthcare routine. Production and process automation is only at the early stages
Pilotin myötä datan käytön esteiksi tunnistettiin esimerkiksi terveydenhuollon tietojärjes- compared with many other fields of activity.
telmien monimutkaisuus, tiedon puute, käyttöoikeuksien rajoitteet ja tietosuojasäädökset (tässä The pilot identified some impediments to the use of data, such as the complexity of health
järjestyksessä). Hyvinvointianalyysiohjelman, johon kuului myös hyvinvointivalmennusta, information systems, the lack of information, restricted user rights and data protection
puolestaan nähtiin tuovan lisäarvoa niin ammattilaisille, asiakkaille kuin koko palvelujärjestel- regulations. Health analytics programme including customer coaching and case management,
mälle. Erityisesti laadunhallinnan, muutosjohtamisen ja asiakasviestinnän arvioitiin parantu- was seen as providing added value for professionals, customers and the service delivery system. In
van, jos hyvinvointianalytiikkaa käytettäisiin nykyistä enemmän. particular, it is envisaged that the greater use of data analytics will improve quality management,
Tulevaisuus näyttää kuitenkin valoisalta. Olemme parhaillaan matkalla kohti osallistavaa change management and communication with customers and their families.
ja ennakoivaa hyvinvointia, terveys 1.0:sta älykkääseen terveys 4.0:aan. Tämä matka on aikoi- Despite some reservations, the future looks bright. We are currently on our way towards
naan alkanut erilaisten tietoaineistojen muuttamisella digitaaliseen muotoon, jatkunut eri inclusive and proactive well-being, from Health 1.0 to smart Health 4.0. This journey began with
tietoaineistojen yhdistelyn oppimisella ja etenee parhaillaan kohti entistä yksilöllisempien the conversion of various data into digital form, continued by learning how to combine various
palvelujen kehittämistä. Matka jatkuu kohti tekoälyn ja algoritmien mahdollistamia yksilöllisiä data materials and is currently moving towards the development of increasingly individualised
päätöksenteon tukipalveluja ja parempaa asiakasymmärrystä. Suomi ja Viro ovat tämän mat- services. The journey will continue towards individualised support services for decision-making
kan edelläkävijöitä. and better understanding of customers, enabled by artificial intelligence and algorithms. Finland
Julkaisussa esitellään uudenlaisia, jo käytössä olevia keinoja hyödyntää dataa, kuten and Estonia are at the forefront of this journey.
Terveyshyötyarvio, joka tunnistaa väestön hoitovajeita ja auttaa löytämään kullekin yksilölle This publication proposes new ways of using data that is already available and in use, such as
tehokkaimmat ennaltaehkäisy- ja hoitovaihtoehdot sekä KardioKompassi®, joka auttaa arvioi- the Health Benefit Analysis, which recognises care gaps in the population and helps find the most
maan henkilökohtaista riskiä sairastua sydän- ja verisuonisairauksiin genomi- ja elintapatieto- efficient alternatives for prevention and treatment, and the KardioKompassi®, which helps
jen perusteella. Niin ikään esittelyssä on sähköinen Omaolo-palvelu, joka tarjoaa asiakkaalle evaluate the risk of individuals contracting cardiovascular diseases by analysing genome and
apua ajasta ja paikasta riippumatta. Datan hyödyntämisen kokonaisuudessa merkittävä rooli lifestyle data. Also presented is the electronic Omaolo service, which offers customers help no
tulee olemaan myös suomalaisilla tietoaltailla ja biopankeilla, joista kerrotaan luvussa 4.5. matter the time or place. Finnish data lakes and biobanks, also addressed in the report, will also
have a significant role to play in maximising the use of personal data.
4 5
Contents
Preface 1
4 Analytic methods and tools for digital care services 48
4.1 Care gap and health benefit – tools for value-based care 48
4.2 Omaolo service 54

Executive summary 2 4.3 KardioKompassi® – using genomics to accurately predict and
prevent cardiovascular disease 58
4.4 Proactive cardiovascular prevention in subjects with a high
1 Introduction 6 hereditary risk by using the Kardiokompassi tool in Estonia 60
4.5 The Finnish biobanks and data lakes 64
2 The future of healthcare – from health 1.0 to health 4.0 8
Towards the era of myhealth: customer inclusion and customer-

5 driven approaches in care services 68
Data analytics transforming health services towards
3
5.1 Inclusion and involvement as a basis for the analysis of social
myhealth services 12 decision-making and the efficacy of services 68
3.1 Teaching healthcare analytics – a new curriculum in healthcare 5.2 Customer inclusion in healthcare and social services 72
education 12 5.3 Health coaching – challenges to widespread incorporation
3.2 Data analytic skills required in the health and social sector 16 within healthcare 78
3.3 Data analytics for decision support in healthcare 20 5.4 Designing individually tailored health promotion programmes
3.4 Visualisation as a tool for data analytics 26 for people with disabilities 82
3.5 Small-scale working life pilots pave the way to data-driven
personalised care services 30 Annex 85

3.6 The value and impacts of advanced analytics in the healthcare
ecosystem 36
3.7 Echos from the health analytics programme (HEAP) 40
3.8 Lessons learned in the health analytics programme (HEAP) 44

6 7
1 Introduction
ANDREW SIRKKA EdD, PRINCIPAL LECTURER, PROJECT MANAGER,
the education remarkably, widening the project, we found the topics very intriguing
SATAKUNTA UNIVERSITY OF APPLIED SCIENCES (SAMK)
horizons of data analytics and its applications to discuss and work with. I hope that this
in service design. publication conveys the same enthusiasm
Since the first digitisations in the field of things, only serve to multiply the amount of This publication discusses the key topics and motivation to its readers, to make future
healthcare, the speed and extent of data available. This enormous increase in related to big data, and its use in healthcare healthcare and social services more flexible
transformation has been increasing on an digital data needs to be utilised much more and social services. The publication consists and individualised based on effectively
annual basis. Fast technology development of effectively to meet customers’ health and of three main parts: 1) the “big picture”, as a deployed data analytics.
disruptive technologies and emerging trends well-being needs. What we need is better knowledge base for the project, discussing Finally, as the HEAP project manager
like robotics, artificial intelligence, 3D deployment of data analysis and analysts global trends and transformations in the and the editor of this publication, I would
printing, precision medicine or patient within the service delivery systems. health industry; 2) the implementation of the like to express my sincere appreciation and
design affect the health industry globally. This publication is one of the outcomes HEAP project and pilot education gratitude to all the experts and students for
More and more fascinating and easy-to-use of a two-year project (2017–2018) called experiences; and 3) interesting novel means their priceless contributions to the project
trendy applications arrive on the market that Health Analytics Programme (HEAP). The and methods for data analytics in healthcare and this publication.
appeal to anyone who wants to monitor project was initiated and funded by Sitra, and and social services. As participants in the
activity, sleep, blood pressure, ECG, pulse, was conducted as a collaboration between
nutrition levels – you name it. Any self- Satakunta University of Applied Sciences
respecting modern individual wants these (SAMK), Tampere University of Technology
apps on their smartphone and feels the need (TTY) and the eMed Lab of the Tallinn
to be actively involved in their own health University of Technology (TalTech). The
and well-being. purpose of the project was to provide
The healthcare and social sector have evidence of the impact of analytical solutions What we need is better deployment
traditionally been seen as information- and their suitability in healthcare and social of data analysis and analysts
intensive industries filing massive amounts services. The project envisaged an education
of information intended for use in a person’s package to provide the expertise required for within the service delivery systems.
care. A long time ago it became obvious that the use of the data analytics. The education
no one would be able to manually handle programme consisted of theoretical studies
that amount of produced or filed (30 ECTS, European Credit Transfer and
information. The mass of data has become Accumulation System) and a pilot phase (20
akin to hazardous waste! It is commonly ECTS) with data analytics projects in
accepted that this manually or electrically students’ working environments introducing
data analytics into practice.
Added to a Steering Committee, the
project established a Working Life
Committee representing the service provider
The mass of data has become organisations in the target region, Satakunta,
akin to hazardous waste! Finland. Students enrolled in this pilot
education programme formed two
simultaneously progressing groups, one in
Pori, Finland and one in Tallinn, Estonia.
gathered information is not accessible and The students in the Estonian group had
does not move between various services and backgrounds from areas other than
professionals that badly need it when serving healthcare, unlike the Finnish students who
their customers. Moreover, digitalisation and all were healthcare professionals. The
modern technology solutions, among other heterogeneity of the student groups enriched
8 9
2 The future of healthcare – Why IHAN? Because more and more

services that we use are digital, which also
MyData model – a model that equips
individuals to control who uses their
from health 1.0 to health 4.0 means global. IHAN gives us the ability to
collect data from different providers. For
personal data, stipulates the purposes for
which it can be used and gives informed
that, clear and open standards are needed. consent in accordance with personal data
MADIS TIIK, MD, SENIOR ADVISOR, SITRA The closest example of IHAN number (a part protection regulations. It makes data
of the IHAN concept) is IBAN, the collection and processing more transparent
international bank account number, which and it helps companies or other organisations
This article discusses the transformation in attendance at or admission to the facility. The gives us a simple address for a person’s bank implement comprehensive privacy protection
the healthcare concept since the first primary aim of the EHR is integration, data account. Why not use a similar solution for policies (Poikola, Kuikkaniemi and Honko
digitisation in the Health 1.0 concept and up sharing between healthcare providers, health information? (See Figure 2.) 2015).
to the future smart Health 4.0. The automation and streamlining of a healthcare The second precondition is consent Sitra will create an international consept
technology-driven development has provider’s workflow. It is very important to management. Making decisions about which for a human-centric and secure data
generated new ecosystems and enabled new ensure that the information generated in the service to use, every inidivual also has to give exchange and part of it will be standardised
potential in health services. However, the EHR is timely, accurate and available all the a certain level of consent to the service by European standardisation process. Sitra is
new ecosystems require new competences time. provider. This can be solved using the also working closely with MyData Alliance.
and outstanding changes in working PHRs are also developed for the
patterns. ecosystems of different services and devices
but are still separate from the EHR. A health FIGURE 1.
Health 1.0 – Digitisation information exchange (HIE) is a centrally THE HEALTHCARE
The widely deployed and popular computer collected dataset from local EMRs, and PROCESS TODAY Laboratory/ Laboratory/
other tests other tests
application, the electronic medical record enables data exchange between different
(EMR), is in its basic version a digitised EMRs, with data passing from one to the
version of the regular traditional paper-based other over the HIE platform (Figure 1).
medical chart for everyone. It contains all the
329 will General
patient’s medical and clinical data history in Health 3.0 – Personalisation 1000 citizens
during one
800 of them
have some
meet
a medical
practitioner Specialist
medical
a single facility, such as a hospital, clinic or The first precondition for Health 3.0 is a month concerns
professional,
e.g. nurse
GP’s office. It is used by healthcare providers personal health account (HA), which consists
to monitor and manage care delivery within of both PHR and EHR-generated data and
the facility. At the same time, there have been which can be fully controlled and managed
different services and devices which collect by individuals themselves. The PHR and
EHR of HIE
data for everyone’s own personal health EHR service providers feed HA with data.
record (PHR). At this stage, they are stand- From the perspective of the individual, the
alone solutions – one device or service which process must be simple and easy to manage.
has its own data storage. The EU General Data Protection
Regulation (GDPR) enables people to take
Health 2.0 – Integration over the control of data, but there is a lack of FIGURE 2.
DEVICES
An electronic health record (EHR) is shared infrastructure and standards for doing so. HEALTH 3.0 – A
Disease PHR
HEALTH ACCOUNT Medical EHR Health
instantly and securely among multiple Moving towards Health 3.0, we have to build services
episode
Sickness data Healthe and data
AND IHAN information wellness
healthcare facilities within a community, trust and security around the health account. SERVICES
ENABLING A
region and state, or, in some cases, the whole Once those components are in place, PATIENT-CENTRED
country. Effective implementation of EHRs everyone can connect with other data APPROACH
can be done after healthcare organisations sources, like genome bank data or data from
IHAN
have adopted complete EMR systems. Like various registries. That´s why Sitra, the
Open data Genomic data
EMRs, EHRs are longitudinal patient-centred Finnish Innovation Fund, started (2018) an
records containing a patient’s full health international project IHAN® to enable us to HEALTH
Account
profile (or, more accurately, a sickness move our personal data between different
profile, because it carries primarily your service and data providers, including our
medical history) starting from the first personal health data.
10 11
Health 4.0 – AI empowered services. First, the 800 people who had FIGURE 4.
THE HEALTHCARE
decision-making services health-related concerns could have started to
PROCESS IN THE
While Health 3.0’s focus is more on securing solve them together with AI. A symptom FUTURE
data exchange under the control of an checker, decision support tools and access to Symptom checker
Nurse
individual, Health 4.0 is more concerned existing medical history would form the basis Data extraction General
800 of them
with the opportunities and services enabled of analytical tools, which will help to clarify 1000 citizens have some
practitioner
EHR
during one Data analytics
medical
by a health account and proper consent and specify the existing condition. month concerns Decision making Specialist
management. It is evident that in this stage After triage, some problems could be Advice and recommendation
the main role will be taken by artificial solved by a healthcare professional, but most Laboratory
intelligence (AI; Figure 3). Decision support of the problems could be solved elsewhere.
and triage systems for better decision- The health account is the connecting particle
making have been in use already for 20 years, between the dataflow from EMRs and other
but thanks to modern machine learning and services, but also feeds the AI for better
advanced analytics we can go much deeper analytics (Figure 4). Self-care HEALTH
account
and closer to personalisation. Different kinds PHR
of analytical services can be built around a Conclusions
health account; maybe we even need new Although we have spent a lot of money and
professionals to deal with that – health time on integrating EMRs, allowing personal
analysts? access to the data, we really do not have
The health account can be also seen as a better health outcomes. One reason for that
market place for different services – one might be that the focus has been wrong –
person may open his or her dataset and concentrating too much on data collection
realise they need further assistance. The and digitisation, rather than building patient- FIGURE 5.
Personal data ownership
Analyst
market can work like a matchmaking centric services and using data analytics. THE
PRECONDITIONS
environment, where knowledge and health GDPR and IHAN will lead the new era of
FOR HEALTH 4.0 Health account
problems face each other and the individual healthcare, where integration is carried out AI MyData
acts as a kind of conductor, who allows or with the consent of data owners, people, and
Analytical services
denies access to the personal dataset. artificial intelligence is used to make better
With all the necessary components in decisions. This will lead to the empowerment Health
account
place, we can design a new process for how of the patient and may have a positive impact Interpretation service CDPR
people should interact with healthcare on personal well-being (Figure 5).

IHAN
Health analyst
Freedom Patient
FIGURE 3. Patient involvement
AI-EMPOWERED DEVICES
Disease PHR
DECISION-MAKING Medical EHR Health
episode Healthe and
services Sickness data data
SERVICES. information wellness
SERVICES
IHAN
Open data Genomic data
HEALTH
Account
2 References 1. Green L. A., Fryer G. E. Jr., Yawn B. P., Lanier D.

and Dovey S. M. (2001), “The ecology of medical care
3. Poikola A., Kuikkaniemi K. and Honko H. (2015),
MyData – A Nordic Model for human-centered
revisited”, New England Journal of Medicine, 344(26): personal data management and processing,
2021–2025. Ministry of Transport and Communication, Finland:
www.lvm.fi/documents/20181/859937/MyData-
2. Sitra (2018), the Human-Driven Data Economy:
nordic-model/2e9b4eb0-68d7-463b-9460-
www.sitra.fi/en/topics/human-driven-data-
821493449a63?version=1.0.
economy/#what-is-it-about.
AI-empowered decision-making services / marketplace
12 13
3 DATA ANALYTICS data and the diverse information systems that

have low interoperability with each other. In
10) patient empowerment; 11) smart
healthcare services; and 12) internship in
TRANSFORMING HEALTH addition, bringing in new technologies to health analytics.
SERVICES TOWARDS
conventional medical service provision
demands smart change management Primary and secondary
MYHEALTH SERVICES approaches, to avoid resistance by healthcare
professionals that are already overwhelmed
use of data
Data is the primary component of building
with continuous changes in their daily work. e-health services and digital tools. Data in
The current situation supports the information technology is the same as cells in
introduction of a new type of healthcare medicine – while cells are foundations of
professional, who understands how health organs, tissues and the human body, data is
and medical data from different databases the foundation of e-services and digital tools.
can be integrated and updated into an easily Data has no meaning without the context.
usable, standardised format. The knowledge Adding context to data generates
of this profession should be based more on information. The same data could carry
the understanding of types and sources of different information, depending on the
data, and how collected information can be surrounding environment. In medicine, data
3.1 Teaching healthcare analytics presented to the decision-maker (rather than is often mixed with information. In the
– a new curriculum in solving the problems of one particular

individual).
analogue world, a clinician’s notes might
include some conclusions in free text without
healthcare education Thus, the health analyst is a professional

