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Unit for the Operational Management of Health and Welfare Information

Annual Report 2011

Annual Report 2011

Unit for the Operational Management of Health and Welfare Information - Annual Report 2011

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Abbreviations

BBA Bachelor of Business Administration

BSc Bachelor of Science

CEN European Committee for Standardization

eAccess Portal for citizens to access their own medical records online

eArchive Electronic patient information archive

eDemocracy Use of information technologies and communication technologies and strategies in political

and governance processes

eHealth Health care supported by electronic processes and communication

ePrescription Electronic prescription

epSOS European Patients – Smart Open Services; open eHealth initiative for a European large-scale

pilot of patient summaries and electronic prescriptions

eService Provision of services via the Internet

EU European Union

EUR Euro (European monetary unit)

HL7 Health Level Seven; a non-profit organisation involved in the development of international

health care informatics interoperability standards

ICT Information and communications technology

IHE Integrating the Healthcare Enterprise; initiative to improve the way computer systems in

health care share information

ISO International Organization for Standardization

IT Information technology

LFA Logical Framework Approach

LFM Logical Framework Matrix

LLM Master of Laws

MA Master of Arts

MD Doctor of Medicine

MSc Master of Science

SNOMED CT Systematized Nomenclature of Medicine – Clinical Terms

VAT Value added tax


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1. INTRODUCTION

The development and implementation of electronic information management in the social services and health

care is based on the Finnish Act on the Electronic Processing of Customer Information in Social Welfare and

Health Care Services (159/2007, ‘Customer Information Act’) and the Finnish Act on Electronic Prescriptions

(61/2007, ‘ePrescriptions Act’). The operational management of electronic data processing in social services and

health care was transferred from the Finnish Ministry of Social Affairs and Health to the National Institute for

Health and Welfare on 1 January 2011. To coordinate electronic data processing, a new Unit for the Operational

Management of Health and Welfare Information was set up in the institute’s Information Department. The unit

has been fully operational since 1 April 2011. As of the beginning of 2012, the unit has also been responsible for

supporting local authorities in their efforts to promote information technology development in social services

and for overseeing the Municipal Project Coordination Office, which is responsible for coordinating the adoption

of the services.

2. ELECTRONIC INFORMATION MANAGEMENT IN SOCIAL SERVICES AND HEALTH CARE

Finland is in the process of adopting an extensive social welfare and health care customer information system

known as the National Archive of Health Information, which caters for the information management needs of

health care providers, pharmacies and citizens across the country.

The National Archive of Health Information comprises an electronic prescriptions service (ePrescriptions), an

electronic patient information archive (eArchive), a portal through which citizens can access their own medical

records online (eAccess) and an information management service for health care professionals (part of eArchive;

allows citizens to control access to their personal information and communicate wishes about their medical

treatment and gives health care professionals access to key information about patients’ health and treatments).

The implementation of the services is based on the Customer Information Act and the ePrescriptions Act.

The National Archive of Health Information is being adopted in stages. The Customer Information Act and the

ePrescriptions Act were revised and transitional provisions added as of the beginning of 2011, which now

stipulate that all health care organisations and pharmacies must begin using the services by the end of 2015.

All pharmacies must be able to offer ePrescriptions to their customers as of 1 April 2012 (transitional period ends

on 31 March 2012). All public health care providers must be able to write ePrescriptions as of 1 April 2013

(transitional period ends on 31 March 2013) and private health care providers (including independent service

providers operating in their premises) as of 1 April 2014 (transitional period ends on 31 March 2014).

All public health care providers must begin using the eArchive service by 31 August 2014 at the latest and private

health care providers a year later (by 31 August 2015). The deadline for private health care providers applies to

all service providers that archive their patient records electronically.

The Decree of the Finnish Ministry of Social Affairs and Health on the charges payable for electronic prescriptions

(1108/2011) contains provisions on writing and issuing ePrescriptions, the associated account certification

process and charges payable for other centralised services in 2012 and 2013.

The long-term objective with regard to national social welfare and health care information management is to

enable more efficient management of customer information (including medical records) and prescriptions, real-

time access to information, shared access and electronic archiving according to open standards. Customers’

opportunities to access and control their own medical records will also improve. These advances will lay a


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foundation for a reform of health care processes, enable the adoption of cheaper and more effective operating

models and improve patient safety.

With regard to social services, legislation governing the management of customer information is likely to evolve

similarly to health care. National information management solutions and an archiving service for social services

will be developed between 2012 and 2015. The objective is to introduce national welfare information

management services in stages.

3. TASKS OF THE UNIT FOR THE OPERATIONAL MANAGEMENT OF HEALTH AND

WELFARE INFORMATION

3.1 Legal basis

The Finnish Act on the National Institute for Health and Welfare was revised (1231/2010) and a new area of

responsibility added as of the beginning of 2011: The National Institute for Health and Welfare is responsible for

planning, coordinating and monitoring the use and implementation of electronic processing of customer

information in social services and health care, the associated information management processes and national

information system services. (Section 2 (1) (4 b))

The new area of responsibility is described in more detail in the Customer Information Act (Sections 6, 14 and 20)

as follows: The National Institute for Health and Welfare may issue more detailed regulations on the data

structures of patient information systems and patient records as well as on the classification of other sensitive

data. The National Institute for Health and Welfare is responsible for configuring the contents, concept models

and data structures to support the operating processes required for the implementation of national information

system services. The National Institute for Health and Welfare is also responsible for the content stored on the

institute’s code server. The National Institute for Health and Welfare is responsible for planning, coordinating

and monitoring the use and implementation of electronic processing of customer information in social services

and health care, the associated information management processes, the national information system services

referred to in Section 14 and the shared data of different administrative sectors.

According to the ePrescriptions Act (Section 24), which was revised as of the beginning of 2011, the National

Institute for Health and Welfare is responsible for planning and coordinating the use and implementation of

electronic prescriptions and the national information system services referred to in the act.

The new responsibilities that were added to the acts in connection with the revisions that took effect as of the

beginning of 2011 were assigned to the Information Department of the National Institute for Health and Welfare,

and the Unit for the Operational Management of Health and Welfare Information was set up to oversee the

aforementioned statutory responsibilities (as of 1 January 2011). The Unit for the Operational Management of

Health and Welfare Information is not responsible for maintaining the data stored on the institute’s code server

or for planning the use and implementation of the shared data of different administrative sectors, as these

responsibilities have been assigned to other units of the Information Department.

According to the Customer Information Act, the Social Insurance Institution of Finland is responsible for

providing an archiving service to enable the storing and use of patient records on behalf of health care service

providers, including a directory service to enable access to patient records and an information management

service that enables patients to control how their personal data are being used. The Social Insurance Institution

of Finland is responsible for keeping logs about the use of data as part of the archiving service. The Social

Insurance Institution of Finland is also responsible for coordinating the service that allows patients to access their

own medical records online, as described in the act. Moreover, the Social Insurance Institution of Finland is the

data controller for the national Prescription Centre associated with the ePrescriptions service and responsible for


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supervising the use of the service. The Social Insurance Institution of Finland may issue more detailed regulations

on the technological specifications and electronic communication properties required for the implementation of

the national information system services referred to in the act.

3.2 Mission

We ensure that information about customers’ health and welfare is available when it is needed.

4. CUSTOMERS AND PARTNERS OF THE UNIT FOR THE OPERATIONAL MANAGEMENT

OF HEALTH AND WELFARE INFORMATION

The Unit for the Operational Management of Health and Welfare Information uses a target group classification

developed specifically for influencing and communications: clients, partners, end customers, producers and

suppliers and the media.

Clients set boundaries and targets and provide a framework for the services. Partners help the unit to produce

outputs (systems, programs and products), to implement solutions successfully, to make efficient use of them

and to bring about operational and qualitative benefits. End customers (users (such as citizens, residents and

policy-holders), professionals, decision-makers) are to whom information and services are targeted; end

customers also use the products and services as tools and as means of information management. Producers

(such as the Social Insurance Institution of Finland in the case of national services and the National Institute for

Health and Welfare in the case of system specifications) and suppliers (such as consultants) are who provide

products and services for the Unit for the Operational Management of Health and Welfare Information. The

media help to increase public awareness and visibility among citizens and organisations.

Relationships with customers and partners are described in more detail in the unit’s communications and

influencing strategy.

5. OBJECTIVES OF THE UNIT FOR THE OPERATIONAL MANAGEMENT OF HEALTH AND

WELFARE INFORMATION UNTIL THE END OF 2015

Operational management must be based on a regularly updated and widely accepted national strategy. Finland’s

latest National Information Management Strategy for Social Services and Health Care was published in 1996, and

it is still being followed. Finland’s eHealth Roadmap was published in 2007. The most important legal basis for

operational management is the Customer Information Act and its revisions that took effect as of 1 January 2011.

The need to revise legislation arose as a result of the revised Finnish Health Care Act (1326/2010) entering into

force on 1 May 2011, which called for harmonisation between the aforementioned acts. The Finnish Act on the

Coordination of Information Management in Public Administration (634/2011, ‘Information Management Act’)

also contains provisions that will have implications on the Unit for the Operational Management of Health and

Welfare Information as soon as 2012. This report only discusses objectives from an operational point of view.

According to the target set in connection with launching the Unit for the Operational Management for Health

and Welfare Information, the services associated with the National Archive of Health Information will give

medical professionals point-of-care access to high-quality information about any previous treatments by the end

of 2015. With regard to social services, electronic information management and customer information

processing have been developed within the boundaries set by legislation.


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Thirteen targets have been set for operational management (Table 1). The first eight targets are for the five-year

term of 2011–2015. Until the end of 2015, the main emphasis in operational management will be on promoting

the implementation of the Customer Information Act and the ePrescriptions Act, in other words on ensuring that

the services associated with the National Archive of Health Information are implemented within the deadlines

specified in the acts (targets 1–8). Some aspects of targets 9–13 will not be completed until after the initial term.

Each of the targets is viewed as a separate entity in planning. A primary objective is set for each entity and

interim targets, the measures required to achieve them and a detailed action plan of tasks agreed. All in all, the

process is a major undertaking. This is why each of the actions is viewed as a separate project and progress

monitored on the basis of indicators specified in project plans.

Table 1. Operational management targets for 2011–2015 1. Electronic prescriptions are in use throughout the country and all parties that are required to do so

by law have joined the Prescription Centre. 2. Service providers have joined the national eArchive service and begun using the archiving service. 3. The structure and contents of patient records held in the National Archive of Health Information

have been harmonised across the country and the records are archived electronically.

4. Customers are able to monitor how their personal data are being used, allow or deny access, enter treatment preferences to the information management service and browse their own medical records. Health care professionals are able to use the information management service to access key information about patients’ health and treatments.

5. Health care professionals (including pharmacies) have the skills required to use national information system services.

6. Citizens have access to real-time information about the National Archive of Health Information (electronic prescriptions, electronic patient information archive, access to own medical records, information management service).

7. The level of information security and data protection in the information systems is high and regularly monitored.

8. All relevant laws and national cross-sectoral principles are being observed in the information management associated with social welfare and health care.

9. Data structures enable the adoption of innovations that promote the prevention of illnesses and improve the quality of treatment and patient safety (e.g. by supporting decision-making).

10. Information system solutions generate business intelligence and enable statistical information to be collected efficiently and cost-effectively.

11. Finland has the preparedness to engage in international exchange of patient records across the EU. 12. Customers are offered electronic social welfare and health care services that include both the

customer’s self-motivated health promotion and treatment and the exchange of information between service providers.

13. Customer information relating to social services is standardised and professionals have point-of-care access to information about any previous services. A national archiving service has been piloted and action taken to prepare for its implementation (assuming that legislation evolves as proposed).

5.1 Electronic prescriptions (ePrescriptions)

The electronic prescriptions (ePrescriptions) service is ready to be adopted at the beginning of 2012. Adoption

requires extensive development work to make several different information systems compatible with the

ePrescriptions service. The adoption of the service has been piloted first in Turku and Kotka and then in the

health care districts of Southwest Lapland and Eastern Savonia, and the number of users has since been

increased systematically by extending the use of the service to new areas. Public service providers are set to

adopt the service according to the timescale produced by the Municipal Project Coordination Office, which was

revised in the autumn of 2011 in connection with events held in each of the health care districts.

Target 2015

Electronic prescriptions are in use throughout the country and all parties that are required to do so by law have

joined the Prescription Centre.


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Progress made in 2011

All public service providers that were required by law to do so joined the national Prescription Centre according

to the timescale produced by the Municipal Project Coordination Office in 2011. The timescale was revised in the

autumn of 2011 in connection with events held in each of the health care districts. Preparations for pharmacies

and public and private service providers to join continued according to previous plans which have now been

coordinated with each other. The plans were revised to also include state health care service providers as well as

social services units that employ physicians and issue ePrescriptions.

According to the ePrescriptions Act, all pharmacies must be able to offer ePrescriptions to their customers as of

1 April 2012 (transitional period ends on 31 March 2012). The Association of Finnish Pharmacies is responsible

for coordinating all aspects of the process that relate to pharmacies (including the joining of pharmacies to the

ePrescription Centre) according to an agreement with the Finnish Ministry of Social Affairs and Health. The Unit

for the Operational Management of Health and Welfare Information is responsible for cooperating closely with

the Association of Finnish Pharmacies and the Municipal Project Coordination Office to ensure that pharmacies

and health care providers adopt the ePrescriptions service in a synchronised manner and in a logical order.

