eHealth Case- Maternity and Infant Clinic on the Net (MIC)

1. eHealth Case- Maternity and Infant Clinic on the Net (MIC) Speaker: Pirkko Kouri, Pricipal Lecturer in Healthcare Technology, PhD, PHN, RN Guests: Tempus delegation Time: 21 Feb 2007

2. Ultimate goals of Finnish health care • Cost-effectiveness • Patient/client & population centeredness • Just distribution of the services (equity) = use based on need ********************************************************* MSAH’s own information society policy • Wide use of information and communication technology • Utilisation of internet penetration

3. Development levels – definition and projectwork e.g. Area of eHealth / eWelfare Levels of developmentDevelopment work EU/ National Laws, standards, terminology, classifications, forms, data definitions RegionalAggreements, data transmissions, databases, archives, cooperation Local Working culture, division of labour, cooperation IndividualPersonal needs, user interface, way of working, teamwork

4. Milestones - Finnish health care system • National Project on Safeguarding the Future of Health Care Services • 2007 National law EHR

5. eHealth, National Project on Safeguarding the Future of Health Care Services – main goals • Ensure access to treatment • Enhance co-ordination and co-operation in specialized health care • Enhance regional co-ordination in primary health care • Emphasize preventive work, one’s own responsibility for one’s own health and the significance of primary health care • Implementation - divided into 40 sub-projects • Preparing the ground for the nationwide electronic patient records, which will be introduced in 2007 (law will be launched Spring 2007)

6. Evolution of e-processes - strategy and plan - education - culture, values - publicity in control Use of e-Health and e-Social processes 5. Adaptation of work processes Integration of IT solutions in daily life 4. Integration Planning and development of e-processes, working models 3. Processes Intranet, Internet groundwork purpose-built 2. Basic development 1. Services/ Products Electronic documents and lists Information management Networks Adapted from www.done360.com

7. The Regional Project Area Maternity care – births are over 99% in hospitals • 85.585 km2 • >1.000 lakes • 681.000 inhabitants • One university hospital • Four central hospitals (five 10/03) • 53 health centres • App. 20 000 social and health care workers . JYVÄSKYLÄ Map of Finland

9. PAGE 2 PHN/ EXAMINATION 37 W PHN/ EXAMINATION 38-40 W PHN/ EXAMINATION 40-42 W DELIVERY ROOM POST NATAL WARD PHN/ (baby) HOME VISIT immediately after discharge PHN/ (mother) HOME VISIT immediately after discharge PHN / Mother´s Medical health check DOCTOR/ Mother´s Medical health check8-9 W after delivery CHILD CLINIC FAMILY PLANNING

10. Basis of the Maternity and Infant Clinic on the Net The Long History of the (Finnish) Maternity Care Services (since 1940´s) Development of Information Society (1990´s) Idea of Maternity Services on the Internet (1997) • Basis of Development Work • Research • Multi-disciplinary • co-operation • Piloting • Feedback / Evaluation • Results • Working models for • experts and • families • Networking • Data/info contents • Software technology • Participants • Health care professionals • Families • Colleges • Software technology experts • Multimedia experts E- Service

11. Expert teams • Central team • Social and Health care experts´ team • Technology experts´ team • Education experts´ team (Savonia was co-ordinator of the MIC project) • Families

12. MIC • is supplementary to today's mother-child clinic services • helps the user in decision making • provides information that has been approved by the special editorial board • enables the use of the services independently of time and place (Internet connection needed) • can be used in many countries (adjustments will be made according to the culture)

19. The MIC: options • Entrance • News • Discussion groups (with peers) • Questions and answers (confidential) • Search (information) • Feedback • Links to other useful Internet sites

20. Search/ information or data bank • Pregnancy • Delivery • Post- natal period • Infant • Parent's relationship • Parenthood • Personal hygiene, appearance • Nutrition and exercise • Drugs, alcohol and smoking • Services to the public • MIC has 135 articles, two videos, 2 animations, 2 interactive photos, 86 photos and 53 drawings checked and approved by editorial board.

21. MIC / contents Example: Drawings

22. Qualified information / content management • Information is reliable, and easy to understand • The quantity of information is adequate • The required information is easy to find • The content creation and management are carried on as part of current (clinical) work processes • The technical solutions guarantee e.g. data integrity, authentication, security and data availability

23. Evaluation - family • Modern way of having services • No queuing in phone • Discussions groups for families (anonymously), where • professionals appear by their names • Service in your own language • Information/contents is versatile, extensive, based on • expertise / reliable

24. Evaluation – maternity care professionals • Extra visits were not needed during pilot phase • The Net Clinic could be used as a manual or in familiarising the new worker • Counselling and giving advice was harmonised • Families got deeper information and advice based on their needs more effectively • Networking and co-operation was more efficient • Written answers took some time to get used to