that potentially covers the existing gap
presenting the source data. This hinders
reuse of collected notes because they are not
between insufficient handling, high volumes computer processable. To make clinical notes
PEETER ROSS, PROFESSOR, EMED LAB, TALLINN UNIVERSITY OF of medical data and the universal available for digital decision support systems
TECHNOLOGY, ESTONIA implementation of artificial intelligence. The they should be standardised and as context
role of the health analyst would be to find specific as possible. Furthermore, the more
relevant data from the various databases, granular the data, the wider the spectrum of
Increasing amounts of health and medical medicine for centuries. Nowadays, when the decide on the quality of data, and present e-services and tools that could be developed.
data, collected from different data sources amount of data collected about patients is data to the decision-makers or enter it into Healthcare professionals have to
and present on healthcare professionals’ exceeding analytical limits of the human digital decision support tools. understand that the quality of e-services
desktops, brings a need to aggregate this data brain, the traditional synthesis of data by one applied on different information systems
and information and present it in condensed professional is not possible. In addition, Core components of depends on the quality of the data they are
form. In an ideal situation, collected data research in biomedical sciences is producing the healthcare analyst’s entering into the information system. The
could be processed with digital tools using so much professional knowledge that keeping curriculum entering of data and its use at the point of
artificial intelligence and decision support the diagnostic and treatment skills of a Three universities in Finland and Estonia care is the primary function of data. This is a
systems. Unfortunately, current data in doctor or nurse up to date requires (Satakunta University of Applied Sciences, part of the modernisation of healthcare and
electronic medical and health record systems aggregation and presentation of this new Tallinn University of Technology and brings some efficiency into processes, but it
is not of sufficient quality for computer information with the help of computers, in Tampere University of Technology) has relatively limited value compared to the
processing in most cases. The health an easily understandable way. developed a curriculum for the health analyst secondary use of data. Secondary use of data
analytics profession might cover this gap in This situation is ideal for introducing profession. The curriculum consists of the is taking advantage of the already collected
the coming years. Below is an overview of the artificial intelligence tools to help healthcare following basic components: 1) primary and data by other users, in different locations. It
content of the curriculum for health analysts. professionals handle ever-increasing amounts secondary use of data; 2) content and trends is the use of data collected by other
The teaching of healthcare professionals, of information. However, despite the high in e-health; 3) digital tools in healthcare; 4) professionals in different locations and
doctors and nurses, traditionally expectations for computer-aided detection of theoretical basis of data analysis; 5) service circumstances. Accordingly, the reuse of free,
concentrates on problems of a particular diseases and digital decision support systems, design and change management; 6) unstructured and non-standardised free text
individual or understanding the development a real breakthrough regarding the above- information systems in healthcare and their is cumbersome and time consuming, while
of specific diseases. This has been an efficient mentioned tools has not happened. integration; 7) digital decision support structured and standardised data that is
way of passing on professional experience Insufficient use of digital tools can be systems; 8) artificial intelligence; 9) practical easily computer processable allows for the
and introducing scientific evidence to contributed to the low quality of the collected design of a health analyst’s work processes; provision of added-value services (not only
14 15
for the person who has entered the data, but takes responsibility for the reliability of the risk scores, visualisation tools, etc.) is part of and is accessible only after approval from the
more widely for all parties in the health tools used and must be confident that they the curriculum. Students have a chance to person him/herself. Therefore, the benefits
domain, including the patient, healthcare will not harm the patient. enter their personal health data into digital for the patient are analysed, and different
professionals and society). tools and see what kind of output is e-services and digital tools for disease
Service design and change delivered. This practical exercise allows prevention and health promotion are
Content of and trends management students to understand the importance of investigated.
in e-health As discussed earlier, the implementation of data availability and quality, because
E-health is a term that defines the innovative tools and shared services in insufficient data would lead to no response Practical experience
introduction of innovation and change healthcare is not possible without from the decision support system. The pilot project for health analyst training,
management into healthcare through redesigning analogue processes. On the other consisting of a total of 50 ECTS, was
digitisation. Similar to banking, where digital hand, change is perceived as a stress factor by Practical design of health conducted at the Satakunta University of
transformation is seen to a large extent (and healthcare professionals, who are typically analyst work processes; Applied Sciences (SAMK) and at Tallinn
e-banking is so common that the term itself conservative in the nature of their everyday internship of health analysts University of Technology (TalTech), during
is rarely used any more), healthcare work. The health analyst profession is new to Different scenarios involving the health three semesters, in 2017 and 2018. There
digitisation should also consign the e-health the healthcare environment and every analyst’s work responsibilities have been were 10 students in Finland and five students
term to history, digitisation being an inherent activity performed by health analysts could designed. Scenarios in which health analysts in Estonia participating in the pilot.
part of ordinary healthcare. However, to be taken as an unwanted event in the health work in a GP’s office and provide doctors Feedback from the students and lecturers was
make this transformation happen students system’s well-established environment. Every with patient summaries collected from collected. Every student had to partake in a
must understand how digitisation can change new service must be designed in such a way different healthcare databases before a practical internship that provided additional
processes and bring new innovative tools that change is almost undetectable by users. patient visit is one option. Scenarios have information about the need and value of the
into healthcare. Another aspect of Alternatively, if the redesign leads to evident also been tested in which health analysts health analyst profession. Input from
digitisation is that it involves new parties in change in the responsibilities or working work at medical call centres and as health different sources was analysed and several
health-related decision processes. This environment, proper change management coaches, providing out-of-pocket services for recommendations about the new profession’s
applies especially to the involvement of should be in place in advance. patients. Each student has a chance to skills and roles in healthcare, and about the
patients. conduct an internship of 20 ECTS credits in curriculum for health analysts, were
Information systems in healthcare services. provided. The results of the pilot from
Digital tools in healthcare healthcare and their different perspectives are discussed in other
Innovation is often related to disruption. integration chapters of this book.
Digital tools in healthcare are disruptive in Although the health analyst will use several To conclude, all participants in the
Understanding the opportunities of
nature, involving the redesign of processes, new digital tools in their workplace, most of pilot project were enthusiastic about the
the involvement of completely new decision- the medical information is collected in new tools while also having knowledge need for this profession and found the
makers and sometimes making traditionally healthcare providers’ sophisticated electronic proposed curriculum comprehensive.
about their potential harm is an
highly specialised services a commodity. medical records. Teaching basic principles of However, the role of the health analyst in
Understanding the opportunities of new design and architecture, data standards and essential part of the curriculum. the management of health status and
tools while also having knowledge about user interfaces used in information systems medical problems in the healthcare
their potential harm is an essential part of the are important elements. Also, how to environment is not yet well defined. In
curriculum. integrate different electronic medical records The importance of patient addition, the design of services where the
and the data provided by them into patient- empowerment is thoroughly discussed in the health analyst could be used is in progress.
Theoretical basis of data centric, electronic health records is essential programme. Data used by healthcare As a result, the curriculum might need
analysis knowledge. professionals should be owned by the patient some further fine-tuning in the future.
Data analysis is based on mathematical
calculations and statistical analysis. Even Digital decision support
though development of analytical tools is not systems and artificial
a part of a health analyst’s profession, the intelligence
understanding of what lies under the hood of The introduction of digital decision support
digital tools is of utmost importance. The systems for the primary use of data (i.e.
user needs to decide what digital tools are entering of structured data into standardised
reliable and evidence-based. While using formats) and for the secondary use of data
decision support systems the health analyst (i.e. to receive alerts, notifications, reminders,
16 17
3.2 Data analytic skills required in also transform governance towards more
customer-driven perspectives (Butcher 2015;
driven) care fails without genuine shared
decision-making and management, working
the health and social sector Kadmon et al. 2016; McNichol et al. 2015;
STM 2016).
in interdisciplinary teams. Evidence-based
practice, integrating the best research with
Opportunities for digitisation have also clinical expertise and patient values for
ANDREW SIRKKA, EdD, PRINCIPAL LECTURER, SATAKUNTA UNIVERSITY been identified by the Finnish Government’s optimum care and active participation in
OF APPLIED SCIENCES key projects, introducing and implementing research and learning activities, requires data
digital healthcare accessible to customers, analytic skills. Applying quality improvement
relatives and professionals. Rapid digital implies analytic competencies to identify
innovation is also evidenced by numerous errors and hazards in care and patient safety,
Healthcare as an Digitisation expanding the start-up events and exhibitions, where digital to constantly measure the quality of care in
information-intensive quantity and quality of data health is a strong presence. More and more terms of structure, process and outcomes in
industry available digital tools are being generated, marketed relation to patient and community needs,
The Health Analytics Programme (HEAP) Digitisation in the healthcare industry is and used to monitor one’s health indicators, and to design and test interventions with the
was launched as a reaction to the increasing moving with a great deal of speed all over the including fitness levels, muscle activity, heart objective of quality improvement. None of
need for data analytic competences in the world, even in developing countries. This is rates, blood pressure and sleep. The current this would be possible without utilising
health sector. The healthcare sector has pushing services and businesses towards discussion debates the pros and cons informatics in terms of communicating and
traditionally been an information-intensive product-as-a-service services, usable regarding usability of the data provided by managing knowledge, and using decision-
industry, collecting large amounts of anywhere and anytime, incorporating wearable trackers in official healthcare making support technologies.
information from various sources (society, personalisation and agile continuous services. Despite active marketing, recent
patients, science, machinery, etc.) for several improvement (Little 2017). Digitisation surveys indicate that only 20-22% of adults A project to pilot education
reasons (health statistics, patient health could mean anything: devices capable of are using wearable health trackers in Finland programmes on health
records, reports). managing digital signals; computerised and in the USA (eMarketer 2017; Statista analytics
Healthcare collects huge quantities of media and communication systems to 2018). The Health Analytics Education Pilot
data about patients, treatments and explain or understand aspects of (HEAP) was launched in 2017, in
procedures in manual or electric records, contemporary social life (Brennen and Kreiss New competences required collaboration with Sitra, Satakunta University
forming vast repositories of health and 2014); or big technology innovations Because of rapid digitisation, large datasets of of Applied Sciences (SAMK), Tampere
care-related information. These repositories radically transforming processes and services information are commonly available. University of Technology (TTY) and Tallinn
are like libraries – only the problem is that by means of information technology Advanced exploratory data analysis University of Technology (TalTech). The
use of this library is blocked! A widely well- (Chilikuri and van Kuiken 2017). No matter techniques are also available to identify project envisaged a study programme for
known constraint, especially in developed what the definition, it is obvious that potentially useful patterns in data. Use of health service analyst competences on the
industrialised countries, is that because of digitisation is constantly and with increased these techniques could provide colossal grounds of the challenges discussed above.
strict data protection legislation, data is hard intensity transforming the world, life, work, benefits and value to organisations and The education programme contained a total
to access (even by the most relevant services, economy and culture. professionals involved in service delivery, as of 30 ECTS theoretical and 20 ECTS practical
professional for supporting optimal care) and Digital transformation, together with well as to customers. studies to implement analytics in real-life
poorly transferred between various care the ideology of consumerism, requires major According to Chilukuri and van Kuiken services. The pilot group consisted of two
providers (Baker 2013; Tiik 2018). changes in service concepts, processes and (2017), digital transformation is more likely student groups, one in Pori, Finland, and the
The value of building huge libraries with means, in all kinds of organisations and to succeed when organisations focus on four other in Tallinn, Estonia.
massive information repositories that are business domains. User-orientation and critical dimensions: capabilities, modern IT Given the issues associated with rapid
scarcely used (if ever) is questionable. Should consumerism are essential parts of modern foundation, delivery engines and sources of digitisation and its attendant challenges for
the system instead pay closer attention to digitised services. They are drivers for change value. These dimensions obviously set new healthcare, designing a one year-long
collecting smart data – data that is beneficial in management and leadership models, in competency requirements for anyone education programme aimed at the
and usable on a wider scale? Should people innovative service concepts and new business working in the sector of healthcare and social furthering knowledge of data analytics for
have a greater ownership of their health data? models, and in the incorporation of digitised services. non-medical healthcare professionals was not
Smart data collection and automated analyses assets and increased use of technology to Kaggal et al. (2016) presents a list of a simple task. To get started, the project
at the patient registration phase could improve and streamline the quality of core competences that all healthcare group had a few meetings to figure out the
expedite and improve quality of care. services provided by/to organisations, professionals should possess, regardless of most essential elements and competency
employees, customers, suppliers, partners their discipline in the 21st-century healthcare requirements to be met and to plan how to
and other stakeholders. Digitised services system. Patient-centred (let alone patient- implement the identified contents in the
18 19
programme. Also, a working life committee Studies consisted of online studies using FIGURE 1.
HEALTH ANALYTICS
with representatives from the main video lectures and online sessions. Weekly
WAS CARRIED
Multimethod education
healthcare service providers in the region face-to-face workshops were held to facilitate OUT AS A FORM
• Weekly tutoral classes
was established, to discuss the needs and the work of the two groups and to keep up OF MULTIMETHOD • Video lectures and student assignments in Moodle e-learning environment
challenges organisations currently face with the progress of the studies. As expected, EDUCATION • Intensive programmes
regarding data analytics. the data analytics part turned out to be quite • Service and tech demos
• Seminars and workshops
A special characteristic of this pilot a challenge for all the students. To support
• Multiprofessional joint classes
education project was having two international aspects and get a deeper insight
• Close collaboration with companies, service provider organisations
simultaneous groups of students in Finland into commonalities and diversities in service
and projects
and Estonia. Additionally, the Estonian deliveries between the two countries, a
students had a variety of professional couple of intensive campus weeks with a
backgrounds compared to the healthcare variety of workshops and seminars
FIGURE 2.
professionals in the Finnish group. (including public seminars on the theme) SOME OF THE PERFORM A VIRTUAL HEALTH
CHECK TO YOURSELF
Heterogeneity in the healthcare services and were held (Figure 1). MAIN LEARNING https://star.duodecim.fi/star/
student groups turned out to be a strength Working on the given assignments the OUTCOMES IN
HEALTH ANALYTICS
and a huge resource, rather than a challenge. students faced difficulties, even as
EDUCATION
Even though in the commerce and retail professional staff in the organisation, in
sector customer orientation is expected to be accessing the required data in the systems.
a centrepiece, it soon became very obvious Many flaws in documentation were
how similar the challenges and shortages identified, which resulted in either limited
were both in commerce and healthcare (or access or a total lack of the required
social services) today. Analytical skills are information. Most documentation is still in
not well known, let alone a core competence, unstructured narrative form, which requires
in either industry. natural language processors (NLP) to
analyse. The massive quantities of collected
data in the organisations was poorly
accessible and used in surprisingly scarce
The students found the pilot period ways. The students found the pilot period
very eye-opening in many ways. In 3.2 References Baker B. (2013), “Great patient care begins at Delivery at the Point of Care Empowered by Big Data
very eye-opening in many ways. particular, students realised how even small-
registration”, in Health Management Technology, April
2013, Vol. 34 Issue 4, p. 17.
and NLP”, Biomedical Informatics Insights 2016: 8(S1)
13-22 doi: 10.4137/BII .S37977.
scale analysis can identify bottlenecks and Brennen S. and Kreis D. (2014), “Digitalization and Little A. D. (2017), “Digital transformation in
Digitization”, in Culture Digitally, cited 12 September developing countries – Promotion and adoption
critical points, in addition to the 2018. Available at: http://culturedigitally.org/2014/09/ should be the main actions for companies and
digitisationisation-and-digitisation/. government”, cited 19 September 2018. Available
The structure of the education opportunities to streamline services. The at: www.adlittle.com/sites/default/files/viewpoints/
Butcher L. (2015), Consumerism Hits Healthcare,
programme consisted of the following student’s pilot projects are discussed in more H&HN: Hospitals & Health Networks, February 2015,
adl_digital_in_emerging_markets.pdf.
theoretical studies: 1) e-health and telehealth, details in the article 3.5 in this publication. Vol. 89 (2), pp. 22-27. McNichol E., McKay A., Milligan C., Bennett K.,
Hulme R. and Joy H. (2015), “A patient-led approach
Health 1.0-4.0 strategies, comparing digitised To conclude, the pilot education Chilukuri S. and Van Kuiken S. (2017), “Four keys
to product innovation in patient education and wound
to successful digital transformations in healthcare”,
health services at national levels; 2) decision programme provided a lot of new McKinsey & Company, cited 13 September 2018.
management”, EWMA Journal, April 2015; 15(1): 47-
51. 5p. ISSN: 1609-2759.
support systems and tools that focus on data perspectives. New skills were also attained Available at: www.mckinsey.com/business-functions/
digital-mckinsey/our-insights/four-keys-to-successful- Statista (2018), “Fitness band, connected car system
analytics, and technology tools provided to regarding how to handle and visualise data, digital-transformations-in-healthcare. and smartwatch ownership in Finland 2017”, cited
19 September 2018. Available at: www.statista.com/
support decision-making in healthcare; 3) and how to automate and streamline eMarketer (2017), “Wearables Still Far from Mass
statistics/716752/survey-ownership-of-smart-home-
Adoption”, cited 19 September 2018. Available at:
client involvement and smart services and customer services through process mapping www.emarketer.com/content/wearables-still-far-from-
devices-in-finland/.
digitools to implement customer engagement and use of AI solutions (Figure 2). mass-adoption. STM (2016), ”Digitalisaatio terveyden ja
hyvinvoinnin tukena Sosiaali- ja terveysministeriön
and client-centredness in services; 4) service Kadmon I., Noy S., Billig A. and Tzur T. (2016),
digitalisaatiolinjaukset 2025”, Sosiaali- ja
“Decision-Making Styles and Levels of Involvement
design and case management; 5) a practical Concerning Breast Reconstructive Surgery: An Israeli
terveysministeriön julkaisuja 2016:5, cited 10
September 2018. Available at: http://julkaisut.
period piloting analytics in healthcare Study”, Oncology Nursing Forum, January 2016
valtioneuvosto.fi/bitstream/handle/10024/75526/
Supplement Online Exclusive Articles; 43 E1-E7. 7p.
services. ISSN: 0190-535X.
JUL2016-5-hallinnonalan-ditalisaation-
linjaukset-2025.pdf.
Kaggal V. C., Elayavilli R. K., Mehrabi S., Pankratz J.
Tiik M. (2018), ”Miksei tieto kulje?”, Tekniikan maailma,
J., Sohn S., Wang Y., Li D., Rastegar M. M., Murphy S.
March 2018, pp. 77-83.
P., Ross J. L., Chaudhry R., Buntrock J. D. and Liu H.,
“Toward A Learning Health-care System – Knowledge
20 21
3.3 Data analytics for decision Repeated manual insertion of the same data
is demotivating for the staff involved. If
after spending some time with his/her
computer code and calculation gadgets. This
support in healthcare relevant, well-defined protocols for data
collection should be designed and observing
does not work in most cases. Designing the
analysis framework requires experts from
these protocols should be ensured and both fields.
TARMO LIPPING, PROFESSOR, TAMPERE UNIVERSITY OF TECHNOLOGY monitored by respective checklists or apps. Let’s take an example of collecting
No analysis can compensate for negligence in patient data in a department carrying out a
data collection. certain kind of treatment. We might end up
Analysis of health-related data is a diverse data analysis is outsourced to the tools and During the HEAP project, there has with a table containing demographic data of
topic spanning from health coaching to routines of commercial information systems, been a lot of discussion on who should the patients such as age, gender, level of
complex environments of intensive care, with exploiting data and data analytics in everyday actually perform the data analysis and where education, diagnosis, BMI, use of alcohol,
various goals, requirements and practices. clinical work is a matter of attitude. To use in the service chain the health data analyst etc., as well as the type (assuming that there
Health data analytics is used at the point of and trust the analysis results, one has to have should step in. There is no single answer to are several alternative treatment types) and
care, in real time; but it is also invaluable in basic knowledge of how these results are this question. It is desirable that medical staff outcome of the treatment. A generic
developing healthcare service chains, obtained. In addition, data analysis can only have at least some preliminary skills to objective of data analysis might just be: “what
treatment standards and guidelines, and be as good as the data it relies on. The data is visualise data available in common formats does the data tell us?” The data analyst can
reducing the overall costs of healthcare while collected by humans and it is difficult to such as Excel or CSV. Performing statistical calculate and visualise various correlations,
maintaining high service quality. Health data motivate oneself to carefully register data if analysis requires more skills and carefulness. such as those between the age or BMI of the
analytics may be integrated into commercial the data is not used, or if those who collect The tools of statistical analysis usually make patient and the treatment result, for example,
clinical decision support (CDS) systems, but the data never receive feedback on its usage. certain assumptions and if these are not or study the practices adopted in the
it can also be used by healthcare experts It is not uncommon to see tables of clinical fulfilled, the results may be misleading. At department by considering the relation of the
locally by collecting relevant data from their data filled with non-informative predefined the higher end of the scale of data analysis assigned treatment type to the level of
immediate work environment and analysing entries, or with fields left empty. methods are the various classification, education and gender of the patient.
data to better understand the impact of their The general steps of data analysis are machine learning and time series modelling Statistical analysis can also address questions
work. In this paper, both types of health shown in Figure 1. The workflow starts with tools, the application of which almost always such as if women tend to have better
analytics applications are considered. In the data collection. Studies where data collection requires involvement of a data analyst. treatment results and what is the statistical
first part, general workflow from data has been performed poorly are often referred Designing the analysis framework is significance of the finding. Using machine
collection to decision-making is discussed. to as “garbage in, garbage out”. Nowadays, often an iterative process where the learning methods, the data analyst can build
The training projects performed by the when there is a lot of discussion about big knowledge and skills from both fields – a model to predict the treatment outcome
students in the HEAP programme belong data and artificial intelligence, many medical and engineering – are required. This based on what is known about the patient.
mostly to this category; the relevant topics organisations decide to collect as much data iterative process usually contains the steps of After performing the calculations and
were covered in the Decision Support as possible, without a good strategy on data data visualisation, evaluation of the results, visualising the results, the data analyst and
Technologies course of the HEAP usage. While this might be justified in some and performing data analysis to produce new the medical expert go through them and
programme. In the second part of the paper, cases, much better results are obtained if the results for visualisation (Figure 1). It is often decide what is meaningful, what deserves
I will consider CDS systems, their functions, purpose of data collection is well specified mistakenly expected that the data analyst, more detailed insight and what is the best
features, aspects of implementation and and there is a clear strategy regarding the when provided with the data, will perform a way of visualising the findings. This triggers
challenges of adoption. These topics were usage of the collected data. The more the trick and come up with useful interpretation a second round of analytics. It may also be
covered in the Decision Support in data collection requires the time and effort of
Healthcare course of the HEAP programme. medical staff, the more important it is to
carefully design the structure of the data to
Data analytics and decision be collected. It is important to implement
support technologies data collection so that there is no need to
To use and trust the analysis results,
Although data analytics is increasingly manually insert the data that can be retrieved one has to have basic knowledge
integrated into various healthcare from other repositories (electronic health
information systems, there are (and will records (EHRs), for example), or that can be
of how these results are obtained.
always be) lots of data collected at various collected semi-automatically (by building
points of the healthcare service chain that interfaces to measurement equipment, for
cannot be incorporated into centrally example). This reduces the workload of data
maintained data repositories. Also, even if collection and makes it less prone to errors.
22 23
FIGURE 1. million adverse drug effects and 190,000 The meta-analysis by Moja et al. (2014), for
STEPS OF DATA
hospitalisations, providing yearly savings of example, found that the usage of CDS
ANALYSIS
Visualisation $44 billion. systems does not affect mortality, however
CPOEs can also improve the quality of prevents morbidity and reduces costs slightly.
patient care processes by: Evaluating CDS systems is not an easy task
− ensuring legibility of medical and the results are often contradictory.
Data
Interpretation
for decision
documentation; Adoption of CDS systems requires changes
support − enabling unambiguous storing in her; in workflow and habits. The best experiences
Evaluation − improving communication of orders to come from institutions where CDS has been
entities carrying out the orders; adopted gradually, function by function, and
− helping to monitor completion of in close co-operation with doctors. If some
orders; functions or features are not accepted or
− when connected to resource planning cause alarm fatigue, they should be modified
software, enabling more efficient billing. or removed. Unfortunately, often the
Data collection Analysis
introduction of information systems is
An important compromise in designing a carried out as a development project, closed
CDS system is the way the information is as soon as the software is in place and
presented to the user. The system may operating, and making further improvements
provide links or info-buttons so that the user based on the feedback is expensive. Bates et
considered if any reference data is available Most commonly however, CDS systems refer can look up relevant information by al. (2003) point out that in order to be
and what are the limitations of using them. to software designed to assist doctors at the themselves or, alternatively, pop-up windows acceptable, the CDS should fit well into the
Obviously, for most common treatments, point when they make decisions about may be used. When drug-drug or drug- workflow of the users, should offer support
such correlations have been studied already treatment. These systems are often called allergy conflicts are detected, the system can in real time, should not deliver irrelevant
and the results can be found from literature. Computer-based Provider Order Entry either generate an alarm, require an information and should not force the user to
However, the data may also describe some (CPOE) systems. The EBMeDS system by explanation why the conflicts are ignored or discontinue her/his flow of activity. They also
site-specific processes in patient care, or Duodecim falls into this category (see www. prevent the user placing such orders found that the users are very willing to
some common practices in a specific unit; ebmeds.org/). altogether. Also, some of the functions of change direction according to the
nobody else will do the work of comparing Common functions provided by a CDS systems are activated before the recommendations provided by the CDS if a
these processes and practices with common CPOE are: decision is made, some are meant to be superior alternative is offered.
standards but the staff in the particular unit. − providing reference knowledge such as performed at the moment of decision- From the implementation point of view,
guidelines or drug specifications; making and some should take effect CDS systems involve various components
Decision support in − anticipating needs (for example, when afterwards. such as a user interface, knowledge base and
healthcare ordering certain drugs, related lab Several meta-analyses have been execution engine (see Figure 2). Various
In this section, CDS systems, usually results can be displayed); performed to assess the effectiveness of aspects should also be considered, such as
integrated into the healthcare information − generating alerts and reminders; the adoption of CDS systems (Bright et al. 2012; the information model to be used,
system and often commercially developed most common alerts are those Moja et al. 2014). These analyses may specification of results to be passed from the
and maintained, are considered. Decision indicating drug-drug and drug-allergy evaluate different aspects of the CDS systems execution engine to the user and the process
support based on data analytics can be adverse effects; such as: of invoking the execution engine. These
applied at various points of healthcare. In its − providing order sets; by listing all orders − clinical outcome (length of stay in components and aspects are not static but
simplest form, decision support may be commonly placed in case of a certain hospital, morbidity, mortality, should continuously evolve as new
provided, for example, by interactive forms diagnosis helps to avoid mistakenly occurrence of adverse effects, reduction knowledge builds up, new methods of data
where, based on the information retrieved leaving some of them out; in redundant laboratory tests, etc.); analysis become available and new ways of
from the EHR, certain fields are prefilled or − providing feedback; − management (smoothness of workflow, data acquisition and information modelling
the information to be filled in can be limited − performing calculations (related to productivity, etc.); are developed. A common way to update an
to a certain range or selection of values. At dosage of drugs, for example). − user experience and acceptability. outdated information system such as a CDS
the other end of the scale are high-end
applications generating, for example, alerts in According to Johnston et al. (2003), it has
intensive care based on complicated data been estimated that in ambulatory settings in
analysis and machine learning algorithms. the USA the usage of CPOEs could avoid two
24 25
is to replace the whole system with a new one Conclusions APPLICATION ENVIRONMENT CDS MODULE
having modern features and capabilities. This Data analytics can be applied in healthcare in
means that for some time before the new many forms and across all stages of the
system is to be installed, the development of healthcare service chain. Exploiting data is Information
mapping
the current system is halted and after the new key to evidence-based medicine,
system is in place, it takes time before it can personalised care and patient involvement. Execution Execution
engine engine
be fully exploited. The solution to this Probably most of the data analytics will stay
problem is a modular design of the CDS below the hood – within commercial
system so that its components can be healthcare information systems and patient
updated separately. Greenes proposes a monitors. However, using these systems and Clinical IT
application Invoking Execution
design where the CDS forms a separate interpreting their results requires at least rules engine
module within the application environment, basic skills in data analytics. These skills are
with the latter containing the clinical currently not included at sufficient level in
information system serving as the interface curricula of study programmes. On the other
between the CDS and the user (Figure 2; hand, the usefulness of the output of any data Decision
specification
Greenes 2014). Within the CDS module, the analysis application is limited by the quality
knowledge base and the execution engine of the data. To perform high-quality data EHR Action
mapping
can also be separated so that, for example, collection usually requires at least some
new data mining and machine learning knowledge of how the data will be used and
algorithms can be implemented without what will be the outcome of the analysis.
redefining the knowledge base or the Data analytics can be seen as a kind of
information model. The structure of Figure 2 literacy, becoming increasingly valuable, FIGURE 2.
presents a general view on CDS. Although a especially in complex environments such as MODULAR
STRUCTURE OF
specific system may not be designed healthcare. It remains to be determined in
A CDS SYSTEM
according to this structure, the components what form data analytics skills will be (REDRAWN FROM
and functions presented here can be included in study programmes in the future. GREENES 2014)
recognised in almost all applications I consider the study module developed and
involving CDS. piloted in the HEAP project as an excellent
start.
Data analytics can be seen as

a kind of literacy, becoming
increasingly valuable,
especially in complex environments
such as healthcare.
3.3 References Bates D. W. et al. (2003), “Ten commandments for

effective clinical decision support: making the practice
Johnston D. et al. (2003), The Value of Computerised
Provider Order Entry in Ambulatory Settings, Center
of evidence-based medicine a reality”, JAMIA. 10 (6), for Information Technology Leadership, Boston, MA.
pp. 523-530.
Moja L. et al. (2014), “Effectiveness of Computerised
Bright T. J. et al. (2012), “Effect of Clinical Decision- Decision Support Systems Linked to Electronic Health
Support Systems: A Systematic Review”, Ann Intern Records: A Systematic Review and Meta-Analysis”, An
Med. 157 (1), pp. 29-43. J Public Health, 104 (12), e12-e22.
Greenes R. A. (2014), “Features of Computer-
Based Clinical Decision Support”, in Greenes R. A.
(ed.), Clinical Decision Support: The Road to Broad
Adoption, 2nd edition, Academic Press.
26 27
3.4 Visualisation as a tool for data Keep visuals simple and to

the point you want to make
Making a graph always involves many
choices. Figure 1 identifies the number of
analytics It is possible to make very exotic visual
impacts, however focusing on a simple key
patients with different diagnoses, also
showing the stent type they received in
message is important to ensure hospital. Stacked bars make total volumes
ESA RAHIALA, SENIOR ADVISOR, SATAKUNTA UNIVERSITY OF APPLIED understandability. Use of several visual easily observed. In this figure, the orange
SCIENCES elements has to be done with care: graph colour indicates cases with MACE
types, number of visual elements, use of occurrence.
colours and textual elements has to be Figure 2 indicates mortality among the
Visualisation can be useful to help people During the first phase, the case data controlled. same basic frame, using a darker colour to
understand summaries or specific aspects of (which was originally collected for a research Typically, visualisation software has indicate a higher number of deaths among
larger amounts of data. There are many project) was anonymised, with only the standard colour sets depending of the patients (in the follow-up period). When
competent software tools to make relatively patient’s age and gender remaining in the number of elements, field names, or comparing the figures, it has to be noticed
easy visualisations from various data sources. data table. In the second phase the data was attributes (colours are typically automatically that Figure 1 shows all MACE incidents,
This article presents and comments on the prepared for the visualisation software by allocated). Often using default settings is whereas Figure 2 only identifies deaths.
key principles illustrated with some examples omitting four rows which did not have, for very fluent. On the other hand, making Although the visualisations have the same
of the data used in Health Analytics some reason, age or gender. Then, data in exceptions takes considerably more time to shape and total numbers of patient cases, the
Education classes. relevant columns was replaced with more fine-tune the figure. message is different.
This article goes through some basic descriptive names/abbreviations and values.
points about using visualisations in analysing This was desirable, as binary type notation
data. Visualisation is not to be used as a (which may be useful for statistical
replacement for statistical tools, but may programs) may not be useful for visualisation
accompany them in one way or another. This software, which uses field/column names and
article contains some figures about a values directly in the construction of a
demonstration using real-life, although visualisation.
anonymised, hospital data related to stroke Visualisation tools can actually help to
cases. find outliers or errors in the data. Whether FIGURE 1.
Abbreviations for the type of stent used an outlier is actually an outlier, an error or a NUMBER OF
FIGURE 1. FIGURE 2.
in the figures below are BAS (Bioactive stent, missing piece of data depends on the case. PATIENTS WITH
MAJOR ADVERSE CARDIAC EVENT BY HEART BASED DEATHS DURING
DIFFERENT
Titanium Nitride Oxide) and DES (Drug- Consideration should also be made of the STENT TYPE FOLLOW-UP
DIAGNOSES BASED
eluting stent). Diagnosis for the incoming data-collecting procedures and how reliable ON THE STENT TYPE Incoming Diagnosis / Stent type Incoming Diagnosis / Stent type
patient can be nstemi, stemi or uap. As a they are. nstemi stemi uap nstemi stemi uap
result, there can be a MACE (major adverse