The Unit for the Operational Management of Health and Welfare Information has engaged in negotiations with

national organisations to establish the current status of specifications, preparedness for and adoption of the

ePrescriptions service as well as the associated account certification and the distribution of ID cards. This process

has revealed several areas where the ePrescriptions service still needs to be revised and improved. With regard

to the timescale, the most urgent revisions include changes to the limited rights of certain professionals to

prescribe drugs and the adoption of new functions.

The staggered adoption plan associated with the ePrescriptions service has been updated to take these

amendments into consideration and to reflect the most recent changes in legislation. Some updates are still to

be finalised. The Unit for the Operational Management of Health and Welfare Information cooperated closely

with the Municipal Project Coordination Office to help service providers to adopt the ePrescriptions service.

Preparations were also made to launch a technical support service for users and to agree on the principles of

change management.

A decision was made in the autumn of 2010 to set up a national steering group for monitoring and overseeing

pilot projects (Turku and Kotka) and the adoption of the ePrescriptions service in the future. A partnership

agreement was signed between the Finnish Ministry of Social Affairs and Health, the National Institute for Health

and Welfare, the Social Insurance Institution of Finland and the Association of Finnish Local and Regional

Authorities and responsibility for organising the steering group given to the Municipal Project Coordination

Office. The steering group includes representatives from the Finnish Ministry of Social Affairs and Health, the

Social Insurance Institution of Finland, the Association of Finnish Pharmacies, the Finnish Medicines Agency,

Helsinki University Pharmacy, the project managers of the Turku and Kotka pilot projects, pharmacies operating

in the pilot areas and the organisations commissioned to supply the patient information and pharmacy systems

used in the pilot projects. When the pilot projects ended in May 2011, the steering group continued to

coordinate the adoption of the ePrescriptions service under the chairmanship of the Finnish Ministry of Social

Affairs and Health and the Municipal Project Coordination Office until 30 September 2011. More and more of the

responsibility for the steering group has been transferred to the National Institute for Health and Welfare since

1 October 2011, when the ePrescriptions project manager at the Unit for the Operational Management of Health

and Welfare Information was appointed as the chairman of the steering group.

The steering group convened 11 times in 2011. The following table summarises the meetings of the steering

group in 2011, the number of participants and the main issues discussed:


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Date Participants Main issues discussed

12/01/2011 17 Questions to the Finnish Medicines Agency, elimination of system errors, Turku pilot project,

progress report on testing, progress reports from Kotka and Turku, suggestions regarding design

specifications, communications, account certification + ID cards + user administration

16/02/2011 16 Improvements relating to the dispensation of prescription drugs in daily dose containers,

monitoring of log data, errors reported by pharmacies, function for editing prescriptions, pilot

projects in Kotka and Turku, system audits, further planning

16/03/2011 19 System testing and auditing, pilot projects in Kotka and Turku, unresolved issues

13/04/2011 17 Pilot projects in Kotka and Turku, testing and auditing, early adoption in the health care districts of

Eastern Savonia and Southwest Lapland, further planning

19/05/2011 10 Adoption by pharmacies, pharmacy staff training, user manuals, final reports on the pilot projects

in Kotka and Turku, progress reports from the health care districts of Eastern Savonia and

Southwest Lapland

14/06/2011 14 New version of the ePrescriptions service and timescale, discussion on suggested improvements

and future product development, ePrescriptions user satisfaction survey, progress reports from

the health care districts of Eastern Savonia and Southwest Lapland, adoption by pharmacies,

adoption by health care providers in 2011

22/08/2011 19 Progress report on the adoption of the ePrescriptions service, adoption in Päijänne Tavastia,

reports from the Social Insurance Institution of Finland and the Unit for the Operational

Management of Health and Welfare Information, unresolved issues

13/09/2011 13 Unresolved issues, progress report on the adoption of the ePrescriptions service, timescale for

updating the design specifications of the ePrescriptions service (v. 2.4), discussion on suggested

improvements and the product development process, agreeing on the process and coordination

of technical support for users and change management

25/10/2011 18 Progress report from Päijänne Tavastia, progress report on the adoption of the ePrescriptions

service, revision of timescales, preparedness for issuing ID cards (Population Register Centre),

status of version 2.4 of the electronic prescriptions system, discussion on suggested

improvements and the product development process, final report from the health care district of

Southwest Lapland

22/11/2011 14 Progress report, discussion on suggested improvements and areas in need of improvement

20/12/2011 19 Closing meeting of the Municipal Project Coordination Office, review of the steering group’s

activities in 2010 and 2011, progress report on the adoption of the ePrescriptions service,

elimination of system errors, provision of technical support for users, account certification, new

administrative regulation on supplying prescription drugs, progress reports on patient information

systems and the systems used by pharmacies

5.2 Electronic patient information archive (eArchive)

A pilot project involving the first version of the eArchive service was launched as planned in Kuopio (5 units) on

15 November 2011. Due to changes in legislation, some of the specifications had to be urgently revised in the

spring and autumn of 2011. Several system providers are still in the process of making their patient information

systems compatible with the eArchive service.

Target 2015

Service providers have joined the national eArchive service and begun using the archiving service.


The first pilot project involving the eArchive service was launched as planned in Kuopio on 15 November 2011.

Plans for the staggered adoption of the eArchive service have been revised to reflect the provisions of a new

decree that is currently being drafted by the Finnish Ministry of Social Affairs and Health (Decree of the Finnish

Ministry of Social Affairs and Health on national information system services, ‘Staggered Adoption Decree’) and

the current status of national services available from the Social Insurance Institution of Finland. The objective is

to publish a new staggered adoption plan as soon as the Staggered Adoption Decree is ratified. The revision

process is on hold until the decree has been issued.


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The Unit for the Operational Management of Health and Welfare Information has engaged in cooperation with

various organisations to test and pilot the eArchive service. Specifications relating to the open standards

required for enabling shared access to the archiving service will be revised on the basis of lessons learned from

testing and pilot projects as well as the development of patient information systems.

Provisional project plans were produced in the autumn of 2011 for the areas of the eArchive service that are due

to be developed in 2012 according to the staggered adoption plan. This process also involved an assessment of

the contents of the service and the need to conduct more research as well as preparations for a roadmap for the

development of new properties and content.

5.3 Information management service and portal for citizens to access their own medical records online

The information management service is a component of the eArchive service and its purpose is to make it

possible for patients to allow or deny access to their personal data according to the Customer Information Act

and to give health care professionals point-of-care access to key information about patients’ health and

treatments. According to the revised Customer Information Act, the responsibility for providing the information

management service for patients belongs to the Social Insurance Institution of Finland. The information

management service comprises seven components or functions: 1) summary of the information provided to the

patient regarding national information system services, 2) list of the data uses that the patient has authorised, 3)

list of the data uses that the patient has denied, 4) the patient’s wishes regarding organ donation, 5) the

patient’s wishes regarding life-prolonging medical treatment, 6) the patient’s other wishes regarding his or her

health care or medical care, and 7) key information about the patient’s health and treatments. (Guideline of the

Finnish Ministry of Social Affairs and Health on processing patient information and implementing Section 9 of the

Finnish Health Care Act and changes to the Customer Information Act, 28 March 2011)

Components 1–6 are stored in the information management service (with the Social Insurance Institution of

Finland acting as the data controller). Component 7 is not stored in the information management service but

used to provide an interface to the eArchive service. This means that the information management service can

also be used to provide a summary of key information about the patient’s health and treatments either to the

patient himself or herself or, subject to the patient’s consent, to health care service providers. Provisions about

the content of the component providing key information about patients’ health and treatments will be included

in the Staggered Adoption Decree according to the Customer Information Act.

Patients’ access to records held in the information management service, the eArchive service and the

Prescription Centre as well as the key information contained in the information management service regarding

their health and treatments will be provided through a service called eAccess. The components of the

information management service will be linked to the eAccess service by 1 September 2014.

Target 2015

Customers are able to monitor how their personal data are being used, allow or deny access, enter treatment

preferences to the information management service and browse their own medical records. Health care

professionals are able to use the information management service to access key information about patients’

health and treatments.


Patients have been able to look up their prescriptions online since 20 May 2010 (Turku) and their medical

records since 15 November 2011 (Kuopio).

Developing functions for the information management service became a matter of urgency at the beginning of

2011. Specifications for the properties that are, according to the Staggered Adoption Decree, to be introduced by


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1 September 2014 at the latest (with the exception of health care and treatment plans) were completed in 2011.

The Unit for the Operational Management of Health and Welfare Information has agreed with the Social

Insurance Institution of Finland to begin work on the specifications required for the second stage of the

Staggered Adoption Decree in 2012.

Work on the specifications of shared regional patient information registers discussed in the Finnish Health Care

Act began in the spring of 2011. Preparations for introducing the national service began in the autumn of 2011. A

project was launched with regional authorities to plan the testing and piloting of the shared systems.

5.4 Standardisation of the data structures of patient information systems

The degree of standardisation in patient records varies from one software application to another and from one

version to the next. There is little uniformity at the moment. In order to harmonise data structures, the contents

and architecture of the most important medical records need to be agreed on a national level, timescales drawn

up for adopting the new standards and a procedure set up to ensure that all patient information systems comply

with the standards by the set deadlines.

In addition to data structures, the content of the records also needs to be consistent, and national guidelines are

required for this. Specifications for the standardised data included in electronic patient records were published in

2007. The situation with national specifications has changed since then, and even the published recording

practices need to be updated and revised.

Target 2015

The structure and contents of patient records held in the National Archive of Health Information have been

harmonised across the country and the records are archived electronically.


The actions launched in 2011 are aimed at enabling the development of nationally standardised patient records. The most important areas that need to be revised in order for the structural specifications of patient records to be compatible with the eArchive service have been identified.

In 2011, the Unit for the Operational Management of Health and Welfare Information worked side by side with a

co-financed project of the Finnish Ministry of Social Affairs and Health and the National Institute for Health and

Welfare called ‘Standardised Patient Records 2010’. This meant that the responsibility for coordinating the

construction of the most essential patient record structures was transferred to the Unit for the Operational

Management of Health and Welfare Information while funding allocated to the project was channelled into

specialist tasks relating to structural specifications. The final report of the project, which was submitted to the

Finnish Ministry of Social Affairs and Health, doubled as a general report of the progress made with regard to

specifications in 2010 and 2011.

The Unit for the Operational Management of Health and Welfare Information also cooperated with the Social

Insurance Institution of Finland in 2011, with the aim of configuring the data structures required for the first

stage of the information management service. Draft versions of the specifications of all components except for

health care and treatment plans have been published online at www.kanta.fi. Work on the specifications of

health care and treatment plans as well as further configuration required for the implementation of the

information management service has begun: Data structures will be published on the code server of the National

Institute for Health and Welfare and operational specifications for the information management service in the

institute’s publication series in 2012.

The Unit for the Operational Management of Health and Welfare Information began work on a new guide

explaining the rules and recommendations for entering standardised data into the National Archive of Health


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Information towards the end of 2011. The guide is likely to be published in 2012. The process also involves

updating the concepts and contents of the specifications so as to make them consistent with the changes made

to legislation and the structure and contents of the eArchive service. Data structure specifications are also

undergoing revisions to make them compatible with the needs of the eArchive service.

A total of 18 workshops were held in 2011 with representatives from the Finnish Ministry of Social Affairs and

Health, the Social Insurance Institution of Finland, the Association of Finnish Local and Regional Authorities and

the National Institute for Health and Welfare. The following table summarises the workshops held in 2011 with

regard to Sections 5.2–5.4, the number of participants and the main issues discussed:


18/01/2011 5 Organisation and planning

31/01/2011 10 Operating model, workshops to be held in the spring of 2012, authorised and denied data uses

14/03/2011 9 Authorised and denied data uses, Finnish Health Care Act, staggered adoption of the eArchive

service

22/03/2011 9 Diagnosis and treatments, wishes regarding organ donation, authorised data uses

04/04/2011 13 Diagnosis and treatments, patients’ access to their own medical records, staggered adoption

26/04/2011 11 Information management service (architecture), medication and diagnosis, authorised and denied

data uses

16/05/2011 13 Information management service (architecture), signing of documents, shared patient information

registers, authorised and denied data uses, list of medications

30/05/2011 13 Authorised and denied data uses, shared patient information registers

14/06/2011 9 Authorised and denied data uses, key information about patients’ health and treatments

(specifications and timescale), information management service (architecture), shared patient

information registers, outsourcing

18/08/2011 11 Key information about patients’ health and treatments (operations, imaging, laboratory tests, risk

factors, diagnosis), personal data, authorised and denied data uses, architecture of the

information management service, wishes regarding organ donation, outsourcing

01/09/2011 16 Authorised and denied data uses (forms), information management service (architecture), key

information about patients’ health and treatments, personal data, wishes regarding organ

donation, eArchive service, log entries in the information management service

19/09/2011 13 Progress reports

13/10/2011 14 Coordination committee on the development of patient information systems (11 October 2011)

and patient information system use cases, delayed access to patient records through the eAccess

portal, treatment plans, outsourcing, PDF archiving, referrals and epicrises, pilot project in Kuopio

27/10/2011 15 Patient information system use cases, status of documents on further configuration, pilot project

in Kuopio, information management service (timescale for technical implementation), authorised

data uses

08/11/2011 13 Progress reports, offline systems, health care and treatment plans, pilot project in Kuopio, e-mail

specifications, patient register coding

22/11/2011 10 Projections, HL7 specifications, patient register coding, view identifiers for key information about

patients' health and treatments, pilot project in Kuopio

13/12/2011 13 Documents, archiving of old patient records, core document, health care and treatment plans,

consent forms, pilot project in Kuopio, restrictions on the size of documents to be archived and/or

revisions to specifications

5.5 Information technology development in social services

A project was launched in 2004 involving information technology development in social services, which was

aimed at improving and harmonising customer information processing and use in social services. The project’s

objective was to establish principles and practices that could be used to standardise the processing of social

welfare customer information, national archiving and the exchange of data between different organisations. The

project continued under the supervision of the Finnish Ministry of Social Affairs and Health until 31 December

2011, even though the National Institute for Health and Welfare had already taken over the responsibility for

granting state aid and signing contracts. The responsibility for information technology development in social

services and all related actions was transferred to the Unit for the Operational Management of Health and

Welfare Information as of 1 January 2012.