25. The Project of the Year 2000 Net Clinic is a good example of how project work can be expanded into new application fields like public administration and so called soft values Net Clinic is based on wide and versatile co-operation and on application of new Internet technology Net Clinic proves that it is possible to develop new innovations also outside big so called growing centres Net Clinic proves that women can work successfully in management or other key positions which have conventionally been classified as men´s work (The evaluation criteria of the The Finnish Project Management Association)

26. Diploma of the Excellent Work Given by the Provincial State Office of Eastern Finland 4.9.2001 Net Clinic is a good example of how project work can be expanded into new application fields like public administration in national level and in future international level

27. O O O o • O MIC has been used/is in use • Kuopio • Helsinki • North-East of Finland (Kuusamo, • Taivalkoski, Posio and Salla) • Rovaniemi and its neighbourhood • Rovaniemi rural commune and • Ranua) x O

28. An eMaternal Health Care Data SystemSTORK

29. The Stork is • secured electronic health data system (EHS) made for professional use • all the information about pregnancy, delivery and puerperium is collected in the same system (so called seamless chain between primary health care and special care) • mutual data contents to maternal units involved

30. Data security • The application • built on special security system used by the hospital • Access rights depends on task or position • those who are involved maternal service chain • Preconditions for usage • mother´s permission to collect and transfer her data (each organisation needs its own permission) • agreement between different organisations • every user has personal user identifier, all usage is logged and saved, even edited/deleted parts will be recorded permanently

31. Storks gives information • Pregnancy follow up, continuous documentation; appointments with public health nurses, midwifes, doctors • Graphics; growth of the uterus, hypertension, weight, partogram • Internal- and external examinations • Medication during pregnancy, delivery, puerperium • Diagnosis of the foetus; e.g ultrasound, lab tests • Lifestyle of the family (nutrition, exercise, smoking, drugs etc) • Sick leaves of the mother • Special area for the nurse documentation

32. Stork gives • The new-born baby his/her social security number • Basic information from earlier pregnancies • Statistics e.g. • for the Stakes (the National Research and Development Centre for Welfare and Health • the nursing research • Forms and applications

33. The first page of the Stork Forms Name, birth date, age, weeks, Notify: the lamp sign, B-gluc high (red color) Lab, X-ray

34. Mother->, Child -> Social worker documentation Both the public health nurse in primary care and the midwife in special care fulfil this area. The written data is available in real time (mother´s permission needed)

35. From Netinformation – Portal to Dynamic Integrated Desktop (DID) My personal computer

36. Aims of the Work • To elaborate the co-operation of different organisations • To develop a consistent way to manage information in Social Work and Health Care organisations • To develop the ”Dynamic Integrated Desktop” (DID) for Social Work and Health Care professionals • To offer further education of Social Work and Health Care professionals • To determine the reliable security standards

37. Dynamic Integrated Desktop (DID ) • a consistent way to manage information in Health Care organisations • Partnership information • Contacts • Office times • Information of services Single sign-on • Professional information • On line (on special fields) • Education • course enrolment, forms • Professional web services • PubMed, Cinahl • Laws and orders • Web services for public • Contact information • Problem solving information • Education • Integration of IT software • ”You get what you need” • EHR, RIS/PACS (digital imaging), biosignals etc. • High level of security

38. View of the DID page Teams Discussion Forums Patients 26.8.2002 Time Name Social security number 8.00 Patrick Patient 12345679573 8.20 Donald Duck 89101128758 8.40 Clark Kent 98459734658 Mail (3 new messages) Document management Links Courses Maintenance August 2002 Magazines & Periodicals News Databases Patients Help Personified, user oriented Information system, task and position in the organization Networked, user organization oriented

39. Tutuks service • Tutuks, a virtual visit to a maternity ward • Utilised work done by MIC • http://www.synnytystutuksi.fi/tutukspalvelu.html

40. Challenges for the Future • Family/citizen participation challenges professionals • e-working environment (models, processes) • eEducation and training • “E-gap” between generations • Usability of ICT-solutions • Integration of ICT-solutions

41. New project • Looking for partner organisations, next Tempus Call or other suitable call

42. New project - Tree of problems NO KNOWLEDGE TRANSFER NO NETWORKING Lack of resources in distance teaching in cultural maternity care Non-transferability of tacit knowledge Lack of cooperation between Euro-Asian HIEs Unfamiliarity with new teaching ways Incapability to respond future needs Former education Lack of ICT skills Retiring (growing) Mobility (teachers and students) Need to study regardless time and space Figure: Project - problem tree

43. Tree of objectives FLEXIBLE NETWORKING CULTURAL MATERNITY CARE AND DISTANCE TEACHING EFFECT ENHANCING READINESS FOR DISTANCE TEACHING IN CULTURAL MATERNITY AND INFANT CARE MAIN AIM OUTCOME Dissemination of Project results Definition of resources needed Designing and evaluating Networking and Distance teaching model Reports, workshops (Implementation) Accepted planns Evaluation of model Implementation Testing of ICT skills Selection of Learning Environment(s) Evaluation of readiness

44. Thank you for your attention Contact info: pirkko.kouri@savonia-amk.fi