200 200
cardiac event, including also deaths) in the What is your message?
follow-up period, but hopefully not any. When composing the visualisations, the 180 180
Several health risk attributes of each person purpose and the audience has to be kept in 160 160
FIGURE 2.
are also included in this demonstration data. mind. What is the message that has to/can be MORTALITY AMONG 140 140
taken out of data? One specific question is THE SAME BASIC
Number of Records
Number of Records
What is your data? visualising changes in time or comparing FRAME AS FIGURE 120 120
The basis of a visualisation is the data, from a them (for more information see Wexler et al. 1. THE DARKER
100 100
COLOUR INDICATES
single table or from several databases (or any 2017).
A HIGHER NUMBER 80 80
combination of those). Data preparation can In our demo case, the goal was to OF DEATHS AMONG
be very different depending of the case. In communicate the proportion of MACE in PATIENTS DURING
60 60
this case the data set was rather small, different subclasses. In particular, THE FOLLOW-UP 40 40
PERIOD.
consisting of 827 rows (patient cases) and 79 considering whether there were some 20 20
columns (attributes or classifications situations that should receive more attention
describing each patient case), and it was (even though this number of cases is rather
0 0
BAS DES BAS DES BAS DES BAS DES BAS DES BAS DES
received in tabular form as a single SPSS small and statistical analysis preferably
format file. requires more cases).
28 29
Excel works fine for many everyday Sense is available, however larger,
purposes, but for big data use it has a administered use in an organisation requires
limitation of one million rows for basic use. a licence fee.
However, when using the data model features Tableau is intended for self-service
of the product, that limitation is no longer a analytics and it works with large amounts of
problem. Calculating/programming is data. However, it has bit limited Extract-
performed in a different way, using DAX Transfer-Load features to manipulate data.
expressions for rows/columns instead of On the other hand, it can load/connect to
(directly pointed) cell functions. many forms of files. It was used in this
Microsoft PowerBI can be described as demonstration because it could read SPSS-
the next level product compared to Excel, files directly (those named above did not). A
because it is intended for visualising larger time-limited trial version is available and
amounts of data using a data model larger, administered use in an organisation
approach. The product has Extract-Transfer- also requires a licence fee.
Load features for communicating with data It seems typical that the above products
sources. A free, end-user version is available, offer free public sites, which means that data,
however larger, administered use in an model and visualisations can be uploaded to
organisation requires a licence fee. be shown in public. This is an interesting
FIGURE 3.
Qlik Sense is intended for self-service possibility for data with general interest and
END-USER business intelligence use (more than the no sensitivity. One must also define whether
CHOICES FOR older and well-established product QlikView, the underlying data can be seen by viewers or
PATIENT HEALTH from the same company). It works with large not (prohibited in this demonstration, even
RISK FACTORS:
amounts of data and it has Extract-Transfer- though no personal identification is
THE LEFT FIGURE
INCLUDES ALL Load features for communicating with data included).
PATIENT CASES, sources. A free, end-user version of Qlik
THE RIGHT FIGURE
ONLY INCLUDES
DIABETES
PATIENTS.
Software trial versions and large amounts of product
specific learning resources about the above-
mentioned tools can be found from:
Giving users the choice to Some comments on • www.tableau.com/
see data from different software tools • www.qlik.com/us/
perspectives The 2018 Gartner Magic Quadrant for • https://powerbi.microsoft.com/en-us/
Modern visualisation tools make it easy for Business Intelligence (BI) and Analytics
the end user to apply filtering or highlight report about BI tools names as leaders: The demo graphs above can also be found on the following site, where it is
selected cases (or combinations out of the Microsoft PowerBI, Qlik and Tableau (here possible to use filtering in practice:
data), though the designer has to make those in alphabetical order). A tool that is well • https://public.tableau.com/profile/esa.rahiala#!/vizhome/stenttivertailu4/
choices available to the end user. Figure 3 known and already available to many is Ageanddiagnosis
presents a limited demo, allowing end-user Excel. Some comments about these four tools
choices for displaying patient health risk (from a visualisation point of view) can only
factors: the left figure includes all patient be made on a general level, because certain
cases, the right figure only includes diabetes products may have special strengths in a
patients. Now the proportions of MACE specific application case and/or in different
(orange) are different, but also the numbers ICT infrastructures. All products are
of patients in each category are different (as developed in continuous cycles and
seen in the scale in the lower-right corner of competition seems to enhance the products
3.4 References Wexler S., Shafer J. and Cotgreave A. (2017), The
each figure). year by year (these comments were made in big book of dashboards: visualising your data using
real-world business scenarios, John Wiley & Sons Inc.,
summer 2018). Hoboken, NJ: www.bigbookofdashboards.com/.
30 31
3.5 Small-scale working life pilots

TABLE 1.
TOPICS AND Topic of analysis Service
pave the way to data-driven

CONTEXTS OF
STUDENT PILOT
Analysis of the Vivago® safety and activity Psychiatric nursing, specialist
personalised care services
PROJECTS
monitoring system’s usability and suitability in hospital care, Finland
psychiatric care contexts. System tested with
two voluntary patients.
ANDREW SIRKKA, EdD, PRINCIPAL LECTURER, SATAKUNTA UNIVERSITY
OF APPLIED SCIENCES Documentation analysis of patients Primary healthcare, healthcare
frequently visiting a health centre acute unit centre, Finland
SARI MERILAMPI, PhD (TECH), PRINCIPAL LECTURER, SATAKUNTA with the diagnosis of "Cannot manage at
UNIVERSITY OF APPLIED SCIENCES home”.
Analysis of new customer-centred Well-being Rehabilitation, regional

Coaching Services and their impact on hospital, specialist healthcare,
This article summarises the experiences and findings, revealing some strengths but also
customers’ lifestyle changes. Finland
concludes the lessons learned during the bottlenecks, irrationalities and a clear need to
Health Analytics pilot education and improve and streamline services. Some of the
Use and experience of e-health check tools in Gynaecology, regional hospital,
working life pilots. The conclusions are made pilot projects are described here in more
women’s health inspections in a specialist care, Finland
by analysing the piloting reports and minutes detail as examples.
gynaecological unit.
of the working life committee meetings, and
a questionnaire sent to organisations Testing a clinical decision
Patient flow in an A & E unit and analysis of A & E, specialist hospital
involved in the project (piloting support system
wait-keepers due to flow blockages. healthcare, Finland
organisations). One of the pilots tested a demo version of the
EBMeDS decision support system (generated
Analysis of cardiac patients’ care path and Cardiac unit, specialist hospital
Key results of the pilot by Duodecim) in screening patients arriving
EBMeDS as a means in clinical decision- care, Finland
projects for their first appointment in a cardiac
making.
The pilot phase of the Health Analytics outpatient clinic. The aim was to test how
Education Project (HEAP) focused on EBMeDS would assist in making a
Analysis of rTMS practices in Finnish Clinical neurophysiology,
introducing data analytics within the comprehensive situation analysis of patients,
specialist care hospitals. specialist care hospitals,
student’s working environment. The pilot to expedite and improve appointments. Data
Finland
phase started with identifying the vast variety from 38 patients (N=38) was used in this
of data available. For most of the students, analysis. Since only a demo version of the
Documentation analysis to improve patient Patient documentation,
finding, collecting and analysing data related system was available, all patient data was
documentation in a urological unit. surgical care, urology unit,
to the selected themes, and how the data and collected from electronic patient records and
specialist care hospital, Finland
results of the analysis could be better utilised manually transferred into the decision
in designing customer-centred services, was support system (included labs, medication,
Assessing care needs and use of triage in Primary healthcare, healthcare
a completely new concept. As an outcome of diagnoses, previous treatments and
phone consultations with customers. centre, Finland
the pilot phase, students provided a written operations).
report of applied analytics and results. The The second phase was to compare the
project reports also aimed to discuss the data available in the doctor’s referrals and in Analysis of documentation and care path for Substance abuse care services,
alcohol abuse services in Estonia. social services, Estonia
meaning of the findings, in regard to service the EBMeDS system for each patient.
design and management of service delivery. Relevant and up-to-date data for 17 patients
The student analysis projects varied a (out of the 38 tested in this pilot project) Analysis of the use of e-PAK portal in E-health services, primary
Estonian general practitioner (GP) practices. healthcare, Estonia
lot in terms of themes and approaches (Table would have been available in the data system
1). Some of the students faced challenges in or in the referral, but was omitted, resulting
data access that forced them to change either in unnecessary and overlapping Analysis and generation of patient health Patient documentation,
the theme or the approach. However, no examinations. status summaries in GP information system in primary healthcare, Estonia
Estonia.
matter how small-scale the pilot project
turned out to be, everyone obtained valuable
32 33
The EBMeDS experiment resulted in Service process mappings The data and patient flow The aim of this analysis was to map the
several benefits. Apart from improving the A few pilot projects used process mapping analyses situation related to patient flow and observed
use of existing relevant patient data, the methods to analyse current services. The Common features of these analyses were that challenges in the target organisation. Patients
decision support system expedited planning method clearly highlighted bottlenecks related data was unstructured and scattered, had been allocated inappropriately in various
of the necessary examinations, care causing unnecessary loss of time, effort and requiring a lot of searching. This problem in units, even overnighting in the corridors
procedures and medication by providing money. A customer-centred approach in patient documentation systems emerged as because of blockage in patient flow to more
relevant remarks and warnings (like drug service requires reassessment and renewal of an outstanding constraint in streamlining appropriate facilities. A rather large number
interactions, follow-up examinations and conventional ways of working. In the above- health and social care services. of wait-keepers (patients waiting to be
tests), and by assessing various risk factors by mentioned EBMeDS analysis, one of the side The patient information required in transferred to more appropriate care
providing comparative population-based results of patient path mapping highlighted alcohol dependence treatment in ambulatory facilities) was due to blockages in the patient
data. The system also supported the drafting how information flow progressed in the care is unstructured social and lifestyle flow between specialist and primary
of various types of referrals and medical cardiac unit. The process map pointed out information by nature. Because of this, healthcare facilities. In addition to
statements for the patient or other parties in several points to streamline service processes currently the data is not collected by family unnecessary discomfort for patients and
the care chain. The EBMeDS system would in the unit (Figure 1). doctors (unlike somatic patient data). The staff, the blockage also created outstanding
FIGURE 1. also be useful in research purposes (e.g. project resulted in generating a structured expenses in the system.
PROCESS MAP OF searching for various patient or treatment document for collecting data in the alcohol The implementation of serial magnet
A PATIENT CARE
profiles). dependence treatment department and simulation therapy (rTMS) practices were
PATH IN A CARDIAC
OUTPATIENT modifying the database in the target analysed in different operating units in
CLINIC organisation to automate the process of Finland. International publications describe
collecting and transferring the data to several different treatment protocols and a
necessary locations. variety of treatment responses. As a new
3 Physical elements
The patient flow analysis from A & E therapy, rTMS care practices are being
User Guidelines Signage Facilities units to other care units also revealed some updated actively on the basis of the
Interface
outstanding bottlenecks to be resolved information provided by recent scientific
(Figure 2). Over the test period, a total of 62 studies.
1 Patient’s case path in the service
patients (out of 74) spent a night in the Treatment practices varied between
emergency room as a result of flow blockage hospitals. There was more variation in pain
Patient Patient Text
receives the receives the Patient’s reminder to User from the emergency room to other relevant treatment practices than in depression
appoitment
doctor’s invitation patient of the Interface
referral letter scheduled appointment care units. The data for this analysis was therapies. Variation occurred at all stages of
collected from patient documentation therapy. Based on the findings of the survey,
COMMINICATION systems (Effica and ExReport), from unit treatment charts were created for the most
2 Front office, visible part of service statistics and from a questionnaire targeted at common care parameters, and models of the
Additional
emergency room secretaries and nurses. division of labour among the various actors
informatin Phone calls Treatment/
requested from to/from
patient/other procedure
patient
care units
VISIBILITY FIGURE 2. Number of patients staying overnight at A & E in a 2-week period of time
4 Back office, invisible part of service PATIENT FLOW IN
12
THE A & E UNIT
10
Doctor
Unit Secretary Secretary Secretary Secretary
Number of Patients
reads the Doctor
secretary coordinates prints out books the mails the
referral and 8
schedules the treatment and
receives the makes pre doctor’s doctor’s checks queue invitation to
scriptions treatment
referral orders orders situation patient
(3-4 mins) 6
INTERNAL COMMUNICATION 4
5 Support and decision-making activities 2
0
16.4. 17.4. 18.4. 19.4. 20.4. 21.4. 22.4. 23.4. 24.2. 25.4. 26.4. 27.4. 28.4. 29.4.
Electric Electric Electric Electric Electric
patient patient patient patient patient
record record record record record Number of patients overnighting at A & E due to blockage in transfer to observation unit
system system system system system Cause for overnights at A & E unknown
Number of unnecessary overnights at A & E due to blockage in flow to wards
Number of patients overnighting at A & E due to blockage in transfer to primary healthcare
34 35
and of the implementation of rTMS therapies performed the assessment. The care plan need for an electronic solution for patient– The key findings of the e-PAK portal
were identified. with set objectives and means was physician communication. Alongside secure service indicated that in all practices,
Reviewing the rTMS process through accomplished in four (n=4) cases out of 10, messaging possibilities, the portal aims to electronic communication makes care
process mapping proved to be a beneficial while the long-term overall care plan was provide more patient empowerment and delivery much easier and more efficient and
way to streamline the therapy process. completed in only in three (n=3) cases out of prevention-oriented healthcare, with the assists with managing the workflow of the
Previously used Excel spreadsheets became 10. The patient’s own assessment of their functionality of a patient health diary. The GP practice. Most healthcare workers in the
useless, since the data was recorded health situation was not mentioned in four way the portal is integrated into service practice were not familiar with the patient’s
immediately in the patient information (n=4) cases, and only partly commented in providers’ workflows differed a lot. Most view of e-PAK. The staff who were
system, making the information available to six (n=6) cases out of 10 (Table 2). commonly it was a tool for family nurses and acquainted with the patient site identified the
all parties at the same time. The process Based on the analysis, most attention was only checked by GPs when a specific health diary as not very user-friendly and, in
diagram also made it possible to identify was paid to assessing physical and cognitive question was to be answered by them. In the general, a potentially useful tool for patient
weak points in the care chain. Job functioning, by means of standardised RAVA analysis, three different modes of using empowerment rather than a direct tool for
distribution has been developed already to and MMSE/CERAD measurements. Relatives e-PAK emerged: 1) one nurse was mainly the GP. In all practices, the view on lifestyle
avoid the process being only in the hands of were involved in assessments only in four responsible for checking and responding to decision support tests and calculators was
one operator. cases out of 10 and the patient’s own e-PAK and regular e-mail messages very positive, motivating and empowering
The patient documentation challenges assessment was mostly documented (with throughout the workday; when a certain customers in their health-related questions
emerged again in the results of patient record few comments in this sample). Social factors question that needed a GP’s opinion arose, without healthcare workers having to provide
analysis in a primary healthcare organisation. were less assessed and most of the patients the response was typically still entered into too much input. It was even thought that the
Patients who repeatedly visit the primary care lacked an overall care plan, even for patients the system by the nurse; 2) all nurses were system could alert patients according to their
emergency services with the diagnosis “cannot frequently visiting healthcare emergency responsible for using e-PAK in addition to health data figures. When patients get
manage at home” were more deeply analysed services because of challenges with living at other responsibilities like answering the concerning results in lifestyle-related tests,
by a student in one of the Finnish health home. phone and performing procedures; GPs were then it is part of the family nurse’s (or GP’s)
centres. The aim of the study was to find out The results of the pilot projects told to check e-PAK only when a specific work to provide them with counselling. This
how the patient’s need for services had been generated lively discussion, both in the question needed their answer; and 3) nurses was definitely not seen as an extra place for a
documented in the patient information working life committee and in various and GPs both checked e-PAK as part of their health analyst.
system. Data was collected on targeted terms: workshops and seminars, where the project everyday routine.
TABLE 2.
functioning, indicators and care plan. The outcomes were presented in confirmation of PATIENTS
importance of measuring functional ability is the importance of constant reassessment and DIAGNOSED AS
noted whenever planning the care. In this analyses of services. “CANNOT MANAGE
analysis the point was to search how those AT HOME” –
DOCUMENTATION
measurements are utilised and registered in Digital tools in care services ANALYSIS RESULTS
the patient information system. The Vivago® activity monitoring system was
A total of 10 (N=10) patient records introduced for the first time in psychiatric
were analysed. The study indicated that nursing. Two patients volunteered to test the
functional measurements were used fairly activity watch for few weeks. The activity
well, either before, after or during care follow-up data visualised clearly the effects of
periods in the health centre. Yet, the obtained treatments and also the impact of
information was scattered in the system, the patient’s environment in the overall
which makes it difficult to find and support situation. This pilot gave a large quantity of
long-term care plans. The patients’ physical data indicating clear constraints in the care
functioning was analysed in nine (n=9) cases chain, especially between hospital and
out of 10, mental or cognitive status in eight ambulatory care services.
(n=8) and social status in three (n=3) cases For digitised customer services, the
out of 10. In seven out of 10 patient usability of the e-PAK portal (generated by
documents the functioning was assessed by a general practitioner Diana Ingerainen in
professional, in three cases (n=3) together Estonia) was analysed from the customer
with a relative, and in two (n=2) cases the point of view. The portal aims to bring
patient was involved in the assessment. Three together primary healthcare providers and
patient documents did not reveal who had their patients, in response to the identified
36 37
3.6 The value and impacts of quality monitoring and contributes to the
quality and accuracy of clinical decisions.
Advanced analytics generates
organisational benefits by improving
advanced analytics in the Both quality monitoring and the accuracy of teamwork, supporting multidisciplinary
healthcare ecosystem
clinical decisions are significant core issues problem-solving and enabling cross-
when employing advanced analytics in functional communication. It can also be
healthcare. Value for the health of the whole claimed that organisational learning takes
population and of individuals is generated, place when the achieved statistical
TARJA VUORELA, MASTER OF SCIENCE IN ECONOMICS AND BUSINESS for example, when a virtual health check is knowledge is used for process development
ADMINISTRATION, MASTER OF ARTS IN TECHNICAL COMMUNICATION.
conducted in a patient data repository with and quality improvement in the
an analytical tool, and those in need of a organisations of the healthcare ecosystem.
A recent study reveals that employing health of the population. The generated value specific health service are proactively invited The expected benefits and performance
advanced analytics in healthcare generates can be identified when evaluating the for a doctor’s appointment based on the that generate value to the stakeholders are
value for several stakeholders, including impacts of using a specific analytical tool, the results. presented in more detail in Table 1.
healthcare service organisers and providers, Health Benefit Analysis, for the purpose. For The gained managerial benefits generate
and individual patients, as well as for the example, the results of health benefit analyses business value through improved care Impacts on value
general health of the population. It also help doctors and other healthcare planning and decision-making procedures co-creation practices and
impacts upon the value co-creation practices professionals to make the right clinical leading to better performances. It also healthcare professions
in the healthcare ecosystem and sets new decisions and give the patients a chance to provides business intelligence, which is An important aspect for the healthcare
requirements for healthcare professionals’ make informed choices between suggested service providers to consider are the impacts
competence. Introducing advanced analytics interventions. Moreover, the results provide of advanced analytics on value co-creation
to healthcare is beneficial, as it provides an essential input for the healthcare service practices in healthcare service production
those in the healthcare ecosystem valuable organisers and providers for successful health The gained managerial benefits and in healthcare service design. The
insights into making informed strategic service targeting and service design, as they generate business value through decision- makers in healthcare organisations
choices and designing new and better- provide a better insight into what kind of need to consider their strategic choices and
targeted health services. It also ensures better health services are needed for the population improved care planning and business scope redefinitions, which are
health outcomes for individual patients and in a given region. decision-making procedures needed when shifting the focus from
helps to reduce health inequalities among the measuring key performance indicators, such
population. Value to stakeholders leading to better performances. as the number of patient visits, to more
through several benefit knowledge-based and data-driven healthcare,
Increase in advanced dimensions what is known as value-based healthcare
analytics in healthcare The studied stakeholders can benefit from valuable for managing the improvement of (Porter and Teisberg 2006), where value is
Employing advanced analytics in healthcare the results of advanced analytics in personnel management and employee determined through shared decision-making,
is expected to increase in the near future. It operational, managerial, strategic and satisfaction. Advanced analytics helps the health outcomes and the betterment of the
will disrupt traditional healthcare business organisational dimensions (Shang and management of the healthcare service patient (Porter 2010). It is evident that using
and service models, the way of working and Sheddon 2002). Value is gained for the health providers by prioritising healthcare resources advanced analytics provides the healthcare
healthcare professions. To understand the service organisers and providers through to produce the needed services for those who service providers with opportunities to
potential benefits and impacts of advanced benefits and improvements in performance benefit most from them, which in turn develop new innovative data-driven
analytics in the healthcare ecosystem, it as measured by several indicators. The value generates value for individual patients and healthcare services.
should be viewed from different perspectives. for individual patients is seen in better the health of the overall population. When advanced analytics in healthcare
The analysis of “big health data” using patient experiences. And the general health In strategic issues, employing advanced is introduced, governmental decision-makers
specific algorithms developed for the of the population improves as a result of analytics creates business value as the and the organisational management of the
purpose helps to identify care gaps among fewer health inequalities, based on the healthcare service providers can gain a healthcare ecosystem should ensure a
the population, organise and provide the improvements and benefits the service competitive advantage through smooth transition to new healthcare service
right care, at the right time and in the right organisers and providers have gained. differentiation. It also supports the business models and facilitate changes in
venue (Rose and Burgin 2014) and give Advanced analytics generates development of additional health service healthcare practices. The impacts of these
patients more decision-making power over operational benefits for healthcare service innovations and contributes to the shift changes are expected to be cross-sectoral as
their own care. This creates value for providers as it improves productivity through towards value-based healthcare, where the the social care sector is expected to become
healthcare service organisers and providers, an accelerated and increased health data definition of value is determined by the more involved in the patients’ healthcare,
for individual patients and for the general usage rate. It enables improved operational betterment of the patients’ health. especially that of elderly people and the care
38 39
cycles for children. The evolving value disruption and transformation of healthcare
Benefit dimensions Indicated expected benefits Value generated to
co-creation practices set requirements for services and professions. This, however,
those in the healthcare ecosystem, as they requires courage and willingness to accept
Operational benefits Improved workflow efficiency Healthcare service need to conform to new ways of working that there will be new practices and
Productivity improvement provider
with patients and professionals from other professionals in the healthcare ecosystem.
Cost reduction
Improved and accelerated use of information
sectors and levels of the healthcare There are also opportunities for professional
Quality monitoring ecosystem. development, as information technology and
Target treatments to those who benefit most Population health It is also of utmost importance for the analytical skills are increasingly needed to
Accuracy of clinical decisions decision-makers and management to identify meet the requirements set by new care
Improved health outcomes Individual patient the need to educate new kinds of healthcare practices and the demand for health
Active participation in own care
professionals. There is a need for completely coaching services among health service
Influence in selected interventions
Improved customer experience
new competences, especially in conducting consumers and patients. Opportunities for
health analytics and interpreting the results. innovation and development will also be
A new healthcare profession could be, for created for the educators of healthcare
Managerial benefits Improved care planning and decision-making Healthcare service
Improved performance provider / organizer
example, a health analyst, who is expected to professionals, as they are in a key position
Improved allocation of resources play a key role in conducting advanced when transferring knowledge, practices and
Business intelligence analytics and interpreting and discussing the working culture to the future healthcare
Improve direction and management of staff results with the patients. New skills are also professionals.
Improve employee satisfaction needed in the structured recording of patient
Reduce health inequalities in the population Population health
data and holistic personalised care planning. The text is based on Tarja Vuorela’s
Narrow the discovered care gaps Individual patient
Prevent cases of overtreatment
In addition to new healthcare professions, MSc (Econ.) thesis on Strategic
doctors, nurses and other healthcare Business Development, “Value
professionals are expected to have new roles, co-creation and potential benefits
Strategic benefits Facilitate discussion among decision makers Healthcare service
Gain comprehensive view for meeting future needs provider / organizer for example as hospitalists and care through big data analytics: Health
Contribute shift to value-based healthcare managers. Benefit Analysis”. The thesis was
Implement the selected vision and maintain focus To conclude, the impacts and changes of published in 2018, University of Vaasa
Build competitive advantages employing advanced analytics indicate digital Theses, Tritonia Academic Library.
Build new business innovations and alliances
Organisational Improve team work