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Target 2015

Customer information relating to social services is standardised and professionals have point-of-care access to

information about any previous services. A national archiving service has been piloted and action taken to

prepare for its implementation (assuming that legislation evolves as proposed).


With regard to information technology development in social services, the measures taken by the Unit for the

Operational Management of Health and Welfare Information in 2011 were aimed at laying the groundwork for

future actions and at coordinating the development project launched in 2004. The responsibility for future

information technology development in social services and all related actions was transferred to the Unit for the

Operational Management of Health and Welfare Information as of 1 January 2012. The Unit for the Operational

Management of Health and Welfare Information prepared for its new responsibilities by recruiting a

development manager as of 7 November 2011 and a project manager as of 1 December 2011. The unit also

cooperated with various different organisations and at many different levels in order to prepare for the handover

of responsibilities. The Unit for the Operational Management of Health and Welfare Information and the project

steering group worked together in 2011 in order to ensure a controlled and smooth transfer of all responsibilities

relating to information technology development in social services. The Unit for the Operational Management of

Health and Welfare Information also took charge of ensuring that the outputs of the project were available to all

interested parties online (www.sosiaaliportti.fi). The Unit for the Operational Management of Health and

Welfare Information also participated in the meetings of the project steering group.

The Unit for the Operational Management of Health and Welfare Information was responsible for granting state

aid on behalf of the National Institute for Health and Welfare and for signing contracts with the various

organisations involved in the social services information technology development project in 2011. State aid was

granted to the Association of Finnish Local and Regional Authorities and to the Centre of Excellence on Social

Welfare in Eastern Finland. Contracts were signed with two departments of the University of Eastern Finland.

The Unit for the Operational Management of Health and Welfare Information also granted funding to a few

consultants and support functions. With regard to internal funding granted to the National Institute for Health

and Welfare, the Unit for the Operational Management of Health and Welfare Information sponsored the efforts

of the Information Structures and Classifications Unit to promote information technology development in social

services. The actions associated with the social services information technology development project were based

on an action plan produced by the project steering group for 2011. The outputs of the project were compiled

into a final report, which was submitted to the Finnish Ministry of Social Affairs and Health.

5.6 Other objectives supporting the development of the National Archive of Health Information

5.6.1 INFORMATION SECURITY AND DATA P ROTECTION IN INFORMATION SYSTEMS

Information security comprises practical measures taken to ensure the availability, integrity and usability of data

while maintaining confidentiality and protecting information from unauthorised access. Data protection refers to

measures taken to ensure that personal data can be processed safely without compromising individuals’ right to

privacy and legal protection. In particular, data protection is linked to the principle of informational self-

determination, which refers to an individual’s right to decide what personal information of his or hers can be

used and to set restrictions on what personal information of his or hers can be collected and disclosed to others.

Information security and data protection are of fundamental importance when it comes to the National Archive

of Health Information. Patients and health care professionals must be able to have absolute faith in the system

so as to avoid situations where the fear of potential misuse of personal information prevents a patient from

seeking medical attention or a health care professional from recording vital information.


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Target 2015

The level of information security and data protection in the information systems is high and regularly monitored.


The Unit for the Operational Management of Health and Welfare Information is responsible for ensuring that the

parties responsible for information security and data protection meet their obligations. Within the Unit for the

Operational Management of Health and Welfare Information, this responsibility has been assigned to

development managers and a legal counsel (as of 1 August 2011). The most important partners with regard to

data protection include the Data Protection Steering Group for Health Care and the Data Protection Steering

Group for Social Services, which are governed by the Office of the Data Protection Ombudsman. The Unit for the

Operational Management of Health and Welfare Information has been a member of the Data Protection Steering

Group for Health Care since the autumn of 2011 and of the Data Protection Steering Group for Social Services

since the end of 2011. Data protection coordinators have been supported in their work by inviting them to

topical training events, for example.

Information security is being promoted by introducing strong authentication for health care professionals and

other individuals who regularly process patient records. The Unit for the Operational Management of Health and

Welfare Information supported the adoption of smart cards in cooperation with the National Supervisory

Authority for Welfare and Health and the Population Register Centre.

An eLearning environment focusing on information security and data protection was created in cooperation with

the Municipal Project Coordination Office.

Experiences from the adoption of national services have revealed practical issues relating to information security

and data protection, and the Unit for the Operational Management of Health and Welfare Information has

engaged in cooperation with the Finnish Ministry of Social Affairs and Health to resolve these.

5.6.2 ENSURING THE COMPETENCE OF PROFESSIONALS

The adoption of national information system services requires that all health care professionals know how to use

the services and that health care processes and operating models are harmonised. Training on operating models

will be provided to help with the transition. Information system training will be provided by the information

system suppliers. The Unit for the Operational Management of Health and Welfare Information works to

promote a harmonised operating model that is independent of the systems.

Target 2015

Health care professionals (including pharmacies) have the skills required to use national information system

services.


Health care professionals were instructed and trained in the adoption of the new systems according to plans

produced by the Municipal Project Coordination Office and the Association of Finnish Pharmacies. The Unit for

the Operational Management of Health and Welfare Information prepared to take over the aforementioned

responsibilities, to continue the development of training provision and to organise regional training courses

according to the staggered timescale as part of the plan for transferring the responsibilities of the Municipal

Project Coordination Office. A new senior adviser on the provision of training in information system services will

be recruited for the Unit for the Operational Management of Health and Welfare Information; the position was

first advertised at the end of 2011.


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Work on the 2012 training programme was launched in the autumn of 2011 in collaboration with the Municipal

Project Coordination Office. A decision will be made about the further development and positioning of an

eLearning environment created by the Municipal Project Coordination Office and other partners. The Social

Insurance Institution of Finland is responsible for the technical maintenance of the eLearning environment.

5.6.3 COMMUNICATION WITH CITIZENS

The responsibility for communicating with citizens has been assigned to the Social Insurance Institution of

Finland by law. Communication with citizens will be integrated into the general communications plan produced

by the Unit for the Operational Management of Health and Welfare Information on one hand and into the

adoption timescales on the other. Ultimately the responsibility for communicating with citizens rests with local

health care organisations, while the Social Insurance Institution of Finland and the Unit for the Operational

Management of Health and Welfare Information are responsible for providing support and instructions. Health

care organisations are supported in their communications by producing common communications materials

targeted at different user groups, by maintaining a centralised website (www.kanta.fi) and by clarifying the

division of communication responsibilities between different parties. The objective of training provided to local

project organisations that are due to adopt the ePrescriptions service is to create a harmonised operating model

for communicating with citizens.

The Social Insurance Institution of Finland has produced written guidelines for informing patients, which include

information about national information system services, the general operating principles of the systems and the

parties responsible for the services, the conditions for disclosing patient information, the rights of patients to

influence the processing of their data, the privacy of patient records and other data protection issues that are

relevant to patients.

Target 2015

Citizens have access to up-to-date information about the services associated with the National Archive of Health

Information.

Citizens are given information about the services associated with the National Archive of Health Information

online at www.kanta.fi as well as through brochures distributed via pharmacies and health care organisations.

Communications materials that are used in other electronic channels are also available. Special groups are also

taken into consideration in communications, and different language versions are made available (national

languages, most important languages of immigrant groups (Arabic, Spanish, French, Somali, Soranî, Russian,

Estonian and three Sami languages)).


Communications have been promoted extensively and actively for example in the autumn of 2011 in connection

with events held in each of the health care districts. As part of communications, the most important national

organisations involved in the project began concept development on the www.kanta.fi website in the summer of

2011. Within the Unit for the Operational Management of Health and Welfare Information, the development of

communications and influencing has been the responsibility of a development manager specialising in

communications as of 1 June 2011.

When the National Institute for Health and Welfare took over the responsibility for operational management,

the responsibility for the overall coordination of communications on the National Archive of Health Information

was also transferred to the institute. A network of communications experts from national organisations and

interest groups that was set up to coordinate communications relating to the National Archive of Health

Information has continued its work under the chairmanship of the National Institute for Health and Welfare. The

network has convened on a regular basis to ensure efficient overall coordination of communications.


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Efforts were made to streamline the planning and implementation of the communications of different

organisations (the Finnish Ministry of Social Affairs and Health, the Municipal Project Coordination Office and the

Social Insurance Institution of Finland) in 2011. The National Institute for Health and Welfare has coordinated

efforts to target influencing and communications more effectively at specific target groups; one recent initiative

associated with influencing and communications is to specify profiles/types for publications of the Unit for the

Operational Management of Health and Welfare Information (e.g. guidelines, recommendations, specifications).

Seven issues of an online newsletter about the National Archive of Health Information were published; the

communications network was responsible for the contents of the newsletter and the Social Insurance Institution

of Finland was responsible for its technical implementation.

The concept development of the www.kanta.fi website and the project extranet was completed for the most

part in December 2011. Six workshops were held to plan updates for the website; the team of developers

comprised consultants involved in the development of the National Archive of Health Information at the National

Institute for Health and Welfare, the Municipal Project Coordination Office and the Social Insurance Institution of

Finland as well as their online communications experts.

Date Topic

05/09/2011 User profiles and use situations of the www.kanta.fi website

09/09/2011 User profiles and use situations of the project extranet

14/09/2011 Service areas, contents, functions and content structure of the www.kanta.fi website

15/09/2011 Service areas, contents, functions and content structure of the project extranet

20/09/2011 Governance of the service areas and contents of the www.kanta.fi website

22/09/2011 Governance of the service areas and contents of the project extranet

More than 270 individuals took part in the 12 training events that were targeted at project organisations and

focused on the implementation and best practices of communication with citizens. The following is a summary of

the events:

Date Target group Location

15/06/2011 Health care district of Lapland Video conference 13/09/2011 Health care district of Helsinki and Uusimaa (Mäntsälä, Järvenpää, Hyvinkää) Järvenpää

21/09/2011 Health care district of Tavastia Proper Lahti 11/10/2011 Health care districts of Southern Karelia and Kymi River Valley Lappeenranta

12/10/2011 Health care district of Northern Karelia Joensuu 19/10/2011 Health care district of Helsinki and Uusimaa (Tuusula, Kerava, Vantaa) Vantaa

24/10/2011 Health care district of Southern Savonia Mikkeli

15/11/2011 Health care district of Helsinki and Uusimaa, eastern Uusimaa Porvoo

08/12/2011 Health care district of Central Ostrobothnia Kokkola 13/12/2011 Health care district of Tampere Region Tampere

16/12/2011 Health care district of Northern Savonia Kuopio

21/12/2011 Health care district of Kymi River Valley Hamina

5.6.4 ENSURING THE LEGALITY OF SOCIAL WELFARE AND HEALTH CARE INFORMATION

MANAGEMENT

The legality and regulatory compliance of the planning, development, coordination, implementation and

monitoring of (electronic) social welfare and health care information management must be assessed and

monitored on a regular basis and in a proactive manner.

Ensuring legality requires proactive and continuous efforts. The following processes and tasks which relate to

ensuring the legality of electronic information management in social services and health care are among

measures that will be repeated throughout the term of the action plan, i.e. between 2012 and 2015.

The objective of the Unit for the Operational Management of Health and Welfare Information is to ensure

legality in a proactive manner and on a continuous basis. The Unit for the Operational Management of Health


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and Welfare Information is responsible for ensuring that the planning, development, coordination,

implementation and monitoring of the services associated with the National Archive of Health Information

comply with national and EU legislation as well as cross-sectoral principles and other rules and regulations.

Legality and regulatory compliance are assessed on a continuous basis and in a proactive manner for example in

connection with planning, committee work and meetings. The success of proactive internal monitoring of legality

hinges on efficient exchange of information and active cooperation between experts, openness and transparency

in all activities and access to legal advice from legal counsels. Legal issues are also discussed with interest groups

and public authorities. The objective is to review all materials and information (outputs) produced by the Unit for

the Operational Management of Health and Welfare Information proactively in order to ensure that they comply

with legislation.

Any illegal procedures or non-conformances identified retrospectively will be rectified as soon as possible and

remedial action taken.

The Unit for the Operational Management of Health and Welfare Information strives to prepare for any

legislative initiatives and amendments that are being drafted in the social services and health care sector and

that may have implications on the services associated with the National Archive of Health Information in a

proactive manner. The Unit for the Operational Management of Health and Welfare Information monitors the

legislative drafting and development of other administrative sectors actively and strives to prepare for such

changes that have or may have implications on the services associated with the National Archive of Health

Information in a proactive manner.

The Unit for the Operational Management of Health and Welfare Information also monitors, evaluates and

strives to predict EU legislation and its development especially with regard to relevance to the services

associated with the National Archive of Health Information.

