the successful use of tools for finnish professionals€¦ · nurses: 200 000 5 university...

The successful use of tools for Finnish professionals

Minna Kaila, MD, PhD, Pediatric AllergistAdjunct Professor /University of TampereSenior Medical Officer /Finohta at STAKESminna.kaila(at)stakes.fi or (at)iki.fimobile +358 50 523 2021

KUOPIO

HELSINKI

TURKU

TAMPERE

OULU

Doctors: 17 000Nurses: 200 000

5 University Hospitals and 21 Hospital Districts~250 Primary Health Care Centers

The ~400 municipalities are responsible for providing *Primary Health Care and * Specialized / Secondary Care

Finnish Health Care System- publicly funded- NHS/Beveridge (van der Zee & Kroneman BMC Health Services Research 2007; 7:94)

TAMPERE

Population 5.3 million*homogenous

Finnish clinical practice guidelines• since late 1980's• EBM guidelines 1989 -->• Current Care guidelines 1994 -->• other guideline related material

• XML -format• indexing

• involved in the development– ~700 clinicians CC + ~300 EBMG

• implementation - hospitals & PHC – the head of the board of CC is one hospital Medical Director

Portal for health care professionals

Kustannus Oy DUODECIM

DUODECIMPortal for health care professionals

Guidelines and evidence

Drug information

Search engines

Patient information

ICD-10

Specialist societiesCME

Dictionaries

InformationInfo 30

Calculators and formsLaskurit ja lomakkeet 26

SoundsÄänet 77

Physician’s ethicsLääkärin etiikka 99

Defense forcesPuolustusvoimat 52

Social Insurance Institution’s guidelines (reimbursement)Kela 131

FinOHTA 132

Vaccinators’ hand bookRokottajan käsikirja 84

Travelers’ health guideMatkailijan terveysopas 89

Evidence summaries 3087

Evidence summariesNäytönastekatsaukset 3596

Laboratory investigationsLaboratoriotutkimukset 6631

Occupational physician (journal)Työterveyslääkäri 432

Finnish Medical JournalLääkärilehi 16141

Finnish Medical Journal DuodecimAikakauskirja Duodecim 9328

PicturesKuvat 2062

Hospital Districts’ localized guidelines /care pathwaysSairaanhoitopiirien hoito-ohjelmat 631

Patient informationPotilasohjeet 555

National criteria for non-emergency careHoidon perusteet 247

Current Care / thorough & all of health careKäypä hoito 278

EBM Guidelines /concise & primary health careLääkärin käsikirja (YKT) 1218

Calculators• Alkoholin käyttö Alcohol use• Antikoagulanttiannostelu Anticoagulant dosing• Ejektiofraktio Ejection fraction• Energiankulutus Energy expentiture• GFR-laskuri Glomerular filtration rate• Haittaluokka ja –prosentti Disability classification • Kehon painoindeksi Body Mass Index• Korjattu QT-aika QT time• Kuivuman korjaus Rehydration• LDL-laskuri LDL-cholesterol calculator• PEF-laskuri PEF-calculator• Reynolds Risk Score (naisille)• SCORE-laskuri SCORE calculator• Tavoitesyke Target rhythm• UKPDS• Veden vajaus hypernatremiassa Water deficit in hypernatremia

InformationInfo 30


SoundsÄänet 77



Social Insurance Institution’s guidelinesKela 131

FinOHTA 132









PicturesKuvat 2062






All guidelines are available in one search engine to 98 % of Finnish physiciansas a part of Physician’s Database

Use of EBMG, Current Care and relateddatabases in the Terveysportti Health Portal

0

2000000

4000000

6000000

8000000

10000000

12000000

2000 2001 2002 2003 2004 2005 2006 2007

Numberof guidelinedocumentsopened10 million/year

Total numberof documentsopened >20 million/year

Current Care - 77 guidelineswww.kaypahoito.fi*in Finnish*also free direct access

Current Care 2006 & citizens' Health Library

• CC hits --> 2 937 866 --> 'the public' 250 009 (ip addresses not in the client register)

Current Care 2006 & citizens' Health Library

• CC hits --> 2 937 866 --> 'the public' 250 009 (ip addresses not in the client register)

• In addition, the public accesses the patientversions of CC guidelines via the 'HealthLibrary' - after official publication 2007: 212 122 guideline hits.