benefits Cross-functional communication Healthcare service
Solve multidisciplinary problems quickly provider
Organizational learning from clinical reports
Process and quality development
Learn to know the patients better
Ensure seamless patient experience Individual patient
TABLE 1.
EXPECTED
POTENTIAL
BENEFITS AND
3.6 References Porter M. E. and Teisberg E. O. (2006), Redefining
Healthcare: Creating Value-based Competition on
Vuorela T. (2018), “Value co-creation and potential
benefits through big data analytics: Health
PERFORMANCE Results, Harvard Business School Press, Boston, MA. Benefit Analysis”, (Master’s thesis, University of
Vaasa). Available at: www.tritonia.fi/en/e-theses/
THAT GENERATE Porter M. E. (2010), “What is Value in Healthcare?”,
abstract/7954/Value+co-creation+and+potential+b
VALUE TO The New England Journal of Medicine, 363:26, 2477-
enefits+through+big+data+analytics%3A+Health+B
2481.
STAKEHOLDERS enefit+Analysis. Shortened link: https://tinyurl.com/
Rose J. and Burgin M. (2014), “Disrupting healthcare y7f4eb4x, accessed 12 September 2018).
(VUORELA 2018:
through big data and predictive analytics”, Managed
89-90). Care Outlook, 27:1, 11-12.
Shang S. and Sheddon P. B. (2002), “Assessing
and managing the benefits of enterprise systems:
The business manager’s perspective”, Information
Systems Journal, 12:4, 271-299.
40 41
3.7 Echos from the health The request for higher-quality data
should not only come from the supervisors.
and health analytics” and “Health analytics”
lectures were also appreciated by the
analytics programme (HEAP) The potential that collecting high-quality
data has for improving the quality of
students. The participating students did not
see the usefulness of the “Data management”
healthcare services should be clear for every lecture and the lectures about assessment of
DORIS KALJUSTE, PROJECT MANAGER, DEPARTMENT OF HEALTH healthcare professional. This can only different eHealth solutions. As a
TECHNOLOGIES, TALLINN UNIVERSITY OF TECHNOLOGY happen if the healthcare professionals recommendation, the students suggested that
recognise that they are not collecting the data they would have wanted to learn more about
just for reporting purposes, but for colleagues interconnections between health databases,
80% had over 10 years’ experience in the field in the health and social care sector. Most international experience and how everyone
of health analytics. More than 65% of the importantly, the data should be collected so can measure health data by themselves and
students had a nursing background, but the that a person has the best possible care in the how the data can be utilised and analysed.
This article reports the student and course students also had backgrounds in natural future, thanks to the valuable information According to the Finnish group, the
moderator feedback about the pilot sciences, economics and physiotherapy. available at the right time. This, however, can topics were clearly seen as interesting and
programme. The student feedback was Among the students, 50% were currently only be achieved when the professionals can relevant. Additional value was gathered by
collected by an e-questionnaire after each working as nurses. The course moderators use up-to-date information systems comparing the Estonian and Finnish
module, and the course moderator feedback were professors from the participating supporting their everyday work and data healthcare systems and their developmental
was collected by an email questionnaire at universities, Dr Andrew Sirkka (SAMK), management. phases. Both groups agreed that it was a great
the end of the programme in September Prof. Tarmo Lipping (TTY) and Prof. Dr From the indicators that already existed way to start the course and the videos were
2018. Peeter Ross (TalTech). before and from the experience gathered presented by people who believe in the
during the programme, there is a clear need potential of this area of study. The lecturers
Introduction Course moderators’ for more comprehensive knowledge about shared their ideas and views, giving the
The Health Analytics Programme (HEAP) perceptions of health data analytics and the skills to actually use it students interesting thoughts to dwell on,
was a learning programme not only for analytics in practice. The programme lifted the curtain and the course was fascinating for its novelty
students but also for the lecturers carrying Currently, an enormous amount of data is to discover and to understand the and somewhat futuristic insights.
out the educational programme. The being collected in the field of healthcare. opportunity to develop a new profession,
feedback gathered from the students and Most of it is for primary use and only a small which could have a very clear role and Decision Support Systems
course moderators is of great value, as it fraction of it can be used for secondary position in healthcare, despite the fact that The “Decision Support Systems” course was
helps to choose the path forward. purposes. Collecting huge amounts of health today there is no compelling need or demand divided into two simultaneous modules:
The programme was divided into a data has no value if it is not made use of from the healthcare providers, industry or “Decision support in healthcare” and
theoretical part and a practical part. The afterwards, which is sadly the situation we market to finance a new health analytics “Statistical analysis and decision support
theoretical part was distributed between are currently in. Rather, healthcare should profession. It is truly a profession of the technologies in CDS systems.” The course
three universities, Satakunta University of focus on collecting smart data – only the data future, ahead of reality. consisted of 21 video lectures given by
Applied Sciences (SAMK), Tampere that makes sense and is used in services. One Professor Tarmo Lipping from Tampere
University of Technology (TTY) and Tallinn way to deal with the waste of data is to search eHealth and Telemedicine University of Technology. The aim of the
University of Technology (TalTech). for answers from data analytics. Data The Health Analytics Programme (HEAP) course was to give the students an
Feedback was collected from the students analytics in general is an essential part of started with the introductory course called understanding of the essence of CDS (clinical
after every theoretical course and from the digitisation to improve and streamline “eHealth and Telemedicine”, moderated by decision support) systems, what components
course moderators at the end of the services, and, luckily, year by year, the rigid Prof. Dr Peeter Ross from TalTech. The aim they contain and how the systems should be
programme. It should be noted that in healthcare system is slowly opening up to it. of the course was to give an overview of designed and evaluated. The statistical data
addition to e-learning, both student groups, It seems that there is a large gap between different aspects of eHealth, healthcare analysis module concentrated on explaining
Estonian and Finnish, held regular student what is done in the leading-edge innovation, health and eHealth literacy and the whole chain from data collection to
seminars with somewhat different homework development projects and how things are the legal/regulatory aspects of eHealth. The decision-making and on giving the
tasks. However, both groups reported the actually being done in the field. For course consisted of 16 video lectures given by preliminary skills needed to perform a basic
seminars to be highly efficient for acquiring maximising the opportunities that data six different lecturers. analysis.
the course topics. analytics provides, experts working in According to the students, the most In the first module, all topics received
A survey carried out among the healthcare have to have a general idea at least useful topics were about the trends, new quite similar feedback from the students,
students in the pilot scheme, at the beginning about the process of data analysis and how to models of care and the evolution from Health regarding the usefulness of specific lectures.
of the programme, showed that more than interpret the collected results. 1.0 to Health 4.0. The “Hospital IT-matrix The lectures “Types and functions of CDS
42 43
systems” and “Knowledge basis of CDS: Big Customer engagement Organisational side important of them would be knowledge of
Data and personalisation” were marked as Like the “Decision Support Systems” course, From the organisational side, the students medicine. This could be either at a nursing
most useful, but other topics were not far the “Customer engagement” course had two recommend having a clear schedule for the level or from other work experience in the
behind. As a recommendation, the students different modules: “Client Involvement and programme with the list of tasks to be done healthcare field (IT, quality management,
would have liked to learn even more about Smart Services” and “Service Design and beforehand. Also, more e-learning elements, etc.).
big data and personalisation, and to have Case Management.” Altogether, six different like short tests after every video lecture, was The current programme created by the
gained more practical knowledge of how to lecturers shared their knowledge of customer recommended. The most liked form of co-operation of three educational institutions
work with different databases and how to engagement in 11 video lectures. Customer videos were the slides and a small video of is a good stepping stone. The content of the
make queries, for instance. engagement is an essential part of the lecturer at the foot of the screen. That curriculum is already very comprehensive,
In contrast to the first module, the implementing health analytics in practice, in way both elements of the lecture could be and the basic content and study methodology
second module “Statistical analysis and terms of streamlining and individualising captured – the supporting material at all are well set up. The programme is currently
decision support technologies in CDS services to meet the customer’s needs. The times and the emotions and drive of the created so that it starts with an overview of
systems” featured a clear favourite with aim of the course was to give the students an lecturer given through facial expressions and eHealth, moves into analytics and finally
regard to the lectures – the “Data description understanding of customer aspects in body language. discusses the means and ways to implement
and visualisation” lecture was considered the services and value for monitoring a customer that knowledge in real-life healthcare
most useful and the other lectures not so journey. In addition, specific skills on how to services.
much. The lecture about “Population central make various types of service process The current programme created by The first run provided a lot of new
values and confidence intervals” had the mappings and measurements over the service knowledge and ideas on how to improve the
lowest score compared with the other delivery processes were another aim. the co-operation of three educational current programme and study experience.
lectures in the module. The students highly In the “Client Involvement and Smart institutions is a good stepping stone. During the programme, the students need
valued the newly acquired knowledge about Services” module the “Measuring customer motivation and indication that analytics
data visualisation and would have liked to engagement” lecture was considered the actually can lead to smoother processes,
know even more about it. Like the first most useful by the participating students. The wide variety of people with higher quality of care and more personalised
module, the students highlighted the need to The students reported that the module was different backgrounds, who were included in medicine. The course moderators suggested
add a more practical approach to the course somewhat self-evident and more focus on this curriculum, was a huge benefit for the that the programme would benefit from
on the CDS systems. According to the course how things should be done in practice, as students. However, in some cases, the lack of adding more statistical and qualitative
moderator, Professor Lipping, statistical well as real-life examples, would have been a English language skills of the lecturers was analysis studies, and possibly some clinical
analysis could in the future be taught in two good addition to the module. The groups noted. courses where students have the chance to
separate courses, one for preliminaries and recommend adding more lectures about user observe clinicians’ work. There could also be
overall understanding, and the other for a perspective and smart services. The path forward some options for those who would like to go
more advanced optional course for those In the “Service Design and Case The course moderators would see the format deeper into using data analysis tools and
who have time and opportunity to get Management” course, the most useful of the studies as a one-year curriculum at a those who are more interested in the impact
“carried away” by the flow of playing around lectures according to the students were master’s or vocational education level. In of analytics. To teach the usage of the tools, a
with the data and software tools. “Health coaching” and “Health coaching applied higher education, health analytics kind of sandbox with test data would be
The students found that the decision technology.” The students reported that, could also form a study module including useful.
support systems course was the most specific similar to the “Client Involvement and Smart practical training. The programme would In summary, the programme was a
and informative in the programme and it Services” module, the “Service Design and have to be multi-professional and would successful co-operation project between the
offers a lot of potential for giving the students Case Management” module would benefit require prior competences so that the student three universities. The co-operation
many different practical assignments on from involving more real-life experience, could comprehend the purpose and value of enhanced the wide expertise available among
calculations, tables, graphs, formulas and specific examples and expertise. analytics. This could mean, for example, a the partners, which was well used in the
analytics tools. This course represents the Overall, the course gave a good minimum of a bachelor’s degree in healthcare programme. The project opened up
“the essence” of health analytics. In the overview of how important service design is, and basic research/analytic thinking skills. opportunities for new networks and partners
future, Professor Lipping would like to make especially in the healthcare field. One can The best background for the students in the field of future endeavours, and this
the course more interactive and give the develop nice tools, but if the users do not would be knowledge of three different skills: development, very much like health
students the chance to be more engaged in adopt them, the tools will end up being medicine, information technology and analytics, is not something that any
practical work from the very beginning. useless. change management. As there are only very professional can do alone.
few people with this background, the most
44 45
3.8 Lessons learned in the health information in the system, to support the
location of relevant data.
bottlenecks and development ideas, improve
customer/patient experience and assist health
analytics programme (HEAP) Analytic competences
professionals streamline their work, improve
decision-making and management towards
Data handling and measuring requires knowledge management, and elevate the
SARI MERILAMPI, PhD, PRINCIPAL LECTURER, SATAKUNTA adequate competences, in addition to generic patient/customer as a resource in both
UNIVERSITY OF APPLIED SCIENCES research skills. The knowledge of health preventive and curative care.
informatics in general is limited among A lot of employers’ time and efforts are
ANDREW SIRKKA, EdD, PRINCIPAL LECTURER, SATAKUNTA UNIVERSITY health and social sector professionals, let spent on documentation, data handling and
OF APPLIED SCIENCES alone the ability to identify measures and searching for data in numerous different
metrics in the data system provided for systems. By improving documentation
measuring, analysing or interpreting and towards more structured approaches, the
Despite the large quantity of data, the use of visualising results. information system would serve everyone
this data is minimal. For example, data more effectively. Either artificial intelligence
related to treatment history and medical Working culture or an analyst could provide patient
This article discusses the observations and records, or the patients’ self-produced data, The culture in the health and social sector information in a more appropriate and
lessons learned from the Health Analytics are surprisingly infrequently used. The encouraging the secondary use of health updated format for each appointment. This
Programme (HEAP) project in 2017-2018. secondary use of data in process data, or health data analytics in general, is allow would healthcare professionals to focus
The project’s aim was to generate an development and measurement is even less. obviously restricted to certain managerial on communicating, examining and caring for
education programme to introduce Health Over this project, the following bottlenecks actions in the health and social sector. the patient. The clinical support systems
Analytics, required in future customer- hindering data use were identified: the data Successful patient services would require using patient record data is also a safety
centred healthcare and social services. itself, the information systems, the skill levels health analysts to support the active issue, assisting professionals in clinical
and the working culture. deployment of patient record data for care decision-making in terms of providing
Current situation and purposes, and to assist in measuring how and remarks like drug interactions or preventing
bottlenecks in data use Data and documentation which treatment/care measures are efficient. unnecessary procedures. By using patients’
As described by the other articles in this There is huge variety in the data quality Patient confidentiality and data protection previous data more effectively, several
publication, customer-centred thinking, produced by different service provides in regulations are of high importance, but they unnecessary operations could be avoided,
rapidly evolving technology, big data and health and social care. Some data is should not block improving and streamlining like overlapping laboratory tests. The timing
data analytics are revolutionising healthcare structured, whereas some is text (such as customer services. of patients’ other services could be also be
services. However, the implementation of the referrals and most of the social care-related The project groups both in Finland and co-ordinated simultaneously, instead of
latest advances in research and service data). If the data is not structured, the in Estonia faced remarkably similar booking multiple appointments over
provision is not very easily processed, as a content of the data may be very ambiguous. challenges and experiences during the pilot different days, causing unnecessary travel,
result of the characteristics and history of the Compatibility of the information provided in programme. To summarise, healthcare- arrangements and inconvenience.
healthcare sector (Chilikuri and van Kuiken patient documentation is challenging, since related tools and health data are not meant An immediate change should take place
2017; Duggal et al. 2018; Rodriguez 2018). in some cases the text is very detailed while for secondary use at present; for example, for concerning documentation. In particular,
The experience from the pilot education in other cases the data only contains companies, students and researchers to thinking about the core issues in
programme identifies data analytics itself as mandatory expressions and phrases (giving develop further. Crowdsourcing is made documentation to provide usable data for the
the most challenging part of the education. insufficient information about the overall impossible, which slows down the progress, patient’s or customer’s overall care. This
One reason for this is the lack of earlier condition of the patient). Documentation and makes the health and social sector an would make documentation more structured,
experience and practice of maths, statistics routines vary between service providers and exceptional industry. focused, meaningful and motivating, also
and data analysis, which are not playing a the routines have changed over time. reducing unnecessary quantities.
major role in the curricula of healthcare- Opportunities for data Educating data analytics could be used
oriented programmes. This also affected the Information systems analytics and the role as a tool for professionals to analyse and
piloting part of the education. Only very The stored health data is fragmented in many of an analyst in health and produce evidence on the outcomes of their
basic analytics (if any) were included within places and the system integration is still social services services. Data analytics is a way to highlight
the development pilots. inadequate, making the handling and use of Surprisingly, even the simplest pilot projects challenges and opportunities, helping
During the piloting phase, one essential important patient information cumbersome. without any deeper, big data analysis professionals develop outcome measures for
finding was the huge amount of data that is This currently requires the user, being aware produced significant findings. With small- their own work. A successful way to reduce
collected during healthcare processes. of the logic and structure of their scale analytics, it was possible to identify change resistance is to encourage staff to
46 47
analyse and develop their own work and roles for health analysts include: 1) assisting both primary and specialist care provider competences required in customer-driven
current practices. professionals in their work (providing patient organisations in the Satakunta region. The case management, 25% were happy about the
Another obvious beneficiary of data summaries, outcomes); 2) supporting working life committee had regular meetings way things are at present.
analytics is management, in terms of patients (coaching, guidance, customer to discuss and reflect on the project’s The complexity of health information
knowledge management. This includes all engagement); and 3) intensifying progress and outcomes in light of the current systems, the lack of information, restricted
management levels from operative management (knowledge management). To situation and transformation that is user rights and data protection regulations
management to regional and interregional conclude, an analyst would be needed across occurring in healthcare and social services in (in this order) were named as the biggest
management of healthcare services. Data many different levels of care services. It is the region. Working life feedback was obstacles to using data. Data analytics was
analysis clarifies, improves and monitors essential to realise that this important gathered by an e-questionnaire that was seen as providing added value to
service processes and therefore assists in profession, with required competences and distributed by email to all members and to professionals, customers and the service
planning the service supply, having a positive jurisdiction, is missing in the current service the student nursing officers in the delivery system by all of respondents. In
impact on the customer journey and system. organisations concerned. particular, quality management, change
customer service experiences. This would Out of 19 persons contacted, 12 management and communication with
benefit everyone. Analytic competences responded to the questionnaire, making the customers and their families were predicted
Customer engagement and health through flexible education response rate as high as 63%. The structured to improve, if data analytics were more
coaching were topics studied and discussed in Based on the experiences and results of the questionnaire focused on enquiring into the highly used.
the health analytics programme. Data HEAP project, a specialist education possible impacts of the project in the The health data analytics project
analytics also offers huge opportunities for programme was drafted to meet the respondents’ thinking. As to the challenges in (HEAP) was complimented for addressing a
developing ways to engage clients, as well as identified competence needs in digital the use of the health data available, the most very current topic that should be included in
preventing diseases. Although shifting the healthcare and social sector services. The commonly identified challenges were a lack all levels of education throughout healthcare
focus towards personalised care and pilot education programme resulted in a of an analytic thinking culture, the lack of and social services. In addition, the project
customer-engaging services requires huge specialist education curriculum to improve time and lack of data analyst services. In had offered the working life committee
changes in service delivery, big data with data the current situation in health data analytics. addition, the respondents pointed out the members a vantage point from which to
analytics offers evidence and tools for risk The pilot education indicated clearly that the reluctance to change working patterns, the observe some remarkable opportunities, but
detection, like lifestyle and genetic factors. future transformation in healthcare and lack of understanding of the possibilities that also some huge challenges. It opened their
Visualisation of different options in lifestyle social services requires new competences, data analytics could bring to services, and the eyes to new aspects, but also to the
choices or treatments would intensify patient/ both in analytics itself and in integrating its fact that currently the data is scattered in constraints in efficacy and cost-effectiveness
customer education and engagement. results into customer services. That is why many places and in fragmented formats of the current system. However, only nine of
Everyone has individual needs, values and the specialist education was planned to requiring lots of time and specialist 12 respondents (75%) reported having
goals, which could be taken into account include some elective modules to welcome all competences to search for and interpret. discussed those identified issues in their
when selecting these different treatment professionals, whether they be interested in The project helped in identifying organisation.
options. Simply asking what the patient/ pure data analysis or data-based client developmental needs, like outstanding The project implementation and key
customer wants could lead to significantly engagement and coaching. in-service education needs related to data results were presented in several seminars
improved customer experience and outcomes. Apart from the specialist education analysis, for renewing operating models in and workshops. Without exception, the
Although health analytics offers huge curriculum, the developed course content the organisation. The need to improve feedback from the audience was encouraging,
opportunities, it is crucial to understand that will be integrated into existing courses knowledge and information transfer between with numerous comments on the importance
the health analyst is not able to fix all the offered as further education and Open various operating units was identified by the of introducing data analytics to streamline
problems or develop service systems on their University studies. Open University studies majority of the respondents. As for the services in the healthcare and social sector.
own. The analyst can identify problems and are infrequently used for in-service education
possibilities, but multidisciplinary teams are to update and transfer required new
needed to interpret the data and find competences to working life. This project
solutions to the situation. The deployment of also identified an international market for
new digital tools, analytics and possibly health data analytic education, since the
analysts in use requires changes to existing needs and challenges for transformation in 3.8 References Chilukuri S. and Kuiken S (van). (2017), “Four keys
to successful digital transformations in healthcare”,
Rodriguez G. (2018), “Technology and innovation: A
healthcare revolution”, cited 10 October 2018: https://
practices. health and social service deliveries are global. McKinsey & Company, cited 13 September 2018. drivinginnovation.ie.edu/technology-and-innovation-a-
Available at: www.mckinsey.com/business-functions/ healthcare-revolution/.
One key question in the successful use digital-mckinsey/our-insights/four-keys-to-successful-
of analytics is to discuss the place of a health Working life feedback digital-transformations-in-healthcare.
Based on the feedback, results and lessons learned
Duggal R., Brindle I. and Bagenal J. (2018), “Digital in the HEAP project, the future scenario for a
data analyst within the customer journey/ The HEAP project established a working life
healthcare: regulating the revolution”, British Medical Specialised Education Programme is presented in
care path, and in the organisation. Identified committee with 13 members representing Journal, 2018; 360: 6. the Annex 1.
48 49
4 ANALYTIC METHODS FIGURE 1.