The Unit for the Operational Management of Health and Welfare Information contributes and strives to

influence the drafting of such legislation that has or may have implications on the planning, development,

coordination, implementation or monitoring of electronic information management in social services and health

care. The aim of the Unit for the Operational Management of Health and Welfare Information is that any

observations, experiences and feedback from operational management and implementation are taken into

consideration in legislative development where appropriate. The Unit for the Operational Management of Health

and Welfare Information also works in close cooperation with interest groups with regard to legislative

development.

The Unit for the Operational Management of Health and Welfare Information offers interest groups consultancy

(such as official advice, guides/guidelines and training) with regard to issues relating to interpreting and

implementing legislation.

The Unit for the Operational Management of Health and Welfare Information contributes to official cooperation

with regard to implementing, interpreting and developing legislation and strives to promote the operation and

founding of cooperative forums and committees.

The Unit for the Operational Management of Health and Welfare Information strives to promote the

simplification and harmonisation of legislation.

Target 2015

All relevant laws and national cross-sectoral principles are being observed in the development of information

management associated with social welfare and health care and the need to revise legislation is assessed

proactively on a regular basis.


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The Unit for the Operational Management of Health and Welfare Information has taken an active interest in the

implementation of the Information Management Act and the development of the public sector architecture

overall. The unit engages in cross-sectoral cooperation according to the division of responsibilities agreed with

the Finnish Ministry of Social Affairs and Health. Operational management and the associated targets and actions

are revised in a systematic manner so as to keep up with changes in legislation (Health Care Act as of 1 May 2011

and Information Management Act as of 1 September 2011). Compliance with legislation has been assessed with

regard to the planning, development, coordination, implementation and monitoring of the services associated

with the National Archive of Health Information.

5.7 Objectives beyond 2015

5.7.1 DATA STRUCTURES AS A SOURCE OF NEW INNOVATIONS

Target 2015

Data structures enable the adoption of innovations that promote the prevention of illnesses and improve the

quality of treatment and patient safety (e.g. by supporting decision-making). Basic solutions are developed taking

into consideration any weaknesses in existing national services and potential for developing a system of

nationally standardised patient records in the future.


In 2011, the emphasis was on the data structures of electronic patient records, but basic solutions were

developed taking into consideration potential for developing a system of nationally standardised patient records

in the future.

5.7.2 INFORMATION SYSTEMS AS A TOOL FOR COLLECTING STATISTICAL INFORMATION AND FOR

GENERATING BUSINESS INTELLIGENCE

Developing tools for collecting statistical information is one of the basic duties of the National Institute for Health

and Welfare, and several units are involved in this work.

A written plan for using patient records that accumulate in the National Archive of Health Information for

statistical purposes will be produced, approved and submitted to the Finnish Ministry of Social Affairs and Health

by 2015. Efforts will be made to harmonise the terminology and concepts used in the production of statistical

information and customer information systems in social services and health care. The structures and

classifications used in the collection of electronic health care information will also be harmonised with the

services associated with the National Archive of Health Information.

Harmonised data specifications will make the collection of information more practical, timely, affordable,

effective and straightforward.

Target 2015

Information system solutions generate business intelligence and enable statistical information to be collected

efficiently and cost-effectively. Basic solutions are developed taking into consideration any weaknesses in

existing national services and potential for future development.


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In 2011, the Unit for the Operational Management of Health and Welfare Information engaged in cooperation

with the statistics authorities of the National Institute for Health and Welfare. The first meeting with the

committee in charge of the reform of information management in outpatient primary health care was held on

6 October 2011.

One of the six strategic priorities chosen by the National Institute for Health and Welfare for the coming years is

for the institute to become an efficient implementer of the reform of electronic information management in

social services and health care and to make use of the outcomes of the reform in its statistical work; this mission

has been assigned to the institute’s Information Department. On 3 October 2011, the Assistant Director-General

in charge of the institute’s Division of Health and Social Services set up an internal strategic steering group which

was charged with the task of increasing the efficiency of electronic information management between 3 October

2011 and 31 December 2015.

Role Name Division/Department/Unit Title Chairman Vesa Jormanainen Information Department/Unit for the Operational

Management of Health and Welfare Information Head of Unit

Deputy Chairman Maritta Korhonen Information Department/Unit for the Operational Management of Health and Welfare Information

Deputy Head of Unit

Member Miia Artama Information Department/Welfare and Health Data Resources Unit

Project Manager

(Deputy Member Riikka Väyrynen Information Department/Services Data Resources Unit Development Manager) Member Sari Atkins Department of Communications Web Editor Member Jaason Haapakoski Information Department/Information Systems

Development and Support Unit Head of Unit

Member Marke Hietanen-Peltola Division of Health and Social Services/Department of Children, Young People and Families/Child, Adolescent and Family Services Unit

Medical Director

Member Tiina Laatikainen Division of Welfare and Health Promotion/Department of Chronic Disease Prevention

Head of Department

Member Jari Lehtonen Information Department/Information Structures and Classifications Unit

Software Engineer

Member Pasi Pohjola Division of Health and Social Services/Service System Department/Technologies and Practices Assessment Unit

Senior Scientist

Member Jonas Sundman Division of Health Protection/Department of Vaccination and Immune Protection/Vaccine Research Unit

Senior Adviser

Member Mikko Virtanen Division of Health Protection/Department of Infectious Disease Surveillance and Control/Epidemiologic Surveillance and Response Unit

Statistician

Secretary Merja Marvelin Information Department/Unit for the Operational Management of Health and Welfare Information

Project Planner

The responsibilities of the steering group include

- to promote horizontal cooperation within the National Institute for Health and Welfare; - to act as a cooperation forum with regard to efforts made within the National Institute for Health and Welfare to promote

electronic information management in social services and health care; - to investigate, pool and discuss development proposals made within the National Institute for Health and Welfare with regard

to electronic information management in social services and health care; - to promote information system solutions that generate business intelligence and enable statistical information to be collected

efficiently and cost-effectively; and

- to produce an action plan for the implementation of the aforementioned objectives between 2012 and 2015.

The steering group can set up committees and consult external experts and propose additions and changes to

the composition of the steering group.

5.7.3 PREPAREDNESS FOR THE EXCHANGE OF PATIENT RECORDS ACROSS THE EU

The European Union has launched a project called epSOS (European Patients – Smart Open Services), which is

aimed at enabling the exchange of patient records across the union in the future. Finland joined the 36-month

extension of the epSOS consortium on 1 January 2011. Key goals of the project are to improve the quality and


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safety of health care for citizens when travelling to another European country. A tangible objective is to enable

interoperability of electronic prescriptions and patient summaries between countries. The ultimate aim of the

project is to define and pilot the processes and applications that will hopefully form a basis for pan-European

interoperability after the project.

To achieve these objectives, EU-level experts get together to agree on conditions for cross-border use of

electronic prescriptions and patient summaries, and the solutions are then piloted extensively across the

participating countries. Finland intends to engage in cooperation with Sweden to pilot the cross-border use of

the ePrescriptions service in the Torne Valley area in 2012 and 2013.

Target 2015

Finland has the preparedness to engage in international exchange of patient records across the EU.


Finland has begun to prepare for the objective that patient information within the EU moves with the patient.

Finland joined the 36-month extension of the epSOS consortium, which aims to pilot cross-border exchange of

information, on 1 January 2011.

The year 2011 marked Finland’s first year in the epSOS consortium: Negotiations with various national, regional

and Swedish interest groups were held in the spring. A partnership agreement concerning the setting up of a

national contact point (Social Insurance Institution of Finland) is being prepared. The objective is to investigate

the legal and technical prerequisites for pilots (including the setting up of a national contact point), to agree on

practical implementation and to plan pilot projects. Work on translating the terminology required for

interoperability progressed throughout 2011, as did work on creating a correlation table of Finnish codes and

uploading these to the central database of epSOS terminology, and this work will continue in 2012. The concepts

and terminology used in the epSOS project are based on the SNOMED CT (Systematized Nomenclature of

Medicine – Clinical Terms) system.

The technical solutions adopted by other epSOS countries were examined in order to learn about the technical

prerequisites for the national contact point. Correlations between the data structures associated with electronic

prescriptions, the transmission of the data and epSOS prescriptions were also studied.

In addition to national initiatives, the National Institute for Health and Welfare contributed to the specifications

of EU-level functions and use cases in 2011. Specifications for use cases involving patients’ access to their own

data were prepared under the chairmanship of the National Institute for Health and Welfare during the first half

of 2011. Moreover, the institute contributed to the work of the teams of experts assigned to deal with clinical

and legal issues throughout the project term as required according to the epSOS Work Packages. The Unit for the

Operational Management of Health and Welfare Information also contributed to the work of the legal and

regulatory domain of the epSOS consortium.

Several units from the Information Department of the National Institute for Health and Welfare are involved in

the work associated with the epSOS project.

5.7.4 ACTION PROGRAMME ON ESERVICES AND EDEMOCRACY

Efforts to provide electronic services for citizens are tied in with the Action Programme on eServices and

eDemocracy of the Finnish Ministry of Finance, which was launched in 2010. The Ministerial Working Group on

Administration and Regional Development discussed the Action Programme on eServices and eDemocracy in its

meeting on 8 December 2011: The programme is among the Finnish Government’s key projects and it runs until

31 December 2015. The project has its own steering group comprising representatives from the participating

ministries and local authorities. The objective of the programme is to provide citizens with helpful, user-friendly


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and easy-to-use online tools and access to public services. The basic premise of the programme is to meet the

needs of customers in all spheres of life and in all circumstances regardless of the administrative sector or

organisation in charge. The aim is to produce tangible services that improve the cost-effectiveness and quality of

the public sector and to make more efficient use of administrative processes and resources.

The health and social services dimension of the programme comprises two modules: services that support

citizens in looking after their personal health and an initiative involving the planning of welfare services. The

Ministry of Finance Advisory Committee on Public Sector ICT voted in favour of the health and social services

dimension of the programme entering the implementation stage in its meeting on 25 January 2012. The main

objective is to produce services that enable citizens to take responsibility for their own welfare and for

preventing problems. Another objective is to make the planning and implementation of care and service

processes more efficient. The plan is, by 31 December 2012, to build services that can be tailored to citizens’

personal needs in order to 1) support citizens in their efforts to promote their own welfare and health, 2) make it

easier for citizens to choose a care or service provider and to seek help, 3) improve the opportunities of citizens

to take part in the development of services, and 4) to increase interaction and communication between citizens

and health care and welfare professionals.

The services include both national and regional components. National services include general information about

social welfare and health, risk tests and self-assessment tools, service directories and feedback systems for

measuring patient and customer satisfaction. Regional services include systems for transmitting test results and

instructions to patients.

The ultimate aim of the programme is to give citizens access to a diverse range of easy-to-use services in a

multitude of channels, enabling them to take responsibility for all aspects of their own health and welfare and for

maintaining and promoting their personal health and welfare. The services can be used to save information

generated by citizens about their personal health and treatments, to exchange information within the health

care system across organisational borders and to make information more easily accessible. The services also

increase the productivity and quality of the work of health care professionals. The Unit for the Operational

Management of Health and Welfare Information will take over the responsibility for building and implementing

any systems that at the end of the development project in 2015 are to remain permanent features in the

national service infrastructure.

Target 2015

Customers are offered electronic social welfare and health care services that include both the customer’s self-

motivated health promotion and treatment and the exchange of information between service providers.


The Unit for the Operational Management of Health and Welfare Information cooperated extensively and

actively with the coordinators of the Action Programme on eServices and eDemocracy in order to ensure that

any links to the National Archive of Health Information were taken into consideration. The Unit for the

Operational Management of Health and Welfare Information also paid close attention to the development of the

health and social services dimension of the Action Programme on eServices and eDemocracy and offered advice

and support.


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6. ACTIONS TO SUPPORT OBJECTIVES IN 2011

The following sections describe the actions taken to mainstream the aforementioned objectives. The actions are

also designed to resolve issues identified during planning (expectations, problems, risks and needs).

6.1 Revised timescales and staggered adoption of the processes associated with the National Archive of Health Information

Committing the various interested parties to the development of the National Archive of Health Information

requires realistic and believable timescales. The timescales and staggered adoption plans for the ePrescriptions

service, the eArchive service, the eAccess portal and the information management service need to be revised to

correspond to the Customer Information Act and consequently to the contents of the services and the deadlines

specified in the Staggered Adoption Decree. The objective is to publish staggered adoption plans for the

ePrescriptions service, the eArchive service and the information management service as soon as the Staggered

Adoption Plan is issued.


Staggered adoption plans are based on the provisional contents of the Staggered Adoption Decree. The plans will

be finalised once the Staggered Adoption Decree has been issued.

6.2 Increasing the efficiency of project management

A shared project management system will be set up for the internal and external projects of the Unit for the

Operational Management of Health and Welfare Information.

The logical framework approach (LFA) was chosen as the management tool in order to cope with the complex

operating environment and to coordinate the many organisations involved.

The scope and complexity of the development work require that the Unit for the Operational Management of

Health and Welfare Information uses a computerised system for managing the project portfolio and for

coordinating projects. Work on adopting the project management system and other associated processes as well

as choosing application software to support the system continues throughout 2012.