Implementation /hospital districts & PHC

Treatment plan/appointmentWhen

Localised guideline /care pathwayBy whom

Localised guideline /care pathwayWhere

(National) guidelineHow

(National) guidelineWhat

Systematic review or studyWhy

Localised guideline /care pathway

Treatment plan/appointment

I Kunnamo

3rd National seminar oncare pathways May 2007

InformationInfo 30


SoundsÄänet 77



Social Insurance Institution’s guidelinesKela 131

FinOHTA 132









PicturesKuvat 2062






terveyspiirinot frontpagePHSOTEY

sosiaalipalvelut yhdistettynot frontpagePKSSK

terveyspiirinot frontpageKainuu

terveyspiiri (Itä-Savon SHP)not frontpageSOSTERI

search: care pathways lnks to CC & EBMGfrontpageKHSHP

search +not frontpageSATshp

alaotsikon alta: terveyskeskuksille (muuta pääasiassa) (lasten ra – ja astma –) not frontpageEPSHP

search + /need a password?frontpageKPSHP

search +frontpageEKSHP

search +not frontpageESSHP

need a passwordfrontpageLSHP

search +not frontpageKSSHP

search + /need a passwordnot frontpageVSHP

search ?? minutes from a known projectnot frontpageVSSHP

search: 2 ?? not frontpagePSSHP

link to TERVEYSPORTTIfrontpagePPSHP

search: 1 publicationnot frontpagePSHP

search: +not frontpageHUS

MISSING: LPSHP, KymSHP, Ahvenanmaa

National Criteria for Non-emergency Care (’care guarantee’)

Current Care GuidelineEvidence

Criteria for treatment

Care Pathway

Evaluation, follow-up, indicators?

PediatricsInternal Medicine

Psychiatry

SurgeryORL....

in all ~200

1.3.2005www.stm.fi

implementation?

*care pathways /house rules*multiprofessional*not only pharmacotherapy*Current Care Guidelines etc. when applicable

more: Risto Mäkinen

www.rohto.fiCentre for Pharmacotherapy Development

1. Homogeneity of health care (culture and value basis)2. Municipal ownership of all (public) health care

facilities3. Lack of any significant competition in health care4. Practically identical university curricula in the 5

medical faculties;

5. High national penetration of the internet technology and high computer proficiency; and

6. One respected medical scientific society responsible of the service, “physicians producing guidelines for physicians”

Promotion of acceptance and wide use of guidelines in Finland

DS CoreWebServer

DS ServiceEPR

Database

Work station

Feedback

Data

DS Component

DS Global Scripts

DS Interactions

DS Local Scripts

DS Indications

DS Guideline Links

Data Data

Feedback Feedback

DS Contraindications

DS Routines

Integrating patient data with evidence:Clinical Decision Support

www.kaypahoito.fi/decisionsupport/decisionsupport.htm

Evidence Based Medicine electronic Decision SupportEBMeDS 2006 – 2009Kunnamo, Komulainen, Kaila, Mäntyranta & al

5th annualG-I-N Network meeting1.-3. October 2008, Helsinki, Finland

Thank you for your attention!

“Implementation in practice”

Metathesaurus• Translation of MeSH into Finnish (FinMeSH)

was first completed in 1989• FinMeSH II with synonyms in 1997

– 22 000 terms– 33 000 synonyms

• National metathesaurus (Metathesaurus Rex)in 2003– Number of terms soon exceeds 100 000– Based on UMLS (which contains nearly 3 million

character strings)– Identifiers (CUIs) link Finnish terms to a number of

vocabularies and classifications– Searching in Finnish e.g. from PubMed

Evidence-based Health Care

1980's 2010

EBM Guidelines1989-

Current Care1994-

FinOHTA1995-

National Health ProjectElectronic Patient RecordCore information2002-

EBMeDSClinical DecisionSupport----? 2010

Basis: *Personal Identification Code 1970's --> *National statistics & registries by Social InsuranceInstitution, National Research and DevelopmentCentre for Welfare and Health, National PublicHealth Institute, etc.

Centre for PharmacotherapyDevelopment-ROHTO 2002-

Managed Uptake ofMedical MethodsMUMM 2005-

National Criteriafor Non-emergencycare 2005-

ICD-10 search engine

• Search term: uti

Searching for the code ofurinary tract infection

38 000 synonyms andsearch terms havebeen added from themetathesaurus I Kunnamo

All ICD-10codes

Selection ofessentialICD-10 codes

Exact hit

I Kunnamo

Care pathway

• There are guidelines (to be implemented)• There is a need (measured?) to develop

(clinical) practices (are there guidelines?)

Provider CustomerProcessProblem /Input

Service / Product

Top-down Bottom-up

the successful use of tools for finnish professionals€¦ · nurses: 200 000 5 university...

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