HEALTH DATA DASHBOARD OF ALL PEOPLE CARED FOR BY PROVIDER
AND TOOLS FOR DIGITAL ORGANISATION SAARIKKA
CARE SERVICES The whole population Age and gender distribution Age and gender distribution
The whole population

Age and gender distribution
Diagnoses Body mass index distribution

Diagnoses
Body mass index distribution
4.1 Care gap and health benefit – Care gap: number of decision support messages triggered Blood pressure distribution
tools for value-based care Blood pressure distribution
ILKKA KUNNAMO, MD, PhD, RESEARCH DIRECTOR, DUODECIM MEDICAL

PUBLICATIONS LTD, HELSINKI, AND GENERAL PRACTITIONER,
SAARIKKA, CENTRAL FINLAND
FIGURE 2.
Health Benefit Analysis identifies care gaps problem list and medication list of the HEALTH DATA OF DIABETES PATIENTS FILTERED OUT OF THE POPULATION
in the population, and helps in selecting the patient, laboratory test results, measurements CARED FOR BY SAARIKKA (ALL THE GRAPHS ARE AUTOMATICALLY FILTERED
AND SHOW THE DATA OF DIABETES PATIENTS ONLY.)
most effective treatments for individuals by such as blood pressure, weight and height,
estimating their health benefits. Health and risk factors such as smoking, are
Benefit Analysis is a new tool that has been collected from the EHR, and anonymously Filtering patients with diabetes
developed by Duodecim Medical sent to a database maintained by Duodecim’s

Number of patients with diabetes Age and gender distribution
Publications Ltd. It is built on the EBMeDS clinical decision support service.
clinical decision support service and can be Risk estimates, such as the risk of
integrated into any electronic health record myocardial infarction or stroke, an estimate
system. The tool has been piloted in 2018 in of renal function (the glomerular filtration
primary care in the City of Helsinki, and in rate), and many other health indicators are Number of patients with diabetes
Age and gender distribution
Saarikka, a primary healthcare and social calculated from the data and stored in the Diagnoses Body mass index distribution
care provider in Central Finland. The tool database. Care gaps, quality measures and Diagnoses
creates population health dashboards, finds health benefit estimates, as described in the
care gaps, measures the quality of care and next paragraphs, are also stored in the
calculates the health impacts of healthcare database. Figure 1 shows part of the main
Body mass index distribution
interventions. dashboard, showing data of all the people
cared for by Saarikka. Figure 2 shows the Care gap: number of decision support messages triggered HbA1c result distribution
Population health dashboard after filtering by diagnosis and

dashboards when selecting all patients with diabetes. HbA1c result distribution
The data of all people in the population

stored in the electronic health record (EHR)
is needed for analysis in coded format. The
50 51
FIGURE 3. Estimating health benefit adverse effects including death, annoying

EXAMPLES OF CARE Reminder by decision support Care gap Quality Number
rule measure of eligible
Most interventions have many different symptoms and burden or inconvenience. An
GAPS IDENTIFIED
BY DECISION (percentage of patients outcomes. Beneficial outcomes include intervention is beneficial if the sum of
SUPPORT RULES, patients with avoiding death, alleviation or disappearance beneficial outcomes outweighs the sum of
adequate care)
EXTRACTED FROM of symptoms or disability, or improvement in harmful outcomes – in other words, its net
THE FULL LIST OF
the quality of life. Harmful outcomes include effect is positive.
CARE GAPS IN THE Hormone replacement therapy 209 52 438
POPULATION OF and advanced age – stop or
SAARIKKA, AND replace with transdermal
CORRESPONDING
QUALITY MEASURES FIGURE 4.
Type 2 diabetes and LDL 203 82 1113
CALCULATED BY THE HEALTH BENEFITS
cholesterol over 2.5 mmol/l
RULES. FROM FIVE Health Benefit Analysis
INTERVENTIONS
Aspirin used for primary 173 92 2267 FOR A SINGLE Visual Dashboard
prevention – consider stopping PATIENT: STARTING
Intervention Health Impact
AN ANTICOAGULANT
DRUG FOR ATRIAL
Moderately high blood pressure 128 69 409 Oral anticoagulants
and high cardiovascular risk – FIBRILLATION, AND (vitamin K inhibiting) 18.762
start medication FOUR DIFFERENT
INTERVENTIONS TO
ASSIST SMOKING Behavioral treatment 28.742
(high intencity)
Atenolol as antihypertensive drug 36 48 69 CESSATION
– replace with a more effective
drug
Bupropion 13.421
Nicotine replacement
17.596
therapy
Varenicline 19,845
Care gap and quality Using clinical decision support rules -70 0 70
measures derived from guidelines is a good method of
In an ideal world, every person should be identifying care gaps. Each rule checks first if
offered healthcare interventions that improve the patient belongs to the target group of an The amount of expected net health benefit from each suggested intervention
health and that are safe. This is accomplished intervention (treatment), and whether the is given. The larger the number (the longer the bar), the larger the net benefit.
If harms outweigh benefits, the bar goes left from zero line, and turns red.
by practising evidence-based medicine. The patient’s characteristics make him/her
best available research evidence is used as the unsuitable for the intervention. The rule then The table view lists the same interventions, and also gives the health condition
for which the intervention is aimed at. Green arrows indicate benefit, and red
basis for clinical decisions, when treatments checks if he/she has already received the arrows indicate harm. The Detailed view shows all effects (outcomes) of the
are selected for the patient from all available intervention. If he/she has not received a intervention, including benefits and harms, and their magnitude. The bottom
treatment options. beneficial intervention, or is receiving a line gives the new effect (benefits minus harms).
We want to find out which patients harmful intervention, a care gap has been
receive adequate care and which patients do found. The care gaps in the population are
not. If they have not received care that reported as a list of interventions, with
benefits them, or they receive care that is numbers of people who have a care gap
ineffective or harmful, a care gap exists. In (Figure 3).
order to determine the care gap, we need the Quality measures are calculated as the
data of all people in the population to be ratio of the number of patients who have Using clinical decision support rules
analysed against evidence-based guidelines received adequate care (and did not have a
derived from guidelines is a good
which recommend treatments they should care gap), and the number of patients eligible
receive. to the intervention (Figure 3). method of identifying care gaps.
52 53
The estimation of net effect is not easy. changes accordingly. The baseline risk of the Intervention
First, we need to know the evidence for each outcomes can be calculated individually for Oran anticoagulants (vitamin K inhibiting)
outcome: by how many per cent does the the patient, if a risk calculator exists. Self-
intervention reduce or increase the care interventions and lifestyle changes will
likelihood of the outcomes (relative effect). be included as interventions alongside
We also need to know the risk of each interventions provided by healthcare
outcome if no intervention is given. With professionals, and their effects, can be
patients at high risk, the amount of absolute compared with each other. The data recorded
risk reduction by the intervention is larger by patients themselves in personal health
than with patients at low risk. The third records will improve the accuracy of the tool.
factor we need to know is the importance of
each outcome for the patient. Avoiding death Conclusion
is more important than avoiding obstipation. Health Benefit Analysis is a new tool for
If we know the magnitude of all these three implementing value-based care and
factors, we can calculate the health benefit or personalised medicine. It can be applied to
harm of an intervention for each outcome as populations in order to find people who
relative effect x risk without intervention x would benefit most from better care. In this
way the tool is expected to reduce health
inequalities. In shared decision-making for
Health Benefit Analysis is a new an individual patient, the comparison of net
health effect of different interventions will
tool for implementing value-based help in selecting the treatment options that
FIGURE 5.
care and personalised medicine. bring the largest health benefit for the CALCULATION
patient. OF NET HEALTH
BENEFIT FROM AN
importance of the outcome. We are building Acknowledgements INTERVENTION –
THE BASELINE RISK
a database that contains the relative effects Sitra has supported the piloting of Health
AND IMPORTANCE
(the evidence), estimates of risk in different Benefit Analysis in Helsinki and Saarikka. OF OUTCOME CAN
types of patients and estimates of the CGI has implemented the decision support BE INDIVIDUALLY
importance of different outcomes. Using this service of Duodecim in the Pegasos EHR EDITED
information, we can calculate the net effects system, enabling Health Benefit Analysis of
of different interventions so that they can be the population. EBSCO Health contributes as
compared with each other. the source of evidence-based knowledge
When a care plan is made together with providing the current best effect estimates for
the patient, the importance of outcomes can benefits and harms of medical interventions
be changed according to the patient’s values used to determine net health benefit.
and preferences, and the net benefit estimate
54 55
4.2 Omaolo service Elements of Omaolo service

FIGURE 1.
OMAOLO SERVICE
ELEMENTS
HANNA NORDLUND, ICT-PROJECT DIRECTOR, SOTE-DIGI OY

Assesment of Care and
Care and
the customers service
service plans
situation implementation
Public health and social services are in deployment can help to solve these problems.
transition in Finland. Digitisation and smart In addition, there is a need for purposive
services are drivers for change, which is also change management, process renewal and a
supported by a structural reform. In new kind of service culture, both among
Observations
addition, the expected reform requires professionals and customers. The reform on Health and
Health and Wellbeing
purposive change management, process objectives set for healthcare and social Wellbeing Health and
check
renewal and a new business culture. The services are achieved only by increasing Personal plan
Wellbeing Coaching
= MyPlan
Omaolo service is an electronic service that customer accountability with respect to
provides silo services to customers, health and by increasing efficiency,
Symptoms / Service /
regardless of time and place. The service productivity and developing new methods Assessments Assessments
package allows customers to assess their and models for service delivery systems.
service needs, plan the care and services
together with a professional, store follow-up Omaolo service
data, and deploy electrical health coaching The Omaolo service is an electronic service
services. The service promptly directs the that provides silo services to customers,
customer to the appropriate service based on regardless of time and place (Figure 1). The
identified needs. A major activity service package enables customers to assess virtual clinic pilot project developed by Sitra research evidence, care recommendations
modification has taken place along with the their care or service needs, plan care and and the city of Hämeenlinna in the year 2014. and other standardised services are equal for
construction of the electronic service services together with a professional and The Omaolo service offers a potential solution all customers.
platform. store related follow-up information, as well to identified bottlenecks in assessing care and In Omaolo, the customer can assess
as deploy eHealth coaching services. The service needs, planning care and service individual symptoms and the need for
Background service promptly directs the customer to the processes, and supporting life and lifestyle service, as well as the overall picture of one’s
Public services in the health and social sector appropriate services. For a customer, this changes. well-being. Symptom assessments allow the
are under huge reform at present. The Health offers the ability to assess their situation in Existing systems and services can often customer to assess the urgency of their
Data Strategy 2020 from the Ministry of the comfort of their own home, avoiding appear as unco-ordinated, whereby the client symptoms and provide guidance to the
Social Affairs and Health (STM 2014) states unnecessary queues or waiting times and is subjected to duplication or repetition of appropriate service. The customer can
that the difficult economic development of providing quick guidance to the right processes with different professionals (due to choose where and when to use the service
the past few years, the sustainability gap and services and processes, without running from inefficiencies, lack of appropriately recorded and will receive instructions immediately. If
the growing need for services for the future one professional to another. With the data or segmentation of data within existing the situation is resolved without a
form an equation that requires structural Omaolo service, each customer chooses the systems). This creates uncertainty about the professional, or just using electronic
reform and the introduction of new best way to deal with authorities. This will patient’s progress, reinforcing the feeling that channels, the customer avoids unnecessary
operating models in the organisation and leave professionals with more time for those there are no solutions to the problem, travel to their health centre (for example). In
production of services. A small minority who use traditional channels (Kuntaliitto particularly in multiple problem/condition situations where a customer needs
consumes most of the health and social 2018). situations. An inevitable consequence is a professional help, the data is ready for the
services. For the majority, this is perceived as The Omaolo service has been developed poor customer experience and prolongation professional, assisting diagnosis and
poor access and availability, with long as part of a key, Finnish government project of the problem. Process changes and digital problem-solving. By means of service
queueing times for services. At present, the (ODA; in Finnish: Omat digiajan service development have gone hand in hand assessment, the customer can likewise get an
structure and situation of reform is attracting hyvinvointipalvelut). The starting point in the Omaolo project, in an effort to immediate estimation of their right to certain
significant public debate in Finland. involved a functional change in customer and promote engagement for both customers and social services and guidance based on the
Technology opportunities are also widely service processes, requiring smarter digital professionals. Through Omaolo, relevant and assessment results.
discussed in terms of required changes, both services (i.e. services that increase the reliable information that traditionally was By doing a welfare check, the clients
in clients’ and professionals’ actions. customer’s role in assessing their situation and accessible only for professionals is made evaluate their own well-being
Structural changes and technology improving well-being). ODA has its roots in a available to customers when needed. The comprehensively. The welfare review
56 57
recommends and encourages lifestyle Customers often need support for Omaolo Benefits Various Target Groups
changes by providing information on life lifestyle changes, but professional resources
expectancy, health risks, the state of well- are often too limited to be able to serve
being and functioning, and oral health. From everyone face to face. Customers can be
this information, the customer learns how to supported by online health coaching that
Service/process
improve their well-being. The service also provides help for lifestyle changes in Occasional Need for social renewal for Long-term Periodic health Oral health
service need in and preventive
services people with illness or a risk examinations
guides the customer to the right professional nutrition, sleep, exercise and stress healthcare
special needs dentistry
when necessary. The welfare check can only management.

be done for oneself and can be used in
conjunction with a long-term follow-up, or New action models and
even with an unemployment service process ways of working
Health and Family care support Immigrants Diabetics Mother and child
(together with a professional). The well- The Omaolo service is suitable for various well-being centres health clinics
Transportation Vulnerable children Hypertension
being check also provides population level customer groups (Figure 2). These customer A&E services Unemployed patients School health
Personal assistants Occupational health
information. groups have been involved in developing Youth
Mental health
processes for their associated services. As a customers
result of this collaboration, new roles and

even units have emerged in organisations,
Omaolo assists professionals such as the digi-nurse job description and
FIGURE 2.
THE OMAOLO
in their work, providing the digital teams/units. Alongside the process SERVICE IS
development, new working patterns and SUITABLE faster and the physician’s working time is that serve customer groups more effectively.
standardised processes that can service models have been generated. FOR VARIOUS saved for more essential care activities (rather Systematic assessment criteria for treatment
be customised when needed. For people in need of multiple services
CUSTOMER
GROUPS
than making unnecessary statements). allows the introduction of symptomatic
the focus is set on improving co-ordination. The client’s access to physiotherapist evaluations. At the same time, services have
For example, new methods for multi- appointments without the doctor’s referral expanded to cover previously excluded
After evaluating the customer’s professional work have been created. When has expedited care, for example, of lower customer groups. Common guidelines for
situation, the Omaolo service helps to plan traditionally a customer has been invited to back pain. Rationalising the conventional self-care, both for customers and
the care or a service process. The goal is for attend several long meetings with a variety of treatment and registration practices of professionals, have improved the quality of
each customer to know what to do next and professionals, now the professionals are professionals has considerably accelerated services and clarified the client’s point of
what the professional will do next. If the brought together to the same meeting with application processing and decision-making. view. Better customer information and data
customer so wishes, the plan will allow more the customer. This saves everyone’s time The “all completed in one visit” model has accelerated decision-making in
professionals to become connected to the significantly, expedites required support and (kerralla kuntoon) in dental care professional appointments.
process and the customer will no longer have assistance services and improves substantially reduces the need for further In addition to process impacts, these
to go through the same procedures with co-operation between professionals. Also, appointments, bringing mutual savings and changes and digitised services are expected
different professionals several times. appointing a primary person, who acts as an comfort. to significantly impact upon customers’
Information moves and saves everybody’s advocate for the customer among other Along with digitisation, it is necessary health and well-being. However, these
time. Omaolo assists professionals in their professionals, has improved the to harmonise procedures. Defining criteria changes will be realised in the longer term
work, providing standardised processes that co-ordination and efficiency of services. for certain customer groups, like those who and therefore the changes will continue to be
can be customised when needed. The client The customer no longer needs to be need multiple services, or vulnerable monitored.
can receive various instructions and tasks responsible for contacting all the different children, has enabled the creation of policies
related to the care plan as reminders. professionals. These kinds of small changes
Through this plan, the customer can store have strengthened the service process and
different monitoring information within allow professional resources to be used more
their plan and, if desired, make it available to cost-effectively. For example, with service
a professional. This way, for example, needs assessments, whenever a C-statement
tracking processes can be partially electrified (i.e. statement regarding the health
and customised to suit the customer’s condition’s long-term impact to the patient)
situation. is not necessary the decision will be made
4.2 References Kuntaliitto (2018), ODA-projekti: www.kuntaliitto.fi/
asiantuntijapalvelut/sosiaali-ja-terveysasiat/akusti/
STM (2014), Tieto hyvinvoinnin ja uudistuvien
palvelujen tukena – Sote-tieto hyötykäyttöön
akusti-projektit/oda. -strategia 2020: http://julkaisut.valtioneuvosto.fi/
bitstream/handle/10024/70321/URN_ISBN_978-952-
00-3548-8.pdf?sequence=1&isAllowed=y.
58 59
4.3 KardioKompassi® – using and blood pressure levels. Through

KardioKompassi’s interactive graphical
promising: roughly 15% of participants had
managed to permanently lower their body
genomics to accurately interface, users can also test how different weight, while 14% of smokers had stopped
predict and prevent

lifestyle changes, such as quitting smoking, smoking. The group with the highest genetic
may impact on their risk (Figure 1). risk more often took action to lower their
cardiovascular disease Findings from Kardio

disease risk. The data thus seems to suggest
that combining genomic and traditional
Kompassi pilot studies health information and communicating this
So far, we have piloted KardioKompassi in the information back to individuals can provide
ELISABETH WIDÉN, MD PhD, ASSOCIATE PROFESSOR, INSTITUTE FOR
MOLECULAR MEDICINE FINLAND, UNIVERSITY OF HELSINKI academic research setting in the ongoing an efficient means for disease prevention.
GeneRISK study (FIMM 2018), which To further promote its clinical
includes 7,350 customers from both public application, KardioKompassi will next be used
The systematic use of genomic risk individuals at high risk are identified in time. and private healthcare providers in Finland. in an Estonian study to be launched this
information to guide clinical decision is The cornerstones for prevention are well All study participants have received personal autumn, where family doctors and their
expected to significantly improve both risk established and include not smoking, weight information on their 10-year risk for coronary patients are testing new and proactive
assessment and prevention of common control, regular exercise and efficient medical heart disease using KardioKompassi. The strategies to prevent cardiovascular disease
multifactorial disease, such as cardiovascular treatment of diabetes, elevated blood pressure preliminary study results are encouraging. (see Chapter 4.4 in this publication). With the
and coronary heart disease. Hitherto this and elevated blood lipids. Unfortunately, Based on initial data obtained from the first more precise risk assessment provided by
opportunity has remained largely untapped, current clinical methods used for disease risk follow-up study, 90% of participants reported KardioKompassi, individuals get the
partly due to insufficient knowledge of the prediction are imprecise and insufficient, that their personal disease risk information opportunity to lower their disease risk and
underlying genetic architecture. The field, leaving almost half of individuals who develop motivated them to take better care of their enjoy healthier lives while the ever-increasing
however, is rapidly changing. disease undetected. Despite the fact that half health. The data on lifestyle changes is also societal healthcare costs may be reduced.
During the past few years, technological of the disease risk is mediated through genetic
FIGURE 1.
advances and systematic large-scale research factors (Wienke et al. 2001), current clinical KARDIOKOMPASSI
have propelled a major scientific breakthrough methods do not make use of genomic ESTIMATES AN
resulting in the discovery of numerous genetic information. INDIVIDUAL’S
loci affecting the risk of multifactorial Therefore, to facilitate the practical use of 10-YEAR RISK FOR
CORONARY HEART
disorders. These discoveries have indicated genomic research findings and to empower
DISEASE AND
that the underlying genetic architecture is individuals to undertake risk-reducing DISPLAYS THE RISK
complex, consisting of thousands of genetic interventions, we have developed an IN MANY DIFFERENT
variants influencing disease risk. Thus, a interactive tool, KardioKompassi®, for patients WAYS. THIS SCREEN
SHOT SHOWS THE
prerequisite for bringing these genetic and doctors to predict and prevent
OVERALL DISEASE
discoveries to the clinic is the development of cardiovascular disease. KardioKompassi is RISK OF A 50-YEAR
novel practical procedures to manage and use developed and owned by the Institute for OLD MALE, AND
large-scale genomic data, and to communicate Molecular Medicine Finland, University of HOW HIS RISK
the risk information to patients and healthcare Helsinki. This risk calculator uniquely DEVELOPS AS A
FUNCTION OF AGE
professionals. combines newly discovered genomic risk
IN COMPARISON
information with traditional medicine and WITH THE AVERAGE
Taking coronary heart disease provides a more accurate disease risk estimate POPULATION RISK.
prevention to new level than any current clinical method. It currently
Coronary heart disease, which is a common estimates an individual’s risk of developing
and severe disease, is a prime example of a coronary heart disease during the coming 10
4.3 References Abraham G., Havulinna A. S., Bhalala O. G., Byars S. WHO (2017), Factsheets – Cardiovascular diseases
common complex disorder where genomic years, based on both traditional health G., De Livera A. M., Yetukuri L., Tikkanen E., Perola (CVDs): www.who.int/mediacentre/factsheets/fs317/
M., Schunkert H., Sijbrands E. J., Palotie A., Samani en/.
information may provide significant information and a genetic risk score including N. J., Salomaa V., Ripatti S. and Inouye M. (2016),
Wienke A., Holm N., Skytthe A. and Yashin A. (2001),
improvement of disease prevention 49,000 genetic variants associated with the “Genomic prediction of coronary heart disease”,
“The Heritability of Mortality Due to Heart Diseases:
European Heart Journal, Volume 37, Issue 43, 3267-
A Correlated Frailty Model Applied to Danish Twins”,
procedures. While coronary heart disease disease risk (Abraham et al. 2016). The impact 3278, https://doi.org/10.1093/eurheartj/ehw450.
Twin Research, 4(4), 266-274. doi:10.1375/twin.4.4.266.
continues to be a leading cause of death in of the genetic score on the disease risk is FIMM (2018), “Finnish Genomes Empowering
Personalised and Predictive Health”: www.fimm.fi/en/
Finland and elsewhere (WHO 2017), there are significant, i.e. it is comparable to the research/grand-challenge-programs/finnish-genome-
efficient means for prevention available, if combined risk of smoking, blood cholesterol sequencing-and-preventiveHealth-care.
60 61
4.4 Proactive cardiovascular