On 9 December 2011, the Director-General of the National Institute for Health and Welfare set up a steering

group to coordinate IT projects associated with the operational management of social services and health care

information management. The steering group’s term runs from 9 December 2011 until 31 December 2013 and its

tasks are 1) to act as a forum for the exchange of information between the members of the steering group and to

keep all members up to date on how projects are progressing, 2) to promote tangible cooperation with regard to

projects in operational issues relating to national information system services, 3) to coordinate cooperation and

decision-making among the members of the steering group in special circumstances involving the resources,

funding or timescales of joint projects, 4) to identify risks involved in IT projects such as potential problems and

to propose solutions, 5) to decide on new studies and the planning and launching of projects and to approve

project plans and changes to plans as well as the closure of projects and final reports, 6) to assign funds to

projects and to coordinate the use of resources within the constraints of the available appropriations, and 7) to

approve specifications to be used in the construction of information systems. The steering group is chaired by

the Head of the Information Department of the National Institute for Health and Welfare with the IT Director of

the Social Insurance Institution of Finland acting as the Deputy Chairman. The other members are the Head of

the Unit for the Operational Management of Health and Welfare Information and the Planning Manager in


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charge of the development of the services associated with the National Archive of Health Information at the

Social Insurance Institution of Finland.

Various different parties have been involved in concept development with regard to the project management

system. The logical framework approach that was adopted earlier already enables most aspects of project

management. A plan enabling the coordination of complex project portfolios between 2012 and 2015 was

produced in the autumn of 2011. The range of computerised project management systems was also examined in

2011 with a view to investing in new software. Efforts are currently being made to turn the agreed strategic

priorities into tangible projects. The Unit for the Operational Management of Health and Welfare Information

consulted experts from the Finnish Government’s central procurement unit to learn more about the role of

competitive tendering in project management.

6.3 Coordinating the configuration process

The Unit for the Operational Management of Health and Welfare Information is responsible for assigning roles to

the organisations participating in the configuration process according to the latest staggered adoption plans. The

most important aim in coordinating the configuration process is to ensure that users and information technology

suppliers have enough opportunities to influence the configuration process at the crucial stages.

The Unit for the Operational Management of Health and Welfare Information is also responsible for establishing

a universal procedure for coordinating the configuration process. Among other things, the procedure will guide

the scheduling of the various stages of the configuration process from identifying development needs and

agreeing on the areas to be developed to programming and the finished specifications. A maintenance plan will

be formulated for earlier specifications, indicating the party responsible for each document and an annual

schedule according to which documents are to be reviewed and updated. The responsibilities of each of the

parties involved in the configuration process will be specified: reviewers of development proposals, coordinators

of the actual configuration work, experts responsible for giving advice and consultancy, approvers and

publishers. The goal is to make the process as flexible as possible while ensuring vigorous quality control.

Several different parties are involved in various different capacities in configuring information management

systems for social services and health care.

The specifications need to be of sufficiently high and consistent quality to ensure the interoperability of the

information system solutions from the perspective of users and system suppliers. A coordination committee on

the development of patient information systems was established according to a plan produced for cooperation in

patient information system development. The committee was set up by the Municipal Project Coordination

Office and two project managers were appointed to coordinate the work: one from the health care district of

Southwest Finland between 16 April 2010 and 28 February 2011 and one from the health care district of

Southern Ostrobothnia between 7 March 2011 and 31 December 2011.

The main objective of the committee is to ensure that any units linking their systems to national information

system services are able to use the services to care for patients and to influence the patient information system

suppliers so that the data produced and used by different information systems are interoperable regardless of

the software. A second objective is to influence national specifications so as to ensure that they are

implementable and that they support the aims of the user organisations.

The committee is responsible for reviewing and revising the specifications of the services associated with the

National Archive of Health Information and, where appropriate, other specifications that have implications on

the development of patient information systems. Cooperation between different interested parties is aimed at

honing operational and technical specifications in order to ensure the harmonised implementation of different

patient information system applications within the agreed deadlines and to make them more useful and user-

friendly. The committee is responsible for keeping patient information system suppliers and health care


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organisations up to date about the progress of specifications for the National Archive of Health Information and

any development needs identified. The committee is also responsible for creating a portal for reporting and

rectifying weaknesses and for committing different parties to the agreed timescales.

Cooperation with regard to system specifications (often in the form of workshops) ensures that any weaknesses

are rectified and that suggestions about improvements to national documents are brought forward: The resulting

revisions and changes make the systems more user-friendly and more reliable and help to harmonise the way

that information is produced and used. The committee is also responsible for reporting on the status of the

information systems and the planned timescales. Any areas where specifications are needed are listed and

suggestions made regarding code systems.

The committee operates in three forums: 1) team of configuration experts at the National Institute for Health

and Welfare, 2) workshops and 3) structured meetings.


The Unit for the Operational Management of Health and Welfare Information took over the responsibility for the

remuneration of the project manager in charge of the coordination committee on the development of patient

information systems from 18 June 2011 until 31 December 2011 following the legislative changes introduced at

the beginning of 2011.

The committee continued to review and revise the specifications with the most critical implications from the

perspective of interoperability (minutes of the meeting, interoperability). Weaknesses identified in the course of

workshops were factored into the development work.

A total of eight workshops were organised for configuration experts in Helsinki in 2011. The following table

summarises the workshops held in 2011, the number of participants and the main issues discussed:


16/02/2011 Documents, logs, offline systems

12/04/2011 20 Staggered adoption of the eArchive service, authorised and denied data uses, service event

18/05/2011 32 Information management service, health care and treatment plans, regional and local framework

architecture for health care

15/06/2011 24 Shared patient information registers, information management service, document settings,

patient information system use cases

23/08/2011 40 Shared patient information registers, authorised and denied data uses, information, future work

of the coordination committee on the development of patient information systems

13/09/2011 32 Authorised and denied data uses, information management service, personal information,

patients’ wishes, shared patient information registers, codes for special circumstances

11/10/2011 28 Codes for special circumstances, consent management, information management service, health

care and treatment plans, risk information

15/11/2011 26 Offline systems, shared patient information registers, register of social welfare and health care

organisations, progress report on staggered adoption, health care and treatment plans

6.4 Official rules and regulations

The changes introduced to the Customer Information Act as of 1 January 2011 extended the right of the National

Institute for Health and Welfare to issue rules and regulations (Section 6). According to the act, the National

Institute for Health and Welfare can issue (binding) regulations on the contents, standards and certain

architectural specifications relating to information management in social services and health care. By using its

right to issue rules and regulations systematically, the National Institute for Health and Welfare can simplify and

improve the coordination of service providers and information system suppliers considerably.

Guidelines for using the right to issue rules and regulations in a systematic manner will be drafted and finalised in

2012. This requires formulating and documenting a process for drafting official rules and regulations. The


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National Institute for Health and Welfare also needs to establish internal (administrative) procedures for issuing

rules and regulations.


Work on guidelines for using the right to issue rules and regulations continued throughout 2011. The Unit for the

Operational Management of Health and Welfare Information published the first guideline on 2 December 2011,

regarding deadlines for the adoption of electronic prescriptions (Guideline 1/2011).

6.5 Financial coordination

A framework agreement between the Finnish Ministry of Social Affairs and Health and the National Institute for

Health and Welfare (between 1 January 2011 and 31 December 2015) authorises the institute to grant state aid.

The National Institute for Health and Welfare is responsible for drafting and issuing decisions about state aid to

simplify and improve the local and regional infrastructure of social welfare and health care information systems.

The institute first granted state aid to the development of social welfare information management in March

2011.


Principles and criteria for granting state aid to support the adoption of the ePrescriptions service were

formulated in 2011. State aid was granted to two recipients to promote information technology development in

social services in 2011.

6.6 Technical support and change management

The Municipal Project Coordination Office was responsible for the provision of technical support and training in

the adoption of the ePrescriptions service in public health care until December 2011. The Unit for the

Operational Management of Health and Welfare Information took over the responsibilities gradually starting on

1 November 2011.

The content of the technical support service was revised to better reflect the needs of the users on the basis of

the experiences of the Municipal Project Coordination Office and the Social Insurance Institution of Finland as

well as a questionnaire produced by the Unit for the Operational Management of Health and Welfare

Information for health care professionals. There is a shortage of trainers, which makes the provision of technical

support more challenging: Experts who are familiar with health care processes and the technical aspects of the

ePrescriptions service are few and far between.

The provision of technical support and training to help health care professionals in the public sector to adopt the

ePrescriptions service will continue as required in 2012. The need to provide technical support and training to

private health care providers will also be assessed. Training and induction materials will be incorporated into the

manual for the adoption of the ePrescriptions service. A lack of environments for learning the operating models

of the ePrescriptions service makes the provision of technical support for health care professionals more

challenging and hinders self-motivated learning. The need and prerequisites for the use of a learning

environment for the services associated with the National Archive of Health Information is being investigated.

The findings can then be used to produce a project plan for setting up the learning environment with the Social

Insurance Institution of Finland.

A description of the change management process will be produced in cooperation with the Social Insurance

Institution of Finland. Potential for strengthening regional know-how in order to support adoption and change

management will be investigated.


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The aforementioned issues have also been discussed in the meetings of the national steering group set up to

monitor and oversee pilot projects and the adoption of the ePrescriptions service and with the Association of

Finnish Pharmacies.


A team was set up to coordinate the transfer of responsibilities from the Municipal Project Coordination Office.

Experts from the Municipal Project Coordination Office and the Unit for the Operational Management of Health

and Welfare Information began to prepare for the transfer on 17 May 2011 once the management team of the

Municipal Project Coordination Office had approved the transfer plan. The transfer plan was divided into themes

and a committee consisting of experts from the Municipal Project Coordination Office and the Unit for the

Operational Management of Health and Welfare Information assigned to each theme. There were 10 themes in

total: communications, training, documents and contracts, regional responsibilities and cooperation with interest

groups, coordination of the development of patient information systems (coordination committee), adoption of

the ePrescriptions service and timescales, adoption manual, costs associated with the adoption of the

ePrescriptions service, and outcomes of other projects and studies.

The management team of the Municipal Project Coordination Office approved the project plan for the transfer

process on 6 September 2011. A logical framework approach and a logical framework matrix (LFM) were adopted

as project management tools. The Unit for the Operational Management of Health and Welfare Information and

the Municipal Project Coordination Office held various meetings to assess the progress of the transfer process.

The process progressed as planned and on time.

The following table summarises the main events associated with the transfer process:

Date Event

25/01/2011 Coordination meeting between the Municipal Project Coordination Office and the Unit for the Operational

Management of Health and Welfare Information

07/02/2011 Team meeting of the Municipal Project Coordination Office with the Head of the Unit for the Operational

Management of Health and Welfare Information participating

09/03/2011 First one-on-one interview with an employee of the Municipal Project Coordination Office (Head of the Unit for the

Operational Management of Health and Welfare Information)

14/03/2011 Second one-on-one interview with an employee of the Municipal Project Coordination Office (Head of the Unit for

the Operational Management of Health and Welfare Information)

21/03/2011 Third one-on-one interview with an employee of the Municipal Project Coordination Office (Head of the Unit for


23/03/2011 Fourth one-on-one interview with an employee of the Municipal Project Coordination Office (Head of the Unit for


29/03/2011 Fifth one-on-one interview with an employee of the Municipal Project Coordination Office (Head of the Unit for the

Operational Management of Health and Welfare Information)

08/04/2011 First planning meeting between the heads of the Unit for the Operational Management of Health and Welfare

Information and the Municipal Project Coordination Office

14/05/2011 Project plan (v. 0.2) for transferring responsibilities from the Municipal Project Coordination Office

17/05/2011 Meeting of the management team of the Municipal Project Coordination Office: Work on the project plan begins.

20/06/2011 First joint planning meeting of the Municipal Project Coordination Office and the Unit for the Operational


15/08/2011 Second planning meeting between the heads of the Unit for the Operational Management of Health and Welfare


22/08/2011 Third planning meeting between the heads of the Unit for the Operational Management of Health and Welfare


30/08/2011 Fourth planning meeting between the heads of the Unit for the Operational Management of Health and Welfare


05/09/2011 Fifth planning meeting between the heads of the Unit for the Operational Management of Health and Welfare


06/09/2011 Meeting of the management team of the Municipal Project Coordination Office: The project plan is discussed and

approved.


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12/09/2011 Second joint planning meeting of the Municipal Project Coordination Office and the Unit for the Operational


16/09/2011 Sixth planning meeting between the heads of the Unit for the Operational Management of Health and Welfare


06/10/2011 Third joint planning meeting of the Municipal Project Coordination Office and the Unit for the Operational

Management of Health and Welfare Information: The progress of the transfer process as per 30 September 2011 is

reviewed.

20/10/2011 Seventh planning meeting between the heads of the Unit for the Operational Management of Health and Welfare


02/11/2011 Fourth joint planning meeting of the Municipal Project Coordination Office and the Unit for the Operational

Management of Health and Welfare Information: The progress of the transfer process as per 31 October 2011 is

reviewed.

15/11/2011 Meeting of the management team of the Municipal Project Coordination Office: progress report

23/11/2011 Fifth joint planning meeting of the Municipal Project Coordination Office and the Unit for the Operational


07/12/2011 Sixth joint planning meeting of the Municipal Project Coordination Office and the Unit for the Operational

Management of Health and Welfare Information: The progress of the transfer process as per 30 November 2011 is

reviewed.

20/12/2011 Meeting of the management team of the Municipal Project Coordination Office: The latest progress report and the

final report from the Municipal Project Coordination Office are discussed.

31/12/2012 All responsibilities of the Municipal Project Coordination Office have been transferred to the Unit for the

Operational Management of Health and Welfare Information.