prevention in subjects with
a high hereditary risk by using
the KardioKompassi tool in
Estonia
MARGUS VIIGIMAA, PROFESSOR, DEPARTMENT OF HEALTH
TECHNOLOGIES, TALLINN UNIVERSITY OF TECHNOLOGY
FIGURE 1. CVD and a large proportion (15%) had higher polygenic hereditary risk) is
MEAN CUMULATIVE
Cardiovascular diseases (CVD) are the main The aim of the present study is to experienced myocardial infarction (Figure 1). considerably higher (Mega et al. 2015). The
RISK OF ANY CVD,
cause of death in Estonia. The aim of the evaluate the health impact and feasibility of a MYOCARDIAL
According to the SCORE risk estimate, close Estonian data confirms this. A preliminary
present study is to evaluate the health impact proactive prevention strategy for CVD in INFARCTION AND to 50% of men and 20% of women in the analysis of 3,157 subjects with high-quality
and feasibility of a proactive prevention Estonian primary healthcare patients with a CARDIOVASCULAR cohort would have needed CVD preventive genotype data in the EGCUT database (aged
strategy for CVD in Estonian primary high polygenic hereditary risk of CVD by MORTALITY OF treatment with statins, although only 4% 30-69 at recruitment) indicated a considerably
THE GENE DONORS
healthcare patients with a high polygenic using the KardioKompassi tool. received it. higher risk for acute CVD events in
IN THE ESTONIAN
hereditary risk of CVD by using the GENOME CENTRE In addition, the CVD risk was estimated individuals with a high polygenic risk (Figure
KardioKompassi® tool. Taking into account Theory part DATABASE with the help of genetic analysis. There is 2). In addition, the efficacy of statin treatment
the high CVD mortality in Estonia, it may be For the estimation of the for CVD in primary (N=30,473, AGE AT evidence from large-scale international studies is considerably higher in individuals with a
RECRUITMENT 30-
expected that preventive treatment of CVD prevention, the European Society of that CVD has a strong hereditary background higher risk in the primary prevention of CVD
74)
based on a personalised overall CVD risk or Cardiology (ESC) suggests the Systematic and is influenced by many genetic factors. It (Mega et al. 2015). Thus, primary prevention
a CVD proactive prevention strategy would Coronary Risk Estimation (SCORE) has been shown that the risk for CVD events is indicated primarily for individuals with a
help to reduce CVD morbidity and mortality instrument (Piepoli et al. 2016; European in the highest quintile (or in individuals with higher polygenic hereditary risk.
in Estonia. Society of Cardiology 2013), which evaluates
an individual’s cumulative 10-year risk of
Introduction CVD mortality (ischaemic heart disease,
Cardiovascular diseases (CVD) are the main stroke, hypertension, heart failure, occlusion
cause of death in Estonia, causing 55% of all of peripheral blood vessels). SCORE has been
deaths. This disease makes a significant developed based on the data from 12
contribution to potential years of life lost European countries, and it takes into account
(25%) and kills approximately 10,000 people the impact of major CVD risk factors FIGURE 2.
per year. For every 100,000 residents ≤65 including sex, age, systolic blood pressure, CUMULATIVE RISK
OF MYOCARDIAL
years old, 250 men and 80 women die of smoking and the level of total cholesterol.
INFARCTION AND
CVD each year, which surpasses the The European CVD prevention and CARDIOVASCULAR
corresponding indicator of most developed treatment guidelines are based on a SCORE MORTALITY IN
countries (Abajobir et al. 2016). estimate (Piepoli et al. 2016). Estonian family THE EGCUT GENE
CVD morbidity and mortality can be doctors also use the SCORE instrument for DONOR COHORT
(N=3,157, AGED 30-69
reduced with effective prevention. Taking into risk estimation (European Society of
AT RECRUITMENT)
account the high CVD mortality in Estonia, it Cardiology 2013). IN SUBJECTS IN
may be expected that preventive treatment of An analysis conducted on the cohort of THE HIGHEST
CVD based on a personalised overall CVD 30 to 74-year-old (age at recruitment) gene POLYGENIC CVD
RISK QUINTILE (OR
risk or a CVD proactive prevention strategy donors in the Estonian Genome Centre of the
WITH THE HIGHEST
would help to reduce CVD morbidity and University of Tartu (EGCUT) database HEREDITARY RISK)
mortality in Estonia. (n=30,473) indicated that close to 50% of COMPARED TO THE
70-year-old men had been diagnosed with REST OF THE COHORT
62 63
A recent study based on large European the intervention group subjects will be The KardioKompassi is an example of Expected results and
cohorts, including more than 12,000 forwarded to family doctors by the EGCUT at how genetic risk factors are taken into account conclusion
individuals from Finland (Abraham et al. the beginning of the study. The family doctor and combined with traditional risk factors in The general objective of the study is the
2016), has demonstrated that integration of a (or family nurse) will arrange an initial visit the prevention of cardiovascular diseases. In evaluation of the health impact and feasibility
polygenic risk score with a conventional with the subject by phone. During the visit, the this study, it will be used in 1,000 Estonian of the CVD proactive prevention strategy in
non-genetic risk score like SCORE makes the family doctor explains the study to the subject, middle-aged subjects with a high polygenic Estonian primary healthcare patients with a
prediction of a CVD risk even more exact obtains informed consent for participation in hereditary risk of cardiovascular diseases, high polygenic hereditary risk of CVD. The
(Abraham et al. 2016; Sitra 2018; FIMM the study (added to the application), states the which is a good start for international hypothesis is that a proactive prevention
2017). Thus, the overall CVD risk based on subject’s hereditary risk and calculates the co-operation in using the KardioKompassi. strategy is effective in the primary prevention
the individual polygenic hereditary risk and overall CVD risk, performs study activities A secure website for the use of the of atherosclerotic CVD in individuals with a
other SCORE-based risk factors should be presented in the data collection form (added to KardioKompassi will be created during the high hereditary risk. The strategy is
evaluated when prescribing preventive the application), advises the subject and starts/ study. Family doctors as well as patients can implementable in the Estonian primary
treatment. changes preventive treatment if needed. During use it. All family doctors participating in the healthcare setting.
In the present study, men aged 30-65 and the study, the intervention group subject visits study will undergo training in the use of the In the current study, we use the
women aged 40-70 with a high polygenic the family doctor’s office three times; the first KardioKompassi before the beginning of the KardioKompassi as a web-based solution that
hereditary risk of cardiovascular diseases visit will take place at the beginning of the study. The patient, who has been informed exploits the genome data (information
(1,000 subjects in total) are recruited from the study, the second after three months and the about his or her increased hereditary CVD obtained from the entire human genome).
database of the Estonian Genome Centre, third after 12 months. risk, can see his or her overall CVD risk and The genome data are combined with
University of Tartu. Taking into account the high CVD its possible reduction by changes in risk traditional health data, such as information
The participating sites are the Estonian mortality in Estonia it may be expected that factors (smoking, being overweight, etc.) with about lifestyle. A secure website will be created
Genome Centre, the University of Tartu and preventive treatment of CVD based on a the help of this instrument. The website for the use of the KardioKompassi during the
Estonian family health centres. The project is personalised overall CVD would help to intends to make accessible relevant health study. Family doctors as well as patients can
chaired by Prof. Margus Viigimaa (North reduce CVD morbidity and mortality in promotion materials (for example publications use it.
Estonia Medical Centre, Tallinn University of Estonia. by the National Institute for Health Today’s healthcare requires combining
Technology). Development and World Health personal eHealth profiles with the genome
Participating subjects with a high and Tools and applications Organization). data and offering personalised advice to those
moderate overall risk are given counselling More accurate risk assessments can help Participating subjects benefit from the with a high genetic risk. Taking into account
regarding healthy choices and their family people take better care of their health. The use of the KardioKompassi website. Although the high CVD mortality in Estonia it may be
doctor will apply preventive treatment, if human genome contains more than 50 they cannot change their CVD hereditary risk, expected that preventive treatment of CVD
required. All subjects will be treated according candidate genes for cardiovascular diseases. it is possible to reduce the overall risk through based on a personalised overall CVD risk or a
to the European Society of Cardiology (ESC) A comprehensive heart disease risk healthy choices. The subject sees his or her CVD proactive prevention strategy would
treatment guidelines corresponding to their assessment will be performed on subjects overall risk on the graph and how much it can help to reduce CVD morbidity and mortality
risk score (Piepoli et al. 2016). Although such participating in the present study. be reduced, for example by stopping smoking. in Estonia.
an approach to the patients is in line with The KardioKompassi (Helsinki, Finland)
current primary care practice, upgraded is a unique tool that has been developed for
Estonian intervention guidelines will be this purpose. In the KardioKompassi project, a 4.4 References Abajobir A. A. et al. (2017), “Global, regional, Mega J. L. et al. (2015), “Genetic risk, coronary heart
and national age-sex specific mortality for 264 disease events, and the clinical benefit of statin
drawn up in the framework of the study cardiovascular risk profile is drawn up for causes of death, 1980–2016: a systematic therapy: an analysis of primary and secondary
making up part of the pre-study training of members of a test group by combining genetic analysis for the Global Burden of Disease Study prevention trials”, The Lancet, 6 June 2015 (cited
2016”, The Lancet, September 2017 (cited 15 19 February 2018); 385(9984): 2264-71. Available
family doctors. The intervention guidelines data with information about each individual’s September 2017); 390(10100): 1151-210. Available from: www.sciencedirect.com/science/article/pii/
from: http://linkinghub.elsevier.com/retrieve/pii/ S014067361461730X.
consist of risk assessment, lifestyle counselling lifestyle and health. Participants can estimate S0140673617321529.
Piepoli M.F. et al. (2016) 2016 European Guidelines on
(giving up smoking, physical activity, their risk for developing CVD with the help of Abraham G. et al. (2016), “Genomic prediction of cardiovascular disease prevention in clinical practice:
nutrition, body weight), approach to the KardioKompassi. coronary heart disease”, European Heart Journal, 14 The Sixth Joint Task Force of the European Society
November 2016 (cited 19 February 2018); 37(43):3267- of Cardiology and Other Societies on Cardiovascular
dyslipidaemia (diagnosis, need for statin The KardioKompassi is a risk calculator 78. Available from: https://academic.oup.com/eurheartj/ Disease Prevention in Clinical Practice (constituted by
treatment, statin choice, monitoring) and taking advantage of a new type of digital article-lookup/doi/10.1093/eurheartj/ehw450. representatives of 10 societies and by invited experts)
Atherosclerosis, 1 September 2016 (cited 5 March
hypertension (diagnosis, treatment). genome data. It is a web-based solution, which ESC (European Society of Cardiology) (2013-2014),
2018); 252: 207-74. Available from: www.ncbi.nlm.nih.
SCORE Risk Charts (cited 8 March 2018). Available
The study subjects are randomised into exploits the genome data (information obtained from: www.escardio.org/Education/Practice-Tools
gov/pubmed/27664503.
CVD-prevention-toolbox/SCORE-Risk-Charts. SITRA (2018), “KardioKompassi: towards better
two groups: the intervention group includes up on the entire human genome). The genome
cardiac health with genome data” (cited 8 March
FIMM ¬– Institute for Molecular Medicine Finland
to 500 subjects and the control group up to 500 data are combined with traditional health data, (2017), Personal Genomics Projects (cited 8 March
2018). Available from: www.sitra.fi/en/articles/cardio-
compass-towards-better-cardiac-health-genome-
subjects. The names and hereditary risk data of such as information about lifestyle. 2018). Available from: www.fimm.fi/en/research/
data/.
ongoing-collaborative-projects/personal-genomics-
projects.
64 65
TABLE 1.
FINNISH BIOBANKS
4.5 The Finnish biobanks Biobanks and Founders Operation
and data lakes Auria Biobank

The University of Turku and hospital districts of
The first clinical biobank in Finland obtained
its license to operate as a biobank in 2014.
Southwest Finland, Satakunta and Vaasa The biobank supports research into cancer,
www.auria.fi/biopankki/en diabetes and cardiovascular diseases.
ANU HOLM, PhD, HOSPITAL PHYSICIST, SATAKUNTA HOSPITAL DISTRICT;
Helsinki Biobank Covers 1.9 million inhabitants. Specialises in
SENIOR RESEARCHER, SATAKUNTA UNIVERSITY OF APPLIED SCIENCES The hospital district of Helsinki and Uusimaa (HUS), the research promoting population health,
University of Helsinki, Kymenlaakso Social and Health identification of factors in disease
Services (Carea), and the South Karelia Social and mechanisms and development of products
healthcare District (Eksote) promoting population health and welfare.
This article discusses the Finnish data lake established by hospital districts, universities, the www.terveyskyla.fi/helsinginbiopankki/en
project that provides a powerful data national blood service and the National
Biobank of Eastern Finland The development of diagnostics and
architecture with a unified location to help Institute for Health and Welfare in Finland
The North Savo Hospital Districts, the South Savo Social treatment supports research addressing
reduce silos across the healthcare enterprise, (THL). The National Supervisory Authority for and Healthcare Authority, Siun Sote – the Joint metabolic disorders, musculoskeletal
and which can be connected from trusted Welfare and Health (Valvira) directs and Municipal Authority for North Karelia Social and Health disorders, neurological disorders, cancer and
services, the Eastern Savo Hospital District, and the mental health.
outside sources including funders, genomic supervises the activities of Finnish biobanks. University of Eastern Finland
research centres, public health databases, Biobanks collect and store samples and related www.ita-suomenbiopankki.fi/en
biobanks and social media feeds. The data lake clinical data for future research. Six of the
Central Finland Biobank Research area covers biological, medical,
allows for effective cross-data analysis and biobanks operate within the hospital districts The Central Finland Hospital District and the University sport and health sciences, and product
incorporates all internal data sources and and four operate nationwide (in Finland). of Jyväskylä development.
www.ksshp.fi/fi-FI/Potilaalle/Biopankki
trusted external sources for mining and analysis The Finnish biobanks collaborate via the
by clinical departments, business analysts and Biobanking and Biomolecular Resources Finnish Clinical Biobank Tampere Samples specifically for cardiovascular
data science teams. Data lakes open up Research Infrastructure network (BBMRI.fi), Pirkanmaa Hospital District, the University of Tampere, disease, cancer, immunology and type 1
Etelä-Pohjanmaa Hospital District and Kanta-Häme diabetes research.
possibilities for integrating information from which is a national node of the European Hospital District
wearables and appliances built on the Internet Research Infrastructure for Biobanking www.tays.fi/fi-FI/Tutkimus_ ja_kehittaminen/Tampereen_
of Things (IoT). This flexible and reliable (BBMRI-ERIC). The BBMRI.fi aims to create Biopankki
platform offers a myriad of new opportunities a research infrastructure, providing support to Northern Finland Biobank Borealis Promotes research into biomedical, clinical
to find trends and correlations, helping high-quality research through use of Northern Ostrobothnia Hospital District, the University and health sciences, and into translational
of Oulu, NordLab and the hospital/healthcare districts of medicine.
providers to create a data-driven, continuous comprehensive collections of biological
Lapland, Länsi-Pohja, Central Ostrobothnia and Kainuu
learning environment. samples and associated data (BBMRI 2018). www.ppshp.fi/Tutkimus-ja-opetus/Biopankki/Pages/
Data lake platforms provide massive default.aspx
scalability, simple management and Data collection and storage THL Biobank A remarkable collection of population and
operational flexibility. The biobanks contain a collection of https://thl.fi/fi/web/thl-biobank family samples, as well as disease-specific
biological samples and related clinical data samples for research purposes. The biobank
focuses on identification and prevention of
Biological samples and for future medical research, not only for a diseases and promotion of population health.
data lakes specific research purpose. Biobank samples
Biological samples and related data represent include blood cells, biological samples, etc. Hematological Biobank Samples and data from patients with
The Finnish Association of Hematology, Institute for haematological disorders.
an important opportunity for medical Clinical data contains information about a Molecular Medicine Finland and Finnish Red Cross Blood
research. Biobanks collect biological samples patient’s healthcare. Service
www.fhrb.fi/front-page.html
and related clinical information for future The collection of samples is regulated by
medical research. Data lakes are platforms the biobank law, approved on 2 October 2012
interlinking comprehensive electronic (law 688/2012). The act entered into force on Finnish Red Cross Blood Service Biobank Specialises in health promotion, prevention of
www.bloodservice.fi/Research%20Projects/biobanking diseases and transfusion medicine. The
healthcare record information. This 1 September 2013 (Soini 2013). The old biobank collects samples from blood donors
information can be used to study the aetiology samples that had been collected before 1 during their blood donation. These samples
can be used in medical research, for example,
of diseases, the development and validation of September 2013 for treatment, diagnostic
as a control group.
new diagnostic methods, and the development purposes or medical research have been
of personalised medicine and drugs. transferred into the biobanks by permission of Terveystalo Biobank Finland Focuses on the population’s health
https://www.terveystalo.com/en/Company/Terveystalo- promotion, identification of factors involved
In Finland, we have 10 biobanks, of which the regional Ethics Committee and the Clinical-Research-/ in disease mechanisms and disease prevention
nine are publicly and one is privately funded decision on the use of the samples for biobank (currently the only private biobank).
(Table 4). The public-based biobanks have been research from Valvira.
66 67
FIGURE 1. Data and samples are stored in secure national solution in the future. This ensures
UNIDENTIFIED
data storage, with high data security that decision-making is based on
SAMPLES ARE Project plan
STORED IN A requirements. Data is pseudonymised, which Research idea Check data
availability and ethical comprehensive and up-to-date information
review
FREEZER, WHERE means that a patient’s identity is replaced with obtained from the Kanta service and hospital
TEMPERATURES a code that the biobank personnel use to information systems.
CAN BE AS LOW AS
identify a sample. Personal information is kept A recent research report by the VTT
−200°C
separately in the code registry, which only Technical Research Centre of Finland (2018)
certain personnel in the biobank have access recognised the potential of artificial intelligence
to. Samples are stored in the biobank until Application Transfer of Research on (AI), specifically in the use of health data for
for samples samples and samples and
FIGURE 2. they are needed for research purposes. Donors and data data data secondary use. AI-based assistants could be
BIOBANK STORAGE are also allowed to monitor the use of their used in eHealth services by providing
CONTAINERS/
samples. Release of the samples and data is automatic feedback and decision support. Also,
FREEZERS ARE
HOUSED IN A BIG carefully recorded. AI could help in modelling different care paths
ROOM in healthcare systems by user group
How to access samples segmentation. By identifying patients who need
and data in biobanks and Return of
relevant the most attention, more cost-effective and
data lakes research results
to biobank Future use of data better timed decisions may be performed.
First, a researcher with a research question Individual-level health data is increasing our The Finnish National eHealth and eSocial
contacts the biobank (or owner of the data understanding of human health. The new Strategy 2020 aims to support well-being and
New samples can be collected during lake), which will do a preliminary examination legislation on personal data files is intended service renewal in Finland. It highlights better
normal healthcare and medical examinations, of the availability of data and samples. This FIGURE 3. FROM to ensure that the healthcare data stored in use of information in research and innovation
in various research projects or primarily for process is typically free of charge. If enough IDEA TO RESEARCH: national and regional data files can also be activities. Data lakes gather the hospitals’
HOW TO ACCESS
the biobanks. Healthcare personnel can ask data is available in the biobank/data lake, used for secondary purposes, i.e. in structured, semi-structured and unstructured
SAMPLES AND
for consent to collect samples and personal research permission from a biobank or hospital RELATED DATA. applications where data is used beyond its data into one place in their native formats for
data for a biobank. In addition, leaflets and district is then required (Figure 3). primary purpose. later use. In high-quality research, data should
consent forms sent by post are used. The biobank’s or hospital’s committee Use of secondary data makes it possible, be complete and accurate. The information
Donating samples is voluntary. The reviews the researcher’s application and checks for example, to compare healthcare providers. should be available for researchers and
donor gives a written consent and it is valid that the proposed project does not overlap with Information on the availability of a service developers in the easiest possible format. The
until further notice. Voluntary donations can ongoing projects using the same datasets and (queue and appointment information), quality national Isaacus project suggested centralised
be used for understanding illness and for samples. After a positive decision from the (e.g. hospital-acquired infections), price and services for accessing national health and social
improving diagnostic and treatment processes committee, an application for materials from costs of the service providers’ activities, welfare data resources (Sitra 2018). This one-
for future patients. One can withdraw the the biobank/data lake can be assessed. There compatible with the agreed indicators, will be stop shop with the new act on the secondary
consent and prohibit the further use of typically is a fee for accessing samples and publicly available (THL 2018). use of health and social data proposed by the
samples and data at any time. associated data. The costs cover administrative According to the Finnish eHealth and government opens up new opportunities for
Clinical data is integrated into data lakes services, sample and data processing and eSocial Strategy 2020, clinical decision- new products and the individual targeting of
from the hospital’s databases, such as a delivery. The researcher may inquire about a making support for the needs of healthcare healthcare services, health technology
hospital information system, pharmaceutical preliminary estimate of costs after receiving the professionals will be implemented as a innovations and business-to-customer services.
service system and radiological information biobank’s statement of availability.
system. The information includes, for After a transfer of samples and data,
example, demographic information, inpatient research described in the research plan can be 4.5 References BBMRI.fi (2018), BBMRI Network, cited 7 October
2018: www.bbmri.fi/.
Sitra (2018), ”Well-being data”, cited 7 October 2018:
www.sitra.fi/en/topics/well-being-data/.
stays, outpatient visits and diagnoses in started. The researcher may use material only Information to support well-being and service Soini S. (2013), “Finland on a road towards a modern
international ICD-10 codes. Also, non- for the specified research project. The Finnish renewal. eHealth and eSocial Strategy 2020 (2018): legal biobanking infrastructure”, European Journal of
http://julkaisut.valtioneuvosto.fi/handle/10024/74459, Health Law, 20 June 2013, (3): 289-94.
structured information such as clinical notes Biobank Act requires that the raw data obtained cited 7 October 2018.
THL (2018), ”Kansallisen mittariston valmistelu
are included in data lakes. Biobanks use data from the analyses is returned to the biobank, to Lähteenmäki J., Ervasti M., Fagerström R., van (KUVA-indikaattorit)”, cited 7 October 2018: https://
from data lakes, but data lakes can be used for be later available to other projects. Data is Gils M., Pajula J., Ruutu S., Sigfrids A., Valovirta V. thl.fi/en/tutkimus-ja-kehittaminen/tutkimukset-
and Ylén P. (2018), “Data-driven precision medicine ja-hankkeet/sote-tietopohjan-kehittamishanke/
register-based research also. To be useful for typically returned when the results are ecosystem – stakeholder needs and opportunities”
kansallisen-mittariston-valmistelu-kuva-indikaattorit-.
national and international research purposes, published. Biobanks treat the application and (Research Report; No. VTT-R-03318-18), VTT
Technical Research Centre of Finland: https://cris.vtt. Yhteiskuntatieteellinen tietoarkisto (2016),
data needs to be organised and stored in an research plan as strictly confidential until fi, cited 7 October 2018. ”Tietoarkisto palvelee myös terveystieteilijää”,
Tietoarkisto 46(3). http://urn.fi/urn:ISSN:1795-5254.
integrated manner. published. Ministry of Social Affairs and Health, Finland
Biobank Act, 688/2012.
68 69
5 TOWARDS THE ERA OF particularly important to make a difference

between the concepts of participation and
providers and those in charge of the services.
The highest level of inclusion is represented
MYHEALTH: CUSTOMER inclusion. Inclusion is a comprehensive by a situation where the clients themselves
INCLUSION AND CUSTOMER-

concept, which includes participation. In define the frames for services (service client
comparison to participation, a prerequisite as a decision-maker).
DRIVEN APPROACHES IN for inclusion is that the client can affect the
service process. In other words, client
An essential question related to
inclusion and involvement addresses the way
CARE SERVICES inclusion means that the client participates
actively in the planning and organisation of
they are evaluated, and who evaluates them.
Does the client evaluate them or those who
services, in developing the production of involve the clients? On the one hand,
services and/or their evaluation (e.g. inclusion can be assessed on the basis of an
Leemann and Hämäläinen 2015). In order to individual’s experience. On the other hand, it
make active inclusion possible, the clients can be measured at the organisational level,
need to be involved; in other words, i.e. how the different functions and services
situations that strengthen inclusion must be succeed in promoting inclusion (THL 2018).
5.1 Inclusion and involvement as

arranged in a systematic way. Involvement is For evaluation to be successful, it is also vital
also a strategic stand towards developing to understand the levels of inclusion, so the
a basis for the analysis of services and functions for the clients based
on their needs and starting points.
real possibilities for inclusion can be
evaluated. Assessment is not adequate if the
social decision-making and Mere collection of feedback from the client only has an opportunity to be heard.
the efficacy of services

clients remains at the level of false inclusion.
FIGURE 1. The basic level of inclusion refers to the Inclusion perspectives
CONTENTS active involvement of the client/client groups in Finnish society
OF SOCIAL in the planning of the different stages of the In Finland, the Local Government Act
KIRSTI SANTAMÄKI, SENIOR LECTURER, SATAKUNTA UNIVERSITY OF INCLUSION AND service process. The degree of inclusion and (410/2015, § 22) states that the residents of a
APPLIED SCIENCES MARGINALISATION
involvement increases when the client is local authority area and service users have
(ADAPTED FROM
RAIVIO AND actually participating as an equal and active the right to participate and influence the
This article discusses the concepts of or who have otherwise limited means to act KARJALAINEN 2013) participant in development with the service functions of that local authority area. The
inclusion and involvement from a social and participate in social issues. Activation,
perspective. The article focuses on the involvement and empowerment are examples
opportunities for older adults to participate of ways to enhance citizens’ rights and duties
in the development of their own services as as social actors.
an example of involvement. In addition, it According to Raivio and Karjalainen Guaranteed equal services
and adequate income
explores the potential for enhancing (2013; Figure 1), social inclusion consists of: HAVING -> Decreasing differences
in welfare and health
inclusion and involvement in society. 1) adequate income and adequate and
guaranteed welfare services and security; 2) a
encounters
Inclusion fair division of resources and opportunities hearing
acknowledgement Inclusion,
Inclusion or social engagement (hereafter to act, as well as opportunities for an -> empowerment acceptance, trust
-> demanding INCLUSION -> participation
inclusion) is one of the core themes discussed individual to influence his or her own life; a place -> empowerment
in social policy and society. It has an and 3) inclusion, community spirit and ACTING BELONGING
important meaning for the well-being and integration into society. In other words,
omission desertion,
activity of people. The importance of inclusion involves both the aim of an action denial rejection,
-> alienation MARGINALISATION knocking out
inclusion has been emphasised, in particular, and, at the same time, it is one of the means -> becoming -> withdrawal
an object -> abandonment
for those groups in danger of social exclusion to reach that aim. To achieve the goal of
and for their role in the development of inclusion, it is necessary to enhance client
social and healthcare services. Inclusion and expertise: the actions and involvement of the Narrowing down basic
and minimum security
active involvement are especially important client as a developer or, simply, belonging. and making basic
security means-tested,
for those groups and individuals who have a Client inclusion can be defined and reduction of services
-> Increase in inequality
poorer position in society than the majority interpreted in a variety of ways. It is
70 71
council has to make sure that that there are populations, the active involvement of older things such as case management and dignified public transport and accessibility. The
different ways and opportunities to impact adults in decision-making is only fairly recent. home care (client value) and thereby in the representatives of the elderly people’s councils
the functions. However, local authorities From the perspective of targeted services, development of the content of home care take part in different working groups and in
decide independently how and at what level prevention and health promotion, society (service promise). The kind of work that does drawing up strategies. However, so far there
the inhabitants are involved in the functions cannot afford to leave older adults uninvolved. not provide value for the client is reduced and have not been very many systematic
of the authority. new ways of work that promote the client’s assessments of the effectiveness of the elderly
The Local Government Act gives a Examples of involvement: ability to cope with daily life are introduced. It people’s councils in influencing matters.
variety of examples on how citizens’ services for older adults can only be evaluated in the future how active
participation and exerting influence can be involvement has affected the implementation Prerequisites and
promoted. The local authority can arrange Strength in Old Age Implementation of services and whether the projects have necessities of involvement
discussions and public hearings as well as Strength in Old Age Implementation (2005-) succeeded in making the services more user- Planned involvement is needed in the
panels with local inhabitants to find out their is a project managed by the Age Institute. Its friendly. organisations providing welfare services to
opinions before making decisions. aim is to promote the ability of people over the reach the aims set for the quality and targeting
Representatives of service users can be age of 75 to cope independently, despite Involvement of elderly councils of services in an efficient and economical way.
elected onto local bodies and the local having a reduced capacity to live at home. To According to section 27 of the Local In this way, imbalance between the users and
council can provide opportunities to reach these targets, older adults get evidence- Government Act, local councils have to the organisers of services can be reduced
participate in the planning of the economy of based counselling in physical exercise and establish elderly councils and make sure they (empowerment perspective). As a result,
the local area. Services can be planned and strength and balance training, and outdoor can function so the opportunities for older people accept and become committed to the
developed in co-operation with the service activities are arranged for them. Over 100 adults to participate and exert influence are support and service systems of society.
users, and the residents, societies and other local authorities participate in the project and guaranteed. Several local authorities can share Participation in itself has a positive effect and
communities can be encouraged to plan and new areas are being sought. an elderly people’s council. The elderly it improves people’s self-esteem and civil skills,
prepare issues unprompted. Physical exercise panels have been an people’s council must have an opportunity to which in turn makes it easier to decrease the
The ongoing social welfare and important means of involving older adults in influence the functions of different municipal risk for social exclusion.
healthcare reform places an emphasis on the planning their own exercise. In these panels, bodies, the preparation and follow-up of There is a need for knowledge and
active involvement of different actors in the real improvements in the opportunities to issues that are important for older adults’ competence in analysing the present situation
counties. An important part of the reform is a exercise have been made by older adults, local well-being, health and inclusion. Other and the future needs, so involvement can be
public service promise, a description of those council representatives and decision-makers, important issues for older adults include the implemented in various and more profound
aims and values on the basis of which the the local representatives of the Strength in Old environment, housing, transport and services, ways. Analysis competence requires an ability
county will provide those social and Age Implementation project and the mentors and coping with daily activities. to make use of the existing knowledge of
healthcare services it is in charge of arranging. of the Age Institute. Open interaction as equal According to a survey of the Ministry of service systems, to consider different options
Each county will give a separate service members in the panels is a manifestation of the Environment in Finland (2017) the elderly and to produce data on the basis of which the
promise to its inhabitants (Sote-uudistus the kind of involvement required by the Local councils have actively made motions clients/client groups can make a real difference.
2018). Counties are also obliged to state Government Act. It is important that the especially on the development of home care,
whether the services have been implemented suggestions for improvements in services are
as promised. Equal services for people in actually implemented and their efficacy is
different age groups and with different needs evaluated.
5.1 References I & O – kärkihanke. (I & O project). Available at: http://www.ym.fi/fi-FI/Ajankohtaista/Tiedotteet/
are developed in multidisciplinary https://stm.fi/hankkeet/koti-ja-omaishoito, accessed Vanhusneuvostot_haluavat_vaikuttaa_enemm(42542).
15 September 2018. Accessed 18 September 2018.
co-operation in the counties. The preparatory I & O project
Kuntalaki 410/2015 (Local Government National Institute for Health and Welfare (2018),
groups need to have adequate representation The aim of the I & O project (2016-2018) Act). Available at: www.finlex.fi/fi/laki/ “Osallisuuden edistäminen” (Promoting Inclusion).
ajantasa/2015/20150410, accessed 18 September Available at: https://thl.fi/fi/web/hyvinvoinnin-ja-
from different groups, and public hearings related to the social welfare and healthcare
2018. terveyden-edistamisen-johtaminen/osallisuuden-
must be arranged before decisions are made so reform is to provide older adults, informal and Leemann I. and Hämäläinen R-M. (2015),
edistaminen, accessed 1 September 2018.
as to ensure that different perspectives on how family carers with more equal, better “Asiakasosallisuus. Sosiaalisen osallisuuden Raivio H. and Karjalainen J. (2013), “Osallisuus
edistämisen koordinaatiohanke” (Client Inclusion. ei ole keino tai väline, palvelut ovat” (Inclusion is
to develop services will be taken into account. co-ordinated and cost-efficient services. The Project on Promoting Social Inclusion). Available not a means or tool, services are), in Era T. (ed.)
The results of public hearings must also be underlying practices of the project include at: https://thl.fi/documents/966696/3775621/ Osallisuus -oikeutta vai pakkoa (Inclusion – a right
Tietopaketti_Asiakasosallisuus.pdf/6d5b8baf-d5e4- or obligation?). Jyväskylän ammattikorkeakoulun
taken into consideration to actualise inclusion. increasing the involvement of older adults, 4618-add6-ca0b9a81f214, accessed 18 September julkaisuja 156.
The ideology of involvement focuses on making use of the potential of digitisation, 2018.
Sote-uudistus (Social Welfare and Healthcare
the active involvement of those citizens/ managing by knowledge and co-operation of Ministry of the Environment (2017). Reform). Available at: https://alueuudistus.fi/mika-on-
Vanhusneuvostojen rooli ja vaikutusmahdollisuudet sote-uudistus, accessed 1 September 2018).
groups whose perspectives would otherwise the management staff. ikääntyneiden asumisen ja elinympäristöjen
Voimaa Vanhuuteen – Iäkkäiden
kehittämisessä. Ikääntyneiden asumisen
get scant attention. Although Finland is a In this project, clients, family members kehittämisohjelman 2013–2017 työpapereita 1/2017,
terveysliikuntaohjelma (Strength in Old Age
Implementation). Available at: www.voimaavanhuuteen.
country with one of the fastest-ageing and other stakeholders participate in defining ympäristöministeriö, 5.4.2017. Available at:
fi/, accessed 1 September 2018.
72 73
5.2 Customer inclusion in This article defines customer inclusion

as the customer’s active participation in the
of customer inclusion in mental health and
substance abuse work and services in the
healthcare and social services planning, production, development and
assessment of services. Inclusion involves
Finnish social and healthcare system from
the workers’ perspective (Laitila and Pietilä
interaction with professionals in a way that 2012; Perälä 2014) and from the parents’
SEIJA OLLI, PhD, SENIOR LECTURER, SATAKUNTA UNIVERSITY OF makes it possible for the customer to affect perspective in child healthcare clinics
APPLIED SCIENCES the service process (Kettunen and Kivinen (Mäkinen and Hakulinen 2016). Perälä et al.
2012; Linnanmäki 2017). The (2014) describe inclusion in substance abuse
implementation of customer inclusion in services and Rytkönen et al. (2016)
This article presents various interpretations Raivio and Karjalainen’s (2013) definition of social and healthcare services was considered adolescents’ experiences of basic services.
and methods of customer inclusion well-being, where inclusion is based on Erik with the help of a graduated classification The insight of experts by experience was
implemented in current healthcare and social Allartd’s (1976) three dimensions (having, with four classes. In this classification, studied in Hipp et al. (2016) and the
services based on literature reviews acting, belonging), i.e. an adequate income customer inclusion increases gradually from experiences of an advisory group of patients
conducted during the HEAP project. Various and well-being, functional capacity and the customer’s feedback to the customer’s on developing the services of an organisation
aspects and methods and an analysis of how integration into the community. Isola et al. role as a manager of services. First, the in Lindfors et al. (2017). One of the studies is
to measure customer inclusion were the main (2017) emphasise action as part of inclusion customer is an informer, for example by a quantitative inquiry (Mäkinen and
topics in the module “Customer Involvement in addition to the above-mentioned three giving feedback. In this case, inclusion is false Hakulinen 2016) and four are qualitative
and Smart Services”. dimensions. Inclusion involves belonging to inclusion, and the customer is only interview researches (Hipp et al. 2016; Laitila
an entity, where people have access to a participating. The second class is a basic level and Pietilä 2012; Lindfors et al. 2017;
Introduction variety of resources, which provide well- of customer inclusion, where the customer is Rytkönen et al. 2016) and one a triangular
One of the most important aims of the being, and to interactive relationships, which involved as a customer in the service. The study with a quantitative survey and
Health Analytics Programme (HEAP) was to increase the meaningfulness of living. third class represents a high level of inclusion qualitative interview data (Perälä et al. 2014).
deepen healthcare providers’ competence in Inclusion involves having an opportunity to where the customer influences, helping to
information technology as a way of influence one’s own life, and to make the develop services and improve quality, for Customer inclusion
increasing customers’ inclusion in the service most of opportunities, services and other instance. The fourth class is the highest level at different levels
system. Therefore, it was important to find common matters. Inclusion is manifested in: of inclusion, where the customer manages According to Laitila and Pietilä (2012),
out what customer inclusion means, and how 1) inclusion in one’s own life; 2) inclusion in and defines the service framework (Leemann professionals suggest that currently mental
it has been implemented in social and social processes; 3) inclusion in local welfare and Hämäläinen 2016.) The classification health and substance abuse customers’
healthcare services. Another important thing (Isola et al. 2017; Koivisto et al. 2018). includes knowledge, planning, action, inclusion is only false inclusion and
was to find out what kind of development Inclusion can be divided into decision-making and evaluation inclusion. inadequate. Inclusion was implemented by
needs have been detected so far, and how knowledge, planning, action and decision providing the customers with an opportunity
these challenges can be overcome in a service inclusion depending on how the individual to participate in their own treatment, to
system undergoing digitisation. can participate in the decision-making participate in available activities or to give
Inclusion was implemented
Several terms are used for service users process (Rouvinen-Wilenius et al. 2011). In feedback to the unit. The workers thought
in social and healthcare services (customer, social and healthcare services, inclusion by providing the customers that the customers’ participation is important
client, patient, consumer and individual). means that the customer can participate in and their opinions should be taken into
with an opportunity to participate
Other terms include party, agency, decision-making and is able to affect care consideration, in particular when new
stakeholder and citizen. All these concepts and service processes in some way. in their own treatment. functions and services are developed.
open perspectives for customer inclusion. Participation refers to being part of situations According to Rytkönen et al. (2016),
The words consumer and customer are defined by others and mainly on their customers’ inclusion varies, and they
related to the marketing-based perspective in conditions. Involvement means that the To draw up a survey on customer identified four levels of customer inclusion:
the services, whereas the term patient customers are involved in different situations inclusion, publications on social services and inviting, enabling, prohibiting and excluding.
involves being treated or being ill (Leemann in planning, commenting on and influencing healthcare were searched for in the Medic The level of customer inclusion was affected
and Hämäläinen 2016). things and events, which affect them at database and by using the search engines of in particular by the atmosphere, interaction
Inclusion has been described as a different levels from their own care or electronic publications. The studies selected and services (Table 1).
phenomenon, a comprehensive concept and individual service to the service structure in for the survey described the implementation
a framework. Therefore, it has been defined society (Kettunen and Kivinen 2012;
in a variety of ways. In Finnish discussions Leemann and Hämäläinen 2016; Isola et al.
about inclusion, references are often made to 2017; Koivisto et al. 2018).
74 75
TABLE 1. and companionship was connected with the be made, and attitudes should become more
INVITING ENABLING PROHIBITING EXCLUDING
THE LEVELS
parents’ inclusion. Difficult situations arose, positive towards customer inclusion (Hipp et
OF CUSTOMER Caring Comfortable Uncomfortable Cold
INCLUSION IN THE atmosphere atmosphere atmosphere atmosphere when help was provided for the parents and al. 2016; Lindfors et al. 2017).
BASIC SERVICES IN families, and they created challenges for
Confidential Positive Awkward Oppressive Core factors of customer inclusion
SOCIAL SERVICES
Open Relaxed Stiff Unprotected substance abuse units. In most substance
AND HEALTHCARE
Warm Welcoming Busy Distressing abuse units, multidisciplinary teams dealt Significant factors in customers’ experiences
(RYTKÖNEN ET AL. Safe
2016)
with the children’s and families’ problems of customer inclusion consist of being
Encouraging Enabling Disregarding Discouraging and the experiences were rather positive. In understood and respected. As a result,
interaction interaction interaction interaction most cases, common practices were agreed customer inclusion requires a positive
Encouraging Being heard and Disregarding the Blaming on together with the workers of child attitude and encountering skills from the
Respecting the understood customer Doubting protection, other social workers and the workers. The most important skills include
customer’s Ability to affect Inflexible workers Dominating
rights one’s own care Problem-centred school. Expert teams were often used to consideration of the customer’s needs,
Equal speech support co-operation between these different listening to the customer’s experiences,
Close
agencies. However, co-operation did not encouragement, care and respect. Investing
Meaningful The customers Mechanical The customer work very well between healthcare services in inclusion encounters improves the
service believe the service feels and substance abuse units (Perälä et al. customer’s reliance on the service and the
experience service has experience threatened by
fulfilled their the service 2014). experience of being helped (Laitila and
needs Pietilä 2012; Perälä et al. 2014; Rytkönen at
The customer is Reliance in the Work orientation Frustrating Group activities promoting customer inclusion al. 2016; Mäkinen and Hakulinen 2016).
taken seriously professional based on Feeling betrayed According to the studies, customer inclusion As a result, work settings should
and gets help Service offers performance Makes a
The customer is differ Supports produces distrust challenging was considered important. In other words, promote inclusion activities, i.e. a positive
encouraged to trust in services in the service situation even customers should have the chance to atmosphere in encounters, listening and
participate more participate in the development of services, being heard, as well as encouraging
challenging
practices and quality. The interviewed interaction (Rytkönen et al. 2016). It is also
members of advisory patient groups important to develop the measures and
(Lindfors et al. 2017) and groups of measurement of customer inclusion, so its
The atmosphere of inviting inclusion is they did not get adequate information on experience experts (Hipp et al. 2016) thought quality can be improved in digitised social
caring, interaction is encouraging and it relationship issues or on where they can get their groups functioned in a good and target- services and healthcare in the future
makes the experience of the service help. The majority of families had good oriented way, and they appreciated being (Mäkinen and Hakulinen 2016).
meaningful. A comfortable atmosphere experiences, and they felt that they were members of the group. Networking inside the
creates inclusion and enables interaction, and included. In particular, those parents who group and the chance to influence the Discussion
the customers feel that the service has prepared themselves together for the health services and functions promoted inclusion in According to the research findings, customer
fulfilled their needs. Inclusion is prohibited check-up in the child healthcare clinic both models. Inclusion was enhanced by inclusion was mainly implemented as
by an uncomfortable atmosphere and experienced stronger inclusion. encouragement and equal co-operation with participation in care and services, as
interaction that disregards the customers. Despite problems, parents who had the professionals, by showing appreciation to receiving information and giving feedback.
The service is felt to be mechanical. The level experienced substance abuse problems felt the experts and members of patient groups as In other words, customer inclusion was
where the customer is excluded is related to a that they were included, and they were able well as to the members’ personal abilities to carried out at the first or second level
cold atmosphere and discouraging to cope in everyday activities. According to function. Both groups emphasised good (Leemann and Hämäläinen 2016). There
interaction. The service is felt to threatening. Perälä et al. (2014), the threshold for asking organisation of functions, clear goals and were also problems with getting information
(Table 1). for help had been very high for many adequate time for meetings. and with encounters in these first two, more
As a result, the feeling of being truly parents. Even when they had asked for help, However, there were also development basic, levels of inclusion (Perälä et al. 2014;
understood is closely connected with the it was difficult to get it. The professionals’ needs and challenges. If professionals belittle Mäkinen and Hakulinen 2016). The third
experience of inclusion. According to knowledge of substance abuse was not and question patient activities and level of customer inclusion is the level, where
Mäkinen and Hakulinen (2016), 80% of adequate or the professionals had resorted to experience experts, they weaken inclusion. the customer can participate in planning and
parents felt that they were equal with the hard actions and disregarded the parents. It Hospital staff and organisations should be in developing quality (Leemann and
professionals in the discussions. One fifth of was also hard to get information from service aware of the functions and groups that Hämäläinen 2016), was strived for with the
the respondents felt that their opinions were providers. promote customer inclusion. The groups help of experience experts and advisory
not equivalent with the professionals. The workers thought that working as need feedback on their work and visibility in patient groups. According to the
Another fifth of the respondents felt that companions with the families worked well, the organisation. Structural changes should professionals, it is especially important to
76 77
take the customers’ opinions into be sceptical about customer inclusion. If customers and service users in a digitising Analytics Programme (HEAP) is to meet the
consideration and involve them when new customers only give feedback and participate environment creates both challenges and training needs resulting from the
functions and services are developed (Laitila in care or services, they are not genuinely possibilities for customer inclusion. professionals’ competence challenges. In
and Pietilä 2012). However, the results show involved, since they are not part of the Demands are placed in particular on case addition to competences in analytics and
that this level of inclusion was not reached. planning, evaluation and decision-making management, welfare coaching, the user- analysing, training focuses on finding user-
Unfortunately, the hospital staff were not processes (Leemann and Hämäläinen 2016). friendliness of applications and the friendly services and solutions, which
always even aware of the groups and their Customer inclusion requires new implementation of the collected data in the support the customer’s inclusion and its
aims and functions. In addition, by competences, attitudes and co-operation patient’s care. The aim of the Health implementation.
questioning and belittling the customers’ from the professionals. At times, it is
opinions, patient membership activities and necessary for the professional to shed the role
experience expertise, the hospital of a professional. This can open up new
organisation and its staff weakened inclusion insights into how to create common
(Hipp et al. 2016; Lindfors et al. 2017). understanding. In fact, customers and
However, initial results were obtained patients have a range of experience and
from inclusion at the third and fourth levels. competence that the service providers do not
They are shown in Table 1 in the descriptions have (Kettunen and Kivinen 2012). The
of enabling and inviting inclusion by promotion of customer inclusion involves
Rytkönen et al. (2016). In situations which new training, management and new kinds of
enable inclusion the customers are taken into communication, since changes in actions are
consideration, their experiences are listened not self-evident (Linnanmäki 2017). On the
5.2 References Allardt E. (1976), Hyvinvoinnin ulottuvuuksia Mäkinen A. and Hakulinen T. (2016),
to and they are encouraged. The staff show other hand, even professionals need to be (Dimensions of Well-Being) WSOY, Porvoo. “Vanhempien osallisuus lastenneuvolan laajassa
terveystarkastuksessa” (Parents’ inclusion in a
Hallitusohjelma (2015), Ratkaisujen Suomi (Finland
consideration and respect the customer. heard and common discussions are needed. comprehensive check-up of children in a child
of Solutions; Government Programme 2015),
healthcare clinic), Tutkiva Hoitotyö 14 (4); 21-30.
Investing in inclusive encounters improves Kettunen and Kivinen (2012) suggest Hallituksen julkaisusarja, October 2015. Available at:
http://valtioneuvosto.fi, accessed 15 Sept 2018). Perälä M-L., Kanste O., Halme N., Pitkänen T.,
the customer’s reliance on the service and the coaching for healthcare units so they can Kuussaari K., Partanen A. and Nykänen S. (2014),
Hipp K., Kangasniemi M., Vaajoki A. and Kuosmanen
experience of being helped. develop new ways of acting, which enable L. (2016), “Kokemusasiantuntijan osallisuus
“Vanhempi päihdepalveluissa – tuki, osallisuus
ja yhteistoiminta” (The parent in substance
inclusion. Changes in functions mean that mielenterveyspalvelujen kehittämisessä” (The
abuse services – support, inclusion and co-
inclusion of experts by experience in developing
the customer’s expertise is accepted, and the mental health services), Hoitotiede 28 (4); 286-297.
operation). Available at: www.julkari.fi/bitstream/
handle/10024/116150/URN_ISBN_978-952-302-
At times, it is necessary organisation is arranged in a way that enables Kettunen T. and Kivinen T. (2012), “Osallisuus 214-0.pdf?sequence=1&isAllowed=y, accessed 17
and allows inclusion (Leemann and hoitotyön kehittämisen suunnannäyttäjänä” (Inclusion September 2018.
for the professional to shed Hämäläinen 2016). Real changes can be
as a Vanguard of Development in Healthcare), Tutkiva
Hoitotyö 10 (4); 40-42.
Raivio H. and Karjalainen J. (2013), “Osallisuus
ei ole keino tai väline, palvelut ovat! Osallisuuden
the role of a professional. made by developing healthcare services Koivisto J., Isola A-M and Lyytikäinen M.
(2018), “Osallisuus kuuluu kaikille. Innokylän
rakentuminen 2010 –luvun tavoite- ja
toimintaohjelmissa”, (Inclusion is not a means or tool,
together, but experience knowledge has to be innovaatiokatsaus” (Inclusion belongs to services are). In Era T. (ed.) Osallisuus -oikeutta vai
accepted by the decision-makers at the everybody). Available at: www.julkari.fi/bitstream/ pakkoa (Inclusion – a right or obligation?), Jyväskylän
handle/10024/136074/URN_ISBN_978-952-343-077- ammattikorkeakoulun julkaisuja 156, 12-34, Jyväskylän
In promoting inclusion, three things organisation and by those who make 8.pdf?sequence=1, accessed 15 September 2018. ammattikorkeakoulu.
need to be developed: individual and decisions on service production (Linnanmäki Laitila M. and Pietilä A-M. (2012), “Työntekijöiden Rouvinen-Wilenius P., Aalto-Kallio M., Koskinen-
co-operation factors, organisational factors 2017). käsityksiä asiakkaan osallisuudesta mielenterveys- Ollonqvist P. and Nikula T. (2011), Osa2. “Osallisuus
ja päihdetyössä” (Professionals’ insights into the osana tasa-arvoa” (Inclusion as part of equality). In
and social factors. The results of this survey customer’s inclusion in mental health and substance Rouvinen-Wilenius P. and Koskinen-Ollonqvist P. (ed.),
show that the factors involved in customer Conclusions abuse work), Tutkiva Hoitotyö 10 (1); 22-31. “Tasa-arvo ja osallisuus väylä terveyteen. Järjestöt
suunnannäyttäjinä” (Equality and Inclusion as Ways
Leemann L. and Hämäläinen M-L. (2016),
inclusion consist of: 1) the functions and Increasing inclusion was highlighted in “Asiakasosallisuus, sosiaalinen osallisuus ja matalan
to Health. Associations as Vanguards), Terveyden
edistämisen keskus julkaisuja 9/2011 TEKRY Helsinki,
resources of organisations; 2) workers’ Sipilä’s government programme (2015) and kynnyksen palvelut. Pohdintaa käsitteiden sisällöstä”
pp. 49–66. Available at: www.soste.fi/media/pdf/
(Customer inclusion, social inclusion and low-threshold
actions and attitudes; 3) customers’ in the aims of the ongoing social welfare and services. Discussion on the content of concepts),
julkaisut/tasa-arvo_ ja_osallisuus_2012.pdf, accessed
17 September 2018.
motivation and skills; and 4) division of healthcare reform. The aim of the Yhteiskuntapolitiikka 81 (5), 586-594.
Rytkönen M., Kaunisto M and Pietilä A-M. (2016),
power and dynamics of power. government’s project, entitled Customer- Lindfors S., Joronen K., Roine-Mentula K., Koponen
“Nuorten osallisuuden toteutumisen tasot sosiaali- ja
R. and Rantanen A. (2017), “Asiakasjäsenten
The results also show that the general Driven Services, is to combine the functions kokemuksia erikoissairaanhoidon neuvoa antavasta
terveydenhuollon peruspalveluissa” (The levels of
adolescents’ inclusion in the basic services of social
opinion of the work community towards in social services and healthcare into potilasryhmästä” (Customer members’ experiences of
and healthcare), Tutkiva Hoitotyö 14 (4); 31-38.
an advisory patient group in specialist nursing care),
inclusion has a significant bearing on how customer-driven entities, with which digital, Tutkiva Hoitotyö 15 (2); 14-21.
inclusion succeeds in a care unit (Kettunen flexible and bureaucracy-reducing services Linnanmäki E. (2017), “Asiakkaan ääni kuuluviin
sote-palveluissa” (The customer’s voice must be
and Kivinen 2012; Linnanmäki 2017). The can be provided and which make the heard in social services and healthcare), Duodecim
staff at all levels of the organisation seem to customers more independent. Meeting 133(18);1623-5.
78 79
5.3 Health coaching – challenges multifactorial, including but not limited to