6.7 Segmentation of cooperation with interest groups

Developing the services associated with the National Archive of Health Information within the timescale specified

in legislation requires various national, regional and local organisations to work together. In addition to public

authorities, the vast process also requires contributions from local authorities, joint authorities and private

enterprises. Working with these parties to achieve common goals is one of the most important objectives of the

Unit for the Operational Management of Health and Welfare Information.

Cooperation is structured by segmenting partners and target groups in order to ensure consistent use and

interoperability of social welfare and health care actions and information systems.

The Unit for the Operational Management of Health and Welfare Information is investing in regional and local

cooperation and the provision of technical support by assigning coordinators for regional cooperation and the

adoption of electronic services in each of the five catchment areas for highly specialised medical care.


In 2011, the emphasis was on launching cooperation with the various health care districts: The Unit for the

Operational Management of Health and Welfare Information engaged in cooperation with the Municipal Project

Coordination Office and the Social Insurance Institution of Finland to meet with the directors of 19 health care

districts, their patient records coordinators and information management professionals.

The work of national committees, project groups and steering groups is being streamlined and coordination

developed by pooling management models and committees and by revising procedures. The Municipal Project

Coordination Office, the team in charge of information technology development in social services and the

Standardised Patient Records 2010 project promoted national cooperation through various committees

alongside the Unit for the Operational Management of Health and Welfare Information in 2011. More

coordinated and systematic alternatives for work were sought in 2011 in order to make more efficient use of the

limited human resources available for the tasks required to meet the objectives. All of the aforementioned

functions were grouped more clearly under the guidance of the Unit for the Operational Management of Health

and Welfare Information as of the beginning of 2012. The situation was assessed in the spring of 2011 and the

findings used to reorganise activities. The Unit for the Operational Management of Health and Welfare


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Information spent the year 2011 planning systems and forums that are hoped to enable systematic interaction

with public and private service providers and system suppliers.

Steering groups will be set up for each of the main processes of the Unit for the Operational Management of

Health and Welfare Information (such as ePrescriptions). The Unit for the Operational Management of Health

and Welfare Information began cooperating with patient information system suppliers in the spring of 2011 and

organised an open cooperation event for them towards the end of September. The Unit for the Operational

Management of Health and Welfare Information also participated actively in the work of various industry

networks.

Cooperation with associations representing private health care providers on one hand and trade unions on the

other was launched in the form of bipartite meetings in 2011.

The Unit for the Operational Management of Health and Welfare Information began to build public sector

cooperation with the Finnish Medicines Agency (Medicines Information Strategy) as well as with the National

Supervisory Authority for Welfare and Health and the Population Register Centre, among others, in 2011.


group to coordinate operational cooperation relating to social services and health care information

management. The steering group’s term runs from 1 January 2012 until 31 December 2013 and it is chaired by

the Head of the Unit for the Operational Management of Health and Welfare Information. The members and

deputy members of the steering group are representatives of the Finnish Ministry of Social Affairs and Health,

the Finnish Medicines Agency, the National Supervisory Authority for Welfare and Health, the Social Insurance

Institution of Finland, the Population Register Centre and the Association of Finnish Local and Regional

Authorities.

On 9 December 2011, the Director-General of the National Institute for Health and Welfare appointed a steering

group to support the operational management of information management projects in social services and health

care. The steering group’s term runs from 9 December 2011 until 31 December 2013. The steering group is

chaired by the Head of the Information Department of the National Institute for Health and Welfare with the IT

Director of the Social Insurance Institution of Finland acting as the Deputy Chairman. The other members are the

Head of the Unit for the Operational Management of Health and Welfare Information and the Planning Manager

in charge of the development of the services associated with the National Archive of Health Information at the

Social Insurance Institution of Finland.

The Finnish Government has also set up an advisory committee on electronic information management in social

services and health care. The committee is governed by the Finnish Ministry of Social Affairs and Health and its

term runs from 1 October 2010 until 30 September 2013. The committee initially established a number of

internal divisions to support its work, but these were discontinued on 8 April 2011. The coordination division

held a total of 12 meetings between 16 April 2010 and 8 April 2011, of which four were held in 2011. The

National Institute for Health and Welfare took part in the meetings of the coordination committee, as did the

Head of the Unit for the Operational Management of Health and Welfare Information as of the beginning of

2011. The Head of the Unit for the Operational Management of Health and Welfare Information was one of the

secretaries appointed by the advisory committee.

6.8 Targeting influencing and communications

When the National Institute for Health and Welfare took over the responsibility for operational management,

the responsibility for the overall coordination of communications relating to the National Archive of Health

Information was also transferred to the institute. The Social Insurance Institution of Finland remains responsible

for communication with citizens according to the Customer Information Act. Communications can be targeted at

either citizens or professionals with the help of the www.kanta.fi website.


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The Unit for the Operational Management of Health and Welfare Information participates actively in events

relating to information management in social services and health care as well as in training courses and

professional conferences both in Finland and abroad.


Work on combining the various communications plans associated with the National Archive of Health

Information began in 2011. Influencing and communications were also simplified by segmenting target groups.

The communications network set up for the National Archive of Health Information convened on an almost

monthly basis throughout the year. The work of the network’s most active participants was boosted in the

autumn by developing procedures for dealing with exceptional circumstances, for example. Seven issues of a

newsletter associated with the National Archive of Health Information were published.

Concept development on the contents and structure of the www.kanta.fi website began in August 2011. Various

organisations worked closely together throughout the autumn of 2011 and the work was completed for the most

part in December 2011. Thanks to the concept development process, the contents of the website can now be

targeted at different user groups and various new functions put to use.

An administrative model for maintaining and updating the www.kanta.fi website was formulated, according to

which the responsibility for updating the publishing system still administered by the Social Insurance Institution

of Finland will be divided between the Social Insurance Institution of Finland and the National Institute for Health

and Welfare/Unit for the Operational Management of Health and Welfare Information in the future. The

National Institute for Health and Welfare built an extranet (cooperation platform) for project personnel and the

Social Insurance Institution of Finland developed a secure access portal for the organisations that will ultimately

be part of the National Archive of Health Information.

A report on the visits made by representatives of the Unit for the Operational Management of Health and

Welfare Information to health care districts was prepared for publication in the spring of 2012.

Experts from the Unit for the Operational Management of Health and Welfare Information attended various

events relating to information management in social services and health care as well as training courses and

professional conferences both in Finland and abroad. Experts from the Unit for the Operational Management of

Health and Welfare Information were also asked to give dozens of presentations in these events in 2011.

6.9 Strengthening know-how about competitive tendering and contracts

Competitive tendering and contracts are an important part of the work of the Unit for the Operational

Management of Health and Welfare Information. The unit strengthened its know-how about these issues

together with the other units of the National Institute for Health and Welfare by recruiting a procurement

manager and a legal counsel in 2011. The Unit for the Operational Management of Health and Welfare

Information monitors and supervises the implementation of contracts actively.

The National Institute for Health and Welfare adopted new procurement guidelines and guidelines for small

purchases on 1 January 2012, which the Unit for the Operational Management of Health and Welfare

Information also follows. The objective is to also produce new procurement forms for the National Institute for

Health and Welfare in 2012.

The Unit for the Operational Management of Health and Welfare Information produces a procurement plan for

the following year at the end of each year. This makes purchases easier to anticipate and schedule. The project

management personnel of the Unit for the Operational Management of Health and Welfare Information have

produced a detailed LFA/LFM-based system for this.


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The Unit for the Operational Management of Health and Welfare Information also stays in regular contact with

information system suppliers and monitors the development of the industry in order to better target requests for

quotes at information system suppliers. Moreover, the Unit for the Operational Management of Health and

Welfare Information monitors the progress of framework agreements tendered by the Finnish Government’s

central procurement unit and makes use of them whenever possible.


As of 1 June 2011, any competitive tendering and contracts of the Unit for the Operational Management of

Health and Welfare Information are the responsibility of a procurement manager whose salary is paid between

the Unit for the Operational Management of Health and Welfare Information and the Financial Administration

Unit of the National Institute for Health and Welfare. The National Institute for Health and Welfare spent the

year 2011 drafting new procurement guidelines (THL 1493/2.09.00/2011) and guidelines for small purchases (less

than EUR 30,000) (THL 1494/2.09.00/2011), which were adopted on 1 January 2012 and which the Unit for the

Operational Management of Health and Welfare Information also follows.

The Unit for the Operational Management of Health and Welfare Information organised two events with experts

from the Finnish Government’s central procurement unit to familiarise the personnel of the Unit for the

Operational Management of Health and Welfare Information with procurement processes, framework

agreements, competitive tendering procedures in general and IT purchases in particular (2 December 2011,

9 December 2011).

6.10 Strengthening cooperation between information system clients

The adoption of national information system services and regional and cross-regional cooperation between

parties using the same patient information systems are of paramount importance. The Unit for the Operational

Management of Health and Welfare Information is investing in cooperation between information system clients

by assigning coordinators for regional cooperation and the provision of technical support for the adoption of

electronic services in each of the five catchment areas for highly specialised medical care.

The provisions of the Finnish Health Care Act and Customer Information Act are such that it made sense to

launch cooperation with health care districts by means of on-site visits. Work on establishing and harmonising

needs and expectations continues next with cities and towns, local authorities and joint authorities by focusing

on primary health care and social services.


A decision was made in the spring of 2011 for the Unit for the Operational Management of Health and Welfare

Information to begin cooperating with health care districts. Events held in each of the health care districts in the

autumn of 2011 included participants from the National Institute for Health and Welfare (Information

Department, Unit for the Operational Management of Health and Welfare Information), the Social Insurance

Institution of Finland (team in charge of the development of the services associated with the National Archive of

Health Information) and the Association of Finnish Local and Regional Authorities (Municipal Project

Coordination Office). One of the most important objectives of the events was to consult regional representatives

with regard to the progress made with adopting the ePrescriptions service, planning the adoption of other

services associated with the National Archive of Health Information and their expectations of the Unit for the

Operational Management of Health and Welfare Information. Other issues discussed in connection with the

events were the needs of joint authorities and certain towns regarding cooperation between information system

clients on one hand and regional contracts on the other.

The following table summarises events held and planned in each of the health care districts and the number of

participants from each of the organisations involved:


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Participants

Date Location Health care district

Unit for the Operational

Management of Health

and Welfare Information

Social

Insurance

Institution

of Finland

Municipal

Project

Coordination

Office 26/08/2011 Oulu Northern Ostrobothnia 6 1 1

31/08/2011 Rovaniemi Lapland 5 0 1

02/09/2011 Kemi Southwest Lapland 9 1 2

16/09/2011 Lahti Päijänne Tavastia 6 1 3

19/09/2011 Lappeenranta Southern Karelia, Kymi River Valley 6 1 1

26/09/2011 Turku Southwest Finland 7 1 2

04/10/2011 Mikkeli Southern Savonia 6 1 2

21/10/2011 Helsinki Helsinki and Uusimaa 8 1 3

24/10/2011 Hämeenlinna Tavastia Proper 5 0 2

03/11/2011 Tampere Tampere Region 6 1 3

07/11/2011 Joensuu Northern Karelia 6 1 1

14/11/2011 Kuopio Northern Savonia 8 1 2

17/11/2011 Jyväskylä Central Finland 6 1 2

18/11/2011 Pori Satakunta 6 1 1

29/11/2011 Kokkola Central Ostrobothnia 5 1 1

30/11/2011 Seinäjoki Southern Ostrobothnia 7 1 2

01/12/2011 Vaasa Vaasa Region 6 1 1

12/12/2011 Savonlinna Eastern Savonia 5 1 0

15/02/2012 Kajaani Kainuu 5 1 -

6.11 Architecture

The responsibility for formulating an architectural strategy for information management in the health care and

social services sectors rests with the Finnish Ministry of Social Affairs and Health. Medium-term architectural

development of tactical and operational information management and more detailed overall architectural

development tie in closely with the work of the Unit for the Operational Management of Health and Welfare

Information. The Information Management Act entered into force on 1 September 2011.


The Unit for the Operational Management of Health and Welfare Information participated actively in two

projects sponsored by the Finnish Ministry of Finance (Local Government IT Management Unit) focusing on the

development of regional and local framework architecture for health care information systems. The Unit for the

Operational Management of Health and Welfare Information also participated actively in the architectural

development work organised by the coordination division of the advisory committee on electronic information

management in social services and health care, which operates in connection with the Finnish Ministry of Social

Affairs and Health, in the spring of 2011 and in the work of the steering group for information management in

the administrative sector of the Finnish Ministry of Social Affairs and Health in the autumn of 2011. No definite

division of labour between the Finnish Ministry of Social Affairs and Health and the National Institute for Health

and Welfare has yet been agreed.

6.12 Standardisation

General standards are used in all specifications as far as possible. The primary standards to be followed are CEN,

ISO, HL7 and national public administration standards. The organisations that develop these standards strive to

avoid conflicts and overlaps and to recognise each other’s standards.

The Unit for the Operational Management of Health and Welfare Information monitors the development of

standardisation through networking and participates in standardisation meetings. Standards are monitored in

cooperation with the monitoring group for health care information technology of the Finnish Standards

Association, the technical committee of HL7 Finland as well as other groups and projects. The Unit for the


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Operational Management of Health and Welfare Information is a member of the Board of HL7 Finland as of

1 January 2012. The work and profile development of the IHE Initiative, which studies the application and

interoperability testing of standards, is also followed.


A representative of the Unit for the Operational Management of Health and Welfare Information has been

appointed to the new Board of HL7 Finland. Presentations about the work of the Unit for the Operational

Management of Health and Welfare Information have been given to HL7 Finland and the IHE team, for example.

6.13 Consultancy

The Unit for the Operational Management of Health and Welfare Information plans, steers and monitors

consultancy to support the configuration process in its operating sector.

The Unit for the Operational Management of Health and Welfare Information participates in the work of teams

of experts set up by the National Institute for Health and Welfare insofar as it relates to the planning, steering

and monitoring of the development of national information system services. The Unit for the Operational

Management of Health and Welfare Information is also responsible for coordinating the work of a joint

consultancy network of health care organisations and patient information system suppliers (coordination

committee on the development of patient information systems) and a technical committee on open interfaces.

The Social Insurance Institution of Finland is an important partner for the Unit for the Operational Management

of Health and Welfare Information with regard to consultancy.


In 2011, the Unit for the Operational Management of Health and Welfare Information contributed to the

planning of new committees set up by the Director-General of the National Institute for Health and Welfare that

operate in the Information Structures and Classifications Unit of the institute’s Information Department. The role

of the committees was extended to also cover consultancy required for the development of services associated

with the National Archive of Health Information.

The Unit for the Operational Management of Health and Welfare Information engaged in communication with

regional networks of experts previously coordinated by the Municipal Project Coordination Office. The Unit for

the Operational Management of Health and Welfare Information also set up a number of networks of its own in

2011, in connection with events held in each of the health care districts, for example.

6.14 Quality control (certification)

In order for the entire health care information system infrastructure to work as a whole, it is important that its

components have been constructed in a consistent manner. Ensuring interoperability also ensures that the

systems work right from a technological perspective, enable the transmission of patient records from one system

to another and interpret the contents of each other’s data correctly. Certification of systems and organisations

ensures that they comply with security requirements, in other words that systems come with all the necessary

security properties and that organisations work and use the systems in a secure manner.

All patient information systems must pass interoperability testing before they can be linked to the National

Archive of Health Information and the associated services adopted. Initially testing will be carried out through

the cooperation of several suppliers, but a dedicated testing environment will be created for this purpose in the

future. The Social Insurance Institution of Finland is responsible for coordinating interoperability testing. After

interoperability testing, systems are certified. Pharmacies and health care organisations are responsible for

carrying out the necessary testing according to regulations issued by the Finnish Ministry of Social Affairs and

Health before linking their systems to the National Archive of Health Information.


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The role of operational management in organising certification has not yet been decided.

6.15 Developing a monitoring system

The objective of monitoring is to stay on top of the actions and to report on progress to decision-makers with

potential new actions in mind. The monitoring system for operational management will inevitably be

multilayered: The operating environment, the success of coordination and internal activities all need to be

monitored. The personnel of the Unit for the Operational Management of Health and Welfare Information will

regularly monitor progress relative to the objectives and outputs specified in approved plans using an LFA/LFM-

based system with process and result indicators, for example.

The current status of monitoring was investigated in connection with a health care information technology

survey conducted at the beginning of 2011 as well as in a national social welfare information technology survey.

Monitoring also encompasses assessments and decisions about corrective action, where necessary.

Electronic social welfare and health care information management requires active monitoring by means of

various reliable methods. Research relating to monitoring helps to produce information required for evaluating

progress nationally and, though international cooperation, also for the benefit of international communities

(especially the EU and Nordic cooperation).


The first versions of LFA/LFM-based systems were produced in the autumn of 2011 (forming a basis for an action

plan for 2011/2012–2015).

Monitoring was discussed in 2011 and indicators developed in meetings of the national steering group for the

adoption of the ePrescriptions service and in connection with the events held in each of the health care districts.

6.16 Risk management

Risk management in the Unit for the Operational Management of Health and Welfare Information is based on

earlier risk analyses carried out by the Finnish Ministry of Social Affairs and Health. Risk assessments are carried

out every two years. A risk assessment on the Unit for the Operational Management of Health and Welfare

Information will be carried out in 2012. Risk assessments are also carried out in connection with projects.

The Unit for the Operational Management of Health and Welfare Information prepares for the possibility that a

need arises in the future to carry out unplanned and urgent investigations and assessments on the operational

management of social services and health care information management.


A provisional risk assessment was carried out on the Unit for the Operational Management of Health and

Welfare Information in connection with the general risk assessment of the National Institute for Health and

Welfare in 2011. Risks were also analysed.

An unexpected illogical ePrescriptions function in one patient information system and downtime resulting from

this were a wake-up call for the Unit for the Operational Management of Health and Welfare Information, like

other national organisations, to produce more detailed instructions for dealing with special circumstances. More

detailed instructions are being prepared and a division of responsibilities will be agreed.


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7. OPERATING MODEL OF THE UNIT FOR THE OPERATIONAL MANAGEMENT OF

HEALTH AND WELFARE INFORMATION

The Unit for the Operational Management of Health and Welfare Information supports the development of

social welfare and health care organisations’ services by means of electronic information management. The work

and objectives of the Unit for the Operational Management of Health and Welfare Information are steered by

the Finnish Ministry of Social Affairs and Health.

The practical work of the unit is steered by customers’ needs and expected benefits. Customers include the users

of services (such as citizens, residents and policy-holders), social services and health care professionals,

organisations and the developers of the service system. The customer and interest group analysis will be revised

in 2012.

The national coordination model requires consensus on the roles, scope and responsibilities of strategic and

operational management. The National Institute for Health and Welfare is proactive and promotes dialogue

through steering groups of national organisations, for example.

One of the most crucial operating models is to encourage organisations to cooperate by setting up cooperation

forums and networks, for example. If necessary, the Unit for the Operational Management of Health and Welfare

Information takes a bold role in decision-making.

The internal operation of the unit is being developed according to a matrix approach around the main processes

formed by the services associated with the National Archive of Health Information. These service processes each

have their own coordinators who act as process owners. In addition to service processes, all supporting

processes (means) also have their own coordinators who are responsible for mainstreaming the means in

question across all service processes.

The Unit for the Operational Management of Health and Welfare Information holds unit meetings at least once a

month. The actions of the Unit for the Operational Management of Health and Welfare Information are also

planned, developed, steered, implemented, monitored and assessed according to the planning and management

model of the National Institute for Health and Welfare.

The unit’s operating model is becoming clearer and it is under continuous development. Several more people will

still be recruited to coordinate the unit’s work in regional cooperation and technical support, IT infrastructure

and information system service training.


The Unit for the Operational Management of Health and Welfare Information was set up administratively on

1 January 2011 and it was ready for business as planned on 1 April 2011. The unit’s internal actions were

developed in the direction of systematic planning. Actions were also developed according to a matrix approach

around the main processes formed by the services associated with the National Archive of Health Information on

one hand and other main processes identified in connection with planning the unit on the other. Coordinators

have been assigned to each process and monitoring has begun.

A total of 16 unit meetings were held in 2011, of which nine took place during the first half of the year and seven

during the latter half of the year. In addition to unit meetings, the Unit for the Operational Management of

Health and Welfare Information held four internal planning events during the latter half of 2011.


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8. MANAGEMENT MODEL AND REPORTING OF THE UNIT FOR THE OPERATIONAL

MANAGEMENT OF HEALTH AND WELFARE INFORMATION

Administratively speaking, the Unit for the Operational Management of Health and Welfare Information is part

of the Information Department of the National Institute for Health and Welfare. The head of the unit is a

member of the Information Department’s management team and reports to the Head of the Information

Department, the Director for Administration of the National Institute for Health and Welfare and the Assistant

Director-General in charge of the institute’s Division of Health and Social Services.

The Unit for the Operational Management of Health and Welfare Information follows the planning,

implementation and monitoring practices of the National Institute for Health and Welfare. Performance

reporting covers the period from December 2012 until January 2013 (18 January 2013) and non-conformances

are reported on 30 April 2012 and 24 August 2012.

A proposal was made in connection with planning that the Unit for the Operational Management of Health and

Welfare Information should also present its plans and actions to the advisory committee on electronic

information management in social services and health care, which was set up by the Finnish Government and

operates in connection with the Finnish Ministry of Social Affairs and Health (the committee is chaired by Kari

Välimäki, Permanent Secretary of the Finnish Ministry of Social Affairs and Health and its term of office runs until

30 September 2013). The Head of the Unit for the Operational Management of Health and Welfare Information

is one of the secretaries of the advisory committee.

A more detailed plan will be produced of the roles and responsibilities of the groups included in the management

model and of the exchange of information.


Director-General Pekka Puska set up two steering groups: one to coordinate the administrative processes

involved in setting up the Unit for the Operational Management of Health and Welfare Information

(16 September 2010–31 March 2011) and one to formulate a permanent operating model for the unit (1 April

2011–31 December 2011). The Head of the Unit for the Operational Management of Health and Welfare

Information was a member of both steering groups. The Unit for the Operational Management of Health and

Welfare Information reported regularly to the steering groups regarding the progress of processes. The Unit for

the Operational Management of Health and Welfare Information helped to ensure that the external

organisations that were represented in the steering groups were given enough opportunities to steer processes

at the crucial stages.

The first steering group set up by the Director-General of the National Institute for Health and Welfare was

known as the steering group for planning the coordination of social welfare and health care information

management at the National Institute for Health and Welfare and its task was to coordinate the administrative

processes involved in setting up the unit between 16 September 2010 and 31 March 2011. The steering group

included representatives from the Finnish Ministry of Social Affairs and Health, the Association of Finnish Local

and Regional Authorities, the Social Insurance Institution of Finland, the various health care districts and the

National Institute for Health and Welfare.

Role Name Organisation Title

Chairman Pekka Puska National Institute for Health and Welfare Director-General Deputy Chairman Marina Erhola National Institute for Health and Welfare Assistant Director-General Member Anne Kallio Finnish Ministry of Social Affairs and Health Head of Development (Deputy Member Eija Koivuranta Finnish Ministry of Social Affairs and Health Director) Member Mikael Forss Social Insurance Institution of Finland Director (Deputy Member Veikko Hytönen Social Insurance Institution of Finland Head of Department)


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Member Kari Nenonen Association of Finnish Local and Regional Authorities Deputy Managing Director (Deputy member Jussi Merikallio Association of Finnish Local and Regional Authorities Director) Member Juhani Eskola National Institute for Health and Welfare Assistant Director-General Member Jaakko Penttinen National Institute for Health and Welfare Director for Administration Member Päivi Hämäläinen National Institute for Health and Welfare Head of Department Member Tero Meltti National Institute for Health and Welfare Planning Manager Member Ermo Haavisto Health care district of Kymi River Valley Medical Director (1) Secretary Vesa Jormanainen National Institute for Health and Welfare Senior Adviser (2)

(1) Representative of the Association of Health Care District Directors as of 16 December 2010

(2) Head of the Unit for the Operational Management of Health and Welfare Information as of 1 February 2011

The first steering group was tasked with

- coordinating and ensuring that the most important interested parties were involved in setting up the unit, - steering the setting up process, - formulating a strategy, organisational structure and management system for the new unit, - ensuring that the adoption of the new coordination model runs smoothly/systematically and seamlessly, and - ensuring that enough information is communicated about the setting up of the unit.

The second steering group set up by the Director-General of the National Institute for Health and Welfare was

tasked with formulating a permanent operating model for the unit between 1 April 2011 and 31 December 2011

and it included representatives from the Finnish Ministry of Social Affairs and Health, the Association of Finnish

Local and Regional Authorities, the Social Insurance Institution of Finland, the various health care districts and

the National Institute for Health and Welfare. The group also included one local authority representative.

Role Name Organisation Title Chairman Pekka Puska National Institute for Health and Welfare Director-General Deputy Chairman Marina Erhola National Institute for Health and Welfare Assistant Director-General Member Anne Kallio Finnish Ministry of Social Affairs and Health Head of Development (Deputy Member Eija Koivuranta Finnish Ministry of Social Affairs and Health Director) Member Mikael Forss Social Insurance Institution of Finland Director (Deputy Member Veikko Hytönen Social Insurance Institution of Finland Head of Department) (1) (Deputy member Marja Lindgren Social Insurance Institution of Finland Planning Manager) (2) Member Kari Nenonen Association of Finnish Local and Regional Authorities Deputy Managing Director (Deputy member Jussi Merikallio Association of Finnish Local and Regional Authorities Director) (3) Member Ermo Haavisto Health care district of Kymi River Valley Medical Director (4) Member Hannu Leskinen Health care district of Northern Ostrobothnia Director (5) Member Juhani Eskola National Institute for Health and Welfare Assistant Director-General Member Jaakko Penttinen National Institute for Health and Welfare Director for Administration (6) Member Päivi Hämäläinen National Institute for Health and Welfare Head of Department Member Tero Meltti National Institute for Health and Welfare Planning Manager Member Vesa Jormanainen National Institute for Health and Welfare Senior Adviser Secretary Viveca Bergman National Institute for Health and Welfare Development Manager (1) Deputy member until 29 April 2011

(2) Deputy member as of 29 April 2011

(3) Until 14 August 2011

(4) Representative of the Association of Health Care District Directors

(5) Second representative of the Association of Health Care District Directors as of 14 June 2011

(6) Until 31 August 2011

The second steering group was tasked with

- coordinating and ensuring that the most important interested parties were involved in setting up the unit and in formulating a permanent operating model for the operational management of information management in social services and health care,

- steering the formulation of a permanent operating model for the unit, - formulating objectives, an organisational structure and a management system for the permanent operating model of the unit, - ensuring that the adoption of the new coordination model runs smoothly/systematically and seamlessly, and - ensuring that enough information is communicated about the setting up of the unit.