the following:
studied areas, HC has typically demonstrated
positive outcomes. Overall, it appears that
to widespread incorporation —— roles and responsibilities (of both the HC may be most effective for people who are
within healthcare
HC and patient); highly motivated to change (from the outset)
—— whether HC should be a stand-alone and who have the most severe conditions or
profession or incorporated into existing unhealthy lifestyles.
healthcare professional duties; Specifically identifying the
KYLE MULHOLLAND, RESEARCHER, SATAKUNTA UNIVERSITY OF —— training requirements; characteristics of HC interventions
APPLIED SCIENCES
—— mechanisms for the delivery of HC represents an additional challenge.
services (face to face, online, group, etc.) Consensus regarding ideal intervention
There appears to be a growing burden on the Health coaching —— associated research and ensuring characteristics is lacking, possibly due to the
existing healthcare system, with several Health coaches are healthcare professionals evidence-based practices; broad nature of HC and its potential areas of
factors contributing to this global problem. “trained in behaviour change theory, —— evaluation of HC outcomes. application (HC interventions may be
Increased lifespans and the growing number motivational strategies, and communication applied to numerous potential pathologies,
of ageing individuals have seen an associated techniques, which are used to assist patients potentially requiring differing approaches).
rise in the number of non-communicable to develop intrinsic motivation and obtain Table 1 identifies some potential delivery
diseases (NCDs), or chronic pathologies. skills to create sustainable change for
Should health coaching be characteristics for HC interventions.
Unfortunately, the existing healthcare system improved health and wellbeing” (Wolever et incorporated into existing
appears to be lacking the necessary resources al. 2013). Their role is to support patients, Placement of health coaching within the
to combat this growing problem. The limited operating as skilled partners in the
healthcare professional roles? healthcare system
number of healthcare professionals, management of the patient’s healthcare. Considering growing challenges, such as
combined with this increased patient load, Engaging people in keeping themselves reduced availability and contact time
means patients are having less and less well is an essential component of reducing ill Challenges to the (between patients and healthcare
contact time with healthcare professionals. health and the demand for health services widespread adoption of professionals), the following question can be
This is also an area of considerable concern, (more activated patients experience 8-21% health coaching raised: Should HC be incorporated into
as research is increasingly highlighting the lower healthcare costs) (Hibbard and Gilburt existing healthcare professional roles, or
benefits of patient education, behavioural 2014). Although research suggests that Defining roles, responsibilities and delivered as a stand-alone intervention/
change practices and empowerment in people want to be more involved in their intervention characteristics profession?
managing chronic conditions. These chronic care, this does not typically happen in HC may be delivered by a range of There are numerous potential barriers
pathology management strategies typically practice. There are potentially numerous individuals, with provision not limited to associated with incorporating HC roles into
require spending a significant amount of contributing factors, including reduced time healthcare professionals. Individuals who existing healthcare professional duties. The
time with patients, to ensure successful availability of healthcare professionals, low have experienced similar long-term health most apparent relates to the lack of available
translation of knowledge and skills. levels of patient activation (25-40% of the conditions (and associated HC training) may resources. In addition to time availability,
Accordingly, the ageing population population have low levels of activation), lack also be appropriate for the delivery of HC there are potential resource limitations
increasingly stretched resources and of patient education, reliance on the interventions. As such, there currently does relating to funding and supporting associated
associated healthcare costs are a huge healthcare system to manage conditions, etc. not appear to be conclusive evidence to training. In addition, the potential shift in
concern. To combat this challenge, we need HC aims to empower patients, helping them suggest that one type of coach is more healthcare professional roles may not be seen
to develop and implement systems that to become experts in their own health. effective than others (“Does health coaching as a priority. Due to the relative infancy of
provide alternative treatment options, Considering only 3.2% of patients with work?” 2014). HC, evidence supporting the efficacy of
promote efficiency and reduce costs. The long-term conditions report involvement in There are also challenges to identifying interventions is limited. This can make it
recent emergence of Health Coaching (HC) developing their own care and support plan, the most suitable patient groups for the difficult to justify the necessity of
professionals may help to alleviate this there is huge potential for HC to foster delivery of HC interventions. To date, the incorporating HC interventions into existing
problem. Considering the relative infancy of patient engagement (Mathers and Paynton most commonly studied areas relate to: body healthcare methodologies. Additionally, as
this new profession, there are a number of 2016). weight (or BMI), systolic blood pressure with any innovation, perceptions (from both
challenges to ensuring successful Considering the relative infancy of this (SBP), low-density lipoproteins (LDL), a healthcare professional and bureaucratic
incorporation of HC into the current new profession, there are a number of haemoglobin A1C, health risk appraisal perspective) may create a fear of change.
healthcare system. This paper presents some challenges to ensuring successful (HRA), pain, psychological factors, exercise Should HC be delivered as part of a
of these key challenges. incorporation of HC into the current behaviours and nutrition behaviours (Sforzo separate profession, care should be exercised
healthcare system. These challenges are et al. 2014). For these most commonly to ensure any interventions incorporate
80 81
TABLE 1. delivery of HC interventions, associated facilitate the design and evaluation of HC

Characteristic Potential intervention options
POTENTIAL HC
clinical research is necessary. Unfortunately, interventions that are valid, reliable and
CHARACTERISTICS What? Is HC delivered as a Component of broader intervention
stand-alone there appear to be several factors influencing data-based (Hibbard, Stockard, Mahoney
intervention or as part Stand-alone intervention the quality of existing research. As previously and Tusler 2004).
of an integrated
identified, difficulties arise when attempting
intervention?
to clearly define what constitutes HC and Conclusions
How? How is the In person studies have used this or similar terms to Although research investigating the efficacy
intervention
delivered? Online (including smartphone represent widely varying interventions. of HC interventions should be interpreted
applications) When interpreting research, it is important with caution, HC appears to have a positive
By phone to consider the exact HC methods, providers, influence on patient outcomes. In particular,
duration, frequency, etc. Additionally, most HC has demonstrated positive effects for
Duration Over what period of Single session
time is the studies fail to compare HC with other individuals who have long-term, severe
intervention Intensive intervention period (a few alternatives; or employ HC as a stand-alone conditions or unhealthy lifestyles.
delivered? days/weeks) intervention (rather than part of an Accordingly, HC offers the potential to
Longer periods (over several months, or integrated healthcare strategy). When alleviate some of the healthcare system
even years) interpreting research, it is also important to burden associated with NCDs and an ageing
remember that HC is a prime example of an population. Nevertheless, several challenges
Sessions How many HC Single session intervention based on human need to be overcome before there is a
sessions are needed?
Several sessions
communication and not easily controlled in a widespread incorporation of HC
laboratory setting. This also creates professionals (applying evidence-based
Periodic sessions (no defined amount) difficulties when attempting to quantify intervention strategies) within the existing
research outcomes. Many studies are not healthcare system. This paper has
How often? How often is the Daily data-based, however emerging tools such as highlighted some of these key challenges.
intervention
delivered? Weekly the Patient Activation Measure (PAM)
Monthly
Yearly
Ratio How many individuals One-on-one sessions

are participating in
the intervention? Group setting
communication with the multidisciplinary efficacy of HC identify a vast range of

healthcare team. This is particularly training lengths and intensities (if at all).
important for more complex, long-term Coaching-specific training can range from
conditions, involving an array of healthcare less than two hours to close to two years,
professionals. Questions also arise regarding with a median between six and 40 hours
how this new profession is placed within the (Wolever et al. 2013). Without agreed-upon
5.3 References “Does health coaching work? A summary of key
themes from a rapid review of empirical evidence”
Mathers N. and Paynton D. (2016), “Rhetoric and
reality in person-centred care: introducing the House
(2014). Retrieved from: https://eoeleadership.hee. of Care framework”.
existing system, where funding comes from, standards for the training and practice of nhs.uk/sites/default/files/Does%20health%20
Sforzo G. A., Kaye M. P., Todorova I., Harenberg
who regulates the profession, etc. HC, the public and healthcare professionals coaching%20work%20-%20a%20review%20of%20
S., Costello K., Cobus-Kuo L. and Moore, M. (2017),
empirical%20evidence_0.pdf#overlaycontext=Listen_
are confused about what to expect from and_read_about_health_coaching.
“Compendium of the Health and Wellness Coaching
Literature”, American Journal of Lifestyle Medicine,
Training requirements and ensuring evidence- coaches and how they complement other Hibbard J. and Gilburt H. (2014), Supporting people 1559827617708562.
based practice professions. to manage their health. An introduction to patient
Wolever R. Q., Simmons L. A., Sforzo G. A., Dill
activation, The King’s Fund, London.
D., Kaye M., Bechard E. M. and Yang N. (2013),
With the growing prevalence of HC This lack of definition regarding
Hibbard J. H., Stockard J., Mahoney E. R. and Tusler “A systematic review of the literature on health
programmes, it is currently difficult to minimum training requirements also creates M. (2004), “Development of the Patient Activation and wellness coaching: defining a key behavioral
Measure (PAM): conceptualising and measuring intervention in healthcare”, Global advances in health
determine the expertise and quality of challenges to interpreting research. To ensure activation in patients and consumers”, Health services and medicine, 2(4), 38-57.
coaches. Many studies investigating the evidence-based practices are employed in the research, 39(4p1), 1005-1026.
82 83
5.4 Designing individually tailored where the goal is to work with the individual
at their own living community by reorienting
existing resources (e.g. access, time and
money), so that they will be able to maintain
health promotion programmes their life to promote a healthier lifestyle. The the new healthy lifestyle at the conclusion of
for people with disabilities

aim of these individually tailored, the intervention.
community-based intervention programmes
is to enhance natural support systems within Using welfare technology
the participant’s home and community in health promotion
KATI KARINHARJU, SENIOR LECTURER, SATAKUNTA UNIVERSITY OF environment, where the programme needs to programmes for people
APPLIED SCIENCES, PORI, FINLAND
be flexible enough to accommodate changes with disabilities
in their life circumstances and routines In addition to individually tailored health
RIIKKA TUPALA, RESEARCHER, SATAKUNTA UNIVERSITY OF APPLIED (Marcus and Forsyth 2009). Individually promotion programmes, the methods and
SCIENCES, PORI, FINLAND tailored, community-based programmes are monitors to assess the benefits of the
determined to be most cost-effective when programme also need to be designed from
Over one billion people in the world have created to measure physical activity for compared to structured fixed-facility the user perspective. Methods of user-
some form of disability and nearly 200 people using wheelchairs. programs (Clanchy et al. 2016). oriented designing, like the Design for
million of them are experiencing Somebody, Design for All and Universal
considerable difficulties in their health and Health promotion for people Design frameworks give guidelines to meet
functioning (World Health Organization with disabilities the user’s needs (Finn and Loane 2016;
2011). People with disabilities can gain Health promotion is the process of enabling Wheeleri enables people using Aragall, Neumann and Sagramola 2013).
similar benefits from health promotion people to increase their health and control Among the field of welfare technology, the
programmes as individuals without a over their health. The purpose of health walkers and wheelchairs devices to promote physical activity and to
disability (Rimmer et al. 2010). However, to promotion is to positively influence to monitor the distance and objectively evaluate physical activity
be successful, health promotion programmes individuals’ health behaviour, ensuring they programmes for people with disabilities are
for people with disabilities need to be are achieving sufficient behaviour for health speed they are travelling. limited. There is an abundance of physical
individually tailored, taking into by adopting new daily activities and activity devices available to the ambulant
consideration the complexity of one’s maintaining a new healthier lifestyle (Marcus population (Bravata et al. 2007), but these
personal disability as well as environmental and Forsyth 2009). It has been shown that monitors may not be accessible or accurate
resources. This article focuses on the client- different sections of the population (whether Example of a client-centred measures for people with disabilities (Conger
centred health promotion programme for those classified on the basis of gender, socio- health promotion et al. 2015). Especially among people using
people with disabilities, using physical economic status, age or ethnicity) respond programme assistive aids like wheelchairs, the
activity promotion as an example. Physical differently to the same intervention Adapted physical activity promotion movements for daily mobility are very
inactivity is a global health risk that not only (Fertman, Allensworth and Auld 2017). intervention has been demonstrated to different to the movements required for
leads to disease and early death, but also Therefore, the better a health promotion successfully increase physical activity locomotion in able-bodied populations.
imposes a major burden on the economy. In programme matches with individual adoption in adults with brain impairment Satakunta University of Applied
terms of physical activity, adults with characteristics, the more likely the (Clanchy et al. 2016). This programme Sciences (SAMK) and the electronic
disability are not meeting basic physical programme will succeed. However, people combines psychological theories of company Siru Innovations created a welfare
activity recommendations and in the years with disabilities are a very heterogeneous motivation and behaviour change, and each technology device called Wheeleri, that is
ahead, considering the prevalence of group and among the individual programme is individually tailored, based on purposefully designed for customer and
disability is on the rise, this inactivity among characteristics, disability and impairment the client’s stage of motivational readiness research use, to measure physical activity for
people with disabilities will be an even themselves might have broad influences on (Prohaska and Di Clemente 1989). The people using walkers and wheelchairs.
greater concern (Rimmer et al. 2010; World individuals’ capacity to participate and programme aims to help participants create a Wheeleri enables people using walkers and
Health Organization 2016). Therefore, there implement the planned health promotion physically active lifestyle by finding activities wheelchairs to monitor the distance and
is a need for effective physical activity programme. Previous health promotion in their home and nearby community that speed they are travelling. In the ambulant
interventions for people with disabilities. In programmes for people with disabilities have are: 1) effective for improving their health; 2) population, self-monitoring daily distances
order to promote physical activity among primarily been conducted in fixed facilities, safe, by taking into consideration the client’s with a physical activity monitor has been
people with disabilities, objective and such as hospital-based or outpatient-based health condition and functioning; 3) shown to be an effective method for
accessible methods are needed. This paper facilities (Clanchy, Tweedy and Trost 2016). enjoyable, as the activities selected will be the increasing physical activity. It has also been
also presents an example of a novel physical As an alternative, individually tailored health choice of the participant; and 4) sustainable, found that greater wheeled distances by
activity monitor that has been purposefully promotion programmes have been created, meaning the programme is utilising client’s people using wheelchairs improves their
84 85
wheelchair manoeuvring skills and, in turn, disabilities, the intervention needs to be Annex 1 THE EVOLUTION OF THE CONTENT OF HEALTH ANALY TICS EDUCATION
can improve their quality of life. From the individually tailored and take into IN THE HEAP PROJECT
customer use point of view, Wheeleri also consideration not only the characteristics
offers an objective health promotion tool for related to disability and impairment, but also 1) The Content of the International HEAP Pilot Programme (2017–2018):
clinicians and research purposes and it can the personal and environmental factors
be used to evaluate the efficacy and health (World Health Organization 2018). By
benefits of health promotion programmes. creating feasible and accurate technology for 1. eHealth and telemedicine 10 cr
people with disabilities, it is possible to • Digitalisation and Smart Services
Conclusion evaluate the efficacy of health promotion • Health 1.0 → Health 4.0
In conclusion, to be able to create safe, programmes, while also enabling individuals 2. Decision Support Systems & Tools 10 cr
effective, enjoyable and sustainable health to use the technology to monitor their a. Knowledge basis of Decision Support Systems (DSS) in Healthcare
promotion programmes for people with behaviour and improve their own health. b. Decision Support Technologies in Clinical Decision Support
Systems (CDS)
3. Client Involvement & Smart Services 5 cr
a. Customer Involvement in Healthcare and Social Services
b. Self-care Services
c. Coaching in health and wellbeing
4. Service Design & Case Management 5 cr
• Introduction to Service Design
• Methods and Tools to Generate Customer-centred Services
• Customer-centred Case Management
5. Piloting Data Analytics in Health Services 20 cr
• Implementation of Data Analytics
• Innovation & Change Management
• Research in Management & Knowledge Management
5.4 References Aragall F., Neumann P. and Sagramola S. (2013), Marcus B. H. and Forsyth L. (eds) (2009), Motivating 2) The Content of the Proposed Specialised Education Programme Generated
Design for All in progress, from theory to practice, people to be physically active, second edition, Human
EuCAN – European Concept for Accessibility Kinetics, Champaign, IL. in the HEAP Project:
Network, c/o Info-Handicap, Luxembourg.
Prochaska J. O. and DiClemente C.C. (2005),
Bravata D. M. et al. (2007), “Using Pedometers to “The transtheoretical approach”, in Norcross J. C.
Increase Physical Activity and Improve Health: A and Goldfried M. R., Handbook of psychotherapy
Systematic Review” JAMA, 2007; 298(19): 2296-304. integration (Oxford series in clinical psychology; MODULE 1. e-Health and digital services in healthcare and social services 10 cr
second edition), Oxford University Press, Oxford/New Smart technologies in healthcare and social services 3 cr
Clanchy K. M., Tweedy S. M. and Trost S.
York, pp. 147-171.
G. (2016), “Evaluation of a Physical Activity Digital services in healthcare and social services 7 cr
Intervention for Adults with Brain Impairment”, Rimmer H. J., Chen A. M-D., McCubbin A. J., Drum
Neurorehabilitation and Neural Repair, 30(9), 854-865. A. C. and Peterson A. J. (2010), “Exercise Intervention
doi:10.1177/1545968316632059. Research on Persons with Disabilities: What We Know
MODULE 2. Alternative studies:
and Where We Need to Go”, American Journal of
Conger S. A., Scott S. N., Fitzhugh E. C., Thompson
Physical Medicine & Rehabilitation, 89(3), 249-263.
D. L. and Bassett D. R. (2015), “Validity of Physical
doi:10.1097/PHM.0b013e3181c9fa9d.
Activity Monitors for Estimating Energy Expenditure Data Analytics 10 cr Smart Customer Coaching and Case
During Wheelchair Propulsion”, Journal of Physical World Health Organization (2011), World report on
Activity & Health, 12(11), 1520-1526. doi:10.1123/ disability: www.who.int/disabilities/world_report/2011/ PART I Data Analytics and Information Management 10 cr
jpah.2014-0376. report.pdf, accessed 5 October 2018. Systems in Healthcare and social PART I Customer Involvement and
Fertman C. I., Allensworth D. D. and Auld, M. E. World Health Organization (2018), “What is servicse 5 cr Smart Services 5 cr
(2017), “What are health promotion programs?”, Moderate-intensity and Vigorous-intensity Physical
PART II Data Analytics and Decision PART II Data Analytics in Designing
in Fertman C. I. and Allensworth D. D. (eds) (2017), Activity?”: https://www.who.int/dietphysicalactivity/
Health promotion programs: from theory to practice, physical_activity_intensity/en/, accessed 3 October Support Technologies 5 cr Customer-centred Services 5 cr
second edition, Society for Public Health Education, 2018.
San Francisco, 3-27.
Finn E. and Loane J. (2016), “Approaches to Smart
Technology Deployment in Care”, in Merilampi S. MODULE 3. Implementation of Data Analytics in Healthcare
and Sirkka A. (eds) (2016), “Smart eHealth and eCare and Social services 10 cr
Technology. What is that? In Introduction to Smart
eHealth and eCare Technologies”, Chapman and Hall/ Applying Data Analytics in Customer-centred Services 10 cr (development project)
CRC, 31-61.
86 87
SITRA STUDIES 141 SITRA.FI
Sitra Studies is a publication series which Itämerenkatu 11–13
focuses on the conclusions and outcomes PL 160
of Sitra’s future-oriented work. 00181 Helsinki
P. +358 294 619 991
@SitraFund

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S I T R A ST U D I E S 14 1 NOVEMBER 2 0 1 8

4.2 Omaolo service 54

prevent cardiovascular disease 58

4.4 Proactive cardiovascular prevention in subjects with a high

1 Introduction 6 hereditary risk by using the Kardiokompassi tool in Estonia 60

4.5 The Finnish biobanks and data lakes 64

2 The future of healthcare – from health 1.0 to health 4.0 8

Towards the era of myhealth: customer inclusion and customer-

personalised care services 30 Annex 85

3.7 Echos from the health analytics programme (HEAP) 40

3.8 Lessons learned in the health analytics programme (HEAP) 44

2 The future of healthcare – Why IHAN? Because more and more

people should interact with healthcare on personal well-being (Figure 5).

Open data Genomic data

2 References 1. Green L. A., Fryer G. E. Jr., Yawn B. P., Lanier D.

3 DATA ANALYTICS data and the diverse information systems that

– a new curriculum in solving the problems of one particular

healthcare education Thus, the health analyst is a professional

Data analytics can be seen as

3.3 References Bates D. W. et al. (2003), “Ten commandments for

3.4 Visualisation as a tool for data Keep visuals simple and to

result, there can be a MACE (major adverse

3.5 Small-scale working life pilots

pave the way to data-driven

Analysis of new customer-centred Well-being Rehabilitation, regional

5 Support and decision-making activities 2

Organisational Improve team work

4 ANALYTIC METHODS FIGURE 1.

AND TOOLS FOR DIGITAL ORGANISATION SAARIKKA

The whole population

Diagnoses Body mass index distribution

Body mass index distribution

tools for value-based care Blood pressure distribution

ILKKA KUNNAMO, MD, PhD, RESEARCH DIRECTOR, DUODECIM MEDICAL

developed by Duodecim Medical sent to a database maintained by Duodecim’s

Population health dashboard after filtering by diagnosis and

The data of all people in the population

FIGURE 3. Estimating health benefit adverse effects including death, annoying

4.2 Omaolo service Elements of Omaolo service

HANNA NORDLUND, ICT-PROJECT DIRECTOR, SOTE-DIGI OY

when necessary. The welfare check can only management.

result of this collaboration, new roles and

4.3 KardioKompassi® – using and blood pressure levels. Through

predict and prevent

cardiovascular disease Findings from Kardio­

4.4 Proactive cardiovascular

4.5 The Finnish biobanks Biobanks and Founders Operation

and data lakes Auria Biobank

5 TOWARDS THE ERA OF particularly important to make a difference

INCLUSION AND CUSTOMER-

5.1 Inclusion and involvement as

the efficacy of services

5.2 Customer inclusion in This article defines customer inclusion

5.3 Health coaching – challenges multifactorial, including but not limited to

TABLE 1. delivery of HC interventions, associated facilitate the design and evaluation of HC

Ratio How many individuals One-on-one sessions

communication with the multidisciplinary efficacy of HC identify a vast range of

for people with disabilities

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cardiovascular disease Findings from Kardio