The Unit for the Operational Management of Health and Welfare Information reports to the Finnish Ministry of

Social Affairs and Health according to the framework agreement (1 January 2011–31 December 2015) and the

accompanying 2011 financial agreement.


group to coordinate operational cooperation relating to social services and health care information


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management. The steering group’s term runs from 1 January 2012 until 31 December 2013 and it includes

representatives from the Finnish Ministry of Social Affairs and Health, the Finnish Medicines Agency, the National

Supervisory Authority for Welfare and Health, the Social Insurance Institution of Finland, the Population Register

Centre, the Association of Finnish Local and Regional Authorities and the National Institute for Health and

Welfare.

Role Name Organisation Title Chairman Vesa Jormanainen National Institute for Health and Welfare Head of the Unit for the

Operational Management of Health and Welfare Information

Deputy Chairman Tiina Palotie-Heino National Institute for Health and Welfare Head of the Information Structures and Classifications Unit

Member Anne Kallio Finnish Ministry of Social Affairs and Health Head of Development (Deputy Member Teemupekka Virtanen Finnish Ministry of Social Affairs and Health Senior Adviser) Member Juha-Pekka Nenonen Finnish Medicines Agency Director, Information

Resources Development (Deputy Member Petri Pääkkönen Finnish Medicines Agency Project and Systems

Manager) Member Maijaliisa Aho National Supervisory Authority for Welfare and Health Referendary Counsellor (Deputy member Ritva Kujala National Supervisory Authority for Welfare and Health Administrative Director Member Marja Lindgren Social Insurance Institution of Finland Planning Manager (Deputy Member Markku Suominen Social Insurance Institution of Finland IT Director) Member Pekka Jelekäinen Population Register Centre Director (Deputy Member Erkki Wuoma Population Register Centre Systems Integrator) Member Karri Vainio Association of Finnish Local and Regional Authorities Senior Adviser (Deputy member Kauko Hartikainen Association of Finnish Local and Regional Authorities Senior Adviser) Secretary Minna Saario National Institute for Health and Welfare Development Manager

The responsibilities of the steering group include

- to act as a forum for the exchange of information between the members of the steering group and to keep all members up to date on progress;

- to promote tangible cooperation with regard to operational issues relating to national information system services; - to coordinate cooperation in unexpected special circumstances; - to identify potential problems and to propose solutions; - to monitor progress and to support the adoption of national information systems; and - to find solutions for cooperation issues associated with the Unit for the Operational Management of Health and Welfare

Information as part of preparing and monitoring action plans.

The steering group can consult experts and appoint permanent consultants to the group.


group to coordinate IT projects associated with the operational management of social services and health care

information management. The steering group’s term runs from 9 December 2011 until 31 December 2013 and it

includes representatives from the Social Insurance Institution of Finland and the National Institute for Health and

Welfare.

Role Name Organisation Title Chairman Päivi Hämäläinen National Institute for Health and Welfare Head of the Information Department Deputy Chairman Markku Suominen Social Insurance Institution of Finland IT Director Member Vesa Jormanainen National Institute for Health and Welfare Head of the Unit for the Operational


Member Marja Lindgren Social Insurance Institution of Finland Planning Manager

The responsibilities of the IT projects steering group include

- to act as a forum for the exchange of information between the members of the steering group and to keep all members up to date on how projects are progressing;

- to promote tangible cooperation with regard to projects in operational issues relating to national information system services; - to coordinate cooperation and decision-making among the members of the steering group in special circumstances involving

the resources, funding or timescales of joint projects; - to identify risks involved in IT projects such as potential problems and to propose solutions;


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- to decide on new studies and the planning and launching of projects and to approve project plans and changes to plans as well as the closure of projects and final reports;

- to assign funds to projects and to coordinate the use of resources within the constraints of the available appropriations; and - to approve specifications to be used in the construction of information systems.

Issues are brought to the attention of the IT projects steering group by development managers and project

managers. According to the plan, legal counsels from the Unit for the Operational Management of Health and

Welfare Information and the Social Insurance Institution of Finland are invited to act as secretaries in the

steering group’s meetings. The steering group can consult experts and appoint permanent consultants to the

group.

9. RESOURCES AND FINANCES OF THE UNIT FOR THE OPERATIONAL MANAGEMENT OF

HEALTH AND WELFARE INFORMATION

Human resources

The operational management of national (electronic) information management in social services and health care

requires in-depth multidisciplinary know-how about the social welfare and health care service system, its

processes and practices as well as the work of different kinds of professionals. Planning, steering and monitoring

require at least communication and networking skills, ability to systematically monitor international

development as well as experience in implementing programmes and actions and developing and adopting

information systems as well as know-how about legislation, financial administration and human resources

management, procurement, communications, training and project management. In addition to the

aforementioned skills, the Unit for the Operational Management of Health and Welfare Information also has

access to other skills and services available within the National Institute for Health and Welfare.

According to the 2011 financial agreement, the National Institute for Health and Welfare must take Finland’s

National Productivity Programme into consideration when recruiting personnel for the Unit for the Operational

Management of Health and Welfare Information.

The workload of the Unit for the Operational Management of Health and Welfare Information amounted to

approximately 7.8 person-years of work in 2011. As of 1 January 2012, the Unit for the Operational

Management of Health and Welfare Information employs 12 people. The unit’s estimated workload for 2012 is

approximately 19 person-years of work.

Start date Position Name Education 01/02/2011 Head of Unit Vesa Jormanainen MD, MSc (Health Sciences), Specialist

in Public Health Medicine 01/03/2011 Development Manager Maritta Korhonen Licentiate in Education, MA, MSc

(Economics) 01/03/2011 Project Manager Jari Suhonen MSc (Social Sciences) 07/03/2011 Medical Director Heikki Virkkunen MD, Specialist in Anaesthesia and

Intensive Care 14/03/2011 Project Manager Riitta Konttinen BSc (Health Sciences) (open) Project Manager (1) 01/05/2011 Assistant (temporary) (2) Anna-Lena Wilenius 01/06/2011 Development Manager, Communications (3) Hilkka Miettinen MA 01/06/2011 Procurement Manager (4) Kati Laukola LLM 01/08/2011 Legal Counsel (5) Heli Haarala LLM 15/08/2011 Project Planner Merja Marvelin BBA 07/11/2011 Development Manager, Social Services (6) Minna Saario MSc (Social Sciences) 01/12/2011 Project Manager, Social Services (6) Maarit Laaksonen MSc (Health Sciences), MSc (Social

Sciences)


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(1) Jari Porrasmaa held the position from 1 April 2011 until 31 December 2011; a permanent employee will be recruited for the

position in 2012. (2) Sabbatical cover from 1 May 2011 until 1 April 2012; a permanent employee will be recruited for the position in 2012.

(3) Administratively part of the Communications Department; 100% of salary paid by the Unit for the Operational Management of

Health and Welfare Information

(4) Administratively part of the Financial Administration Unit of the Administrative Services Department; 60% of salary paid by the

Unit for the Operational Management of Health and Welfare Information (40% paid by the Financial Administration Unit)

(5) Administratively part of the Unit for the Operational Management of Health and Welfare Information; 50% of salary paid by the

Unit for the Operational Management of Health and Welfare Information (50% paid by the Information Structures and

Classifications Unit/Finnish Ministry of Finance Action Programme on eServices and eDemocracy)

(6) More specifically information management in social services

Several new people will be recruited for the unit in 2012: a senior adviser on the provision of training in

information system services, five senior advisers on regional cooperation and technical support as well as a

development manager for IT architecture. Permanent positions for one assistant and one project manager

(eArchive) will also be advertised.

Start date Position Applicants Deadline for applications dd/mm/2012 Senior Adviser, Information System Services Training 18 applicants 07/11/2011

dd/mm/2012 Senior Adviser, Regional Cooperation and Technical Support (1)

Helsinki University Central Hospital catchment area for highly

specialised medical care (Helsinki) 29 applicants 24/11/2011

Kuopio University Hospital catchment area for highly

specialised medical care (Kuopio) 45

Oulu University Hospital catchment area for highly

specialised medical care (Oulu) 58

Tampere University Hospital catchment area for highly

specialised medical care (Tampere) 34

Turku University Hospital catchment area for highly

specialised medical care (Turku) 20

dd/mm/2012 Development Manager, IT Architecture nn applicants dd/mm/2012 (1) Together the five catchment areas for highly specialised medical care comprise 20 health care districts; the positions will be

based in Helsinki, Kuopio, Oulu, Tampere and Turku.

Appropriations in the 2011 state budget

A total of EUR 16.4 million was assigned to item 33.01.25 (national electronic customer information systems for

social services and health care; 3-year carry-over term) in the 2011 state budget. The appropriations can be used

for six different purposes:

1) Strategic and operational planning and management of the National Archive of Health Information project (Finnish Ministry of Social Affairs and Health, National Institute for Health and Welfare);

2) Development and maintenance of national specifications relating to the National Archive of Health Information project (National Institute for Health and Welfare, Social Insurance Institution of Finland);

3) Compensation payable to the Social Insurance Institution of Finland according to the Finnish Act on the Electronic Processing of Customer Information in Social Welfare and Health Care Services (159/2007) and the Finnish Act on Electronic Prescriptions (61/2007) for the construction of the National Archive of Health Information (national electronic patient information directory and archive service, electronic prescriptions and prescription archive service and a portal for citizens to access their own prescriptions and customer information online) (Social Insurance Institution of Finland);

4) Development and implementation of an electronic customer information system for social services; 5) Granting of state aid towards efforts to increase the efficiency of local infrastructure and information system infrastructure in

social services and health care (Finnish Ministry of Social Affairs and Health, National Institute for Health and Welfare); and 6) Coordination of system development cooperation, adoption and dissemination (Municipal Project Coordination Office).

Explanation and content

The Finnish Government will make a budget-related proposal to the Parliament of Finland to amend the Finnish Act on the

Electronic Processing of Customer Information in Social Welfare and Health Care Services (159/2007) so as to include provisions

on setting up a Unit for the Operational Management of Health and Welfare Information at the National Institute for Health and

Welfare. The Social Insurance Institution of Finland will construct an electronic customer information archive according to the

Finnish Act on the Electronic Processing of Customer Information in Social Welfare and Health Care Services and the Finnish Act

on Electronic Prescriptions. Work on the archive will continue throughout 2011. The Finnish Ministry of Social Affairs and Health

will be responsible for the strategic planning and management of the initiative. The operational unit that will be established at


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the National Institute for Health and Welfare will coordinate the national specifications, management and implementation of

the National Archive of Health Information project, similar works in the social services sector after 2011 and EU-level

cooperation (epSOS). The development and implementation of an electronic customer information system for social services

will continue until 2015. The appropriations will also be used to grant state aid to local authorities and joint authorities for

simplifying and improving the local and regional infrastructure of social welfare and health care information systems.

Estimated use of appropriations (EUR 1,000)

EUR 1,000 Finnish Ministry of Social Affairs and Health

Strategic planning and management (Finnish Ministry of Social Affairs and Health) 400

Construction and maintenance of national information system services (Social Insurance Institution of Finland) 7,290

National Institute for Health and Welfare

Unit for the Operational Management of Health and Welfare Information (National Institute for Health and Welfare)

Salaries and operating costs of the Unit for the Operational Management of Health and Welfare Information 1,000

Producing and maintaining national specifications (National Institute for Health and Welfare, Social Insurance

Institution of Finland)

4,010

State aid towards improving local and regional information system infrastructure 3,100

Coordination of the adoption and development of the system (Municipal Project Coordination Office) 600

Framework agreement of the Finnish Ministry of Social Affairs and Health and the National Institute for Health

and Welfare for 2011–2015

The Finnish Ministry of Social Affairs and Health and the National Institute for Health and Welfare signed a five-

year (1 January 2011–31 December 2015) framework agreement on the implementation and funding of the

operational management of social welfare and health care information management (STM/153/2011 of

10 January 2011) at the beginning of 2011. According to the agreement, the National Institute for Health and

Welfare is responsible for coordinating the national specifications, management and implementation of the

National Archive of Health Information project, similar works in the social services sector after 2011 and EU-level

cooperation (epSOS). The development and implementation of an electronic customer information system for

social services will continue until 2015.

In order to meet its contractual obligations, the National Institute for Health and Welfare can use appropriations

assigned for this purpose to grant state aid to local authorities and joint authorities for simplifying and improving

the local and regional infrastructure of social welfare and health care information systems. State aid can also be

granted to other organisations for implementing and promoting the adoption of the services associated with the

National Archive of Health Information. The priorities and principles specified in the annual financial agreement

must be taken into consideration when granting state aid. The National Institute for Health and Welfare also

needs to consult the Finnish Ministry of Social Affairs and Health before deciding to grant state aid. Any state aid

granted must comply with the provisions of the Finnish Act on Discretionary Government Transfers (688/2001).

The costs arising from carrying out the assignment will be covered by appropriations assigned to these tasks in

the state budget. The amount of the appropriations and the purposes for which they can be spent will be

determined annually in a financial agreement according to the framework agreement. The scope of the actions

and annual funding are based on the appropriations assigned to the work in the state budget.

The framework agreement of the Finnish Ministry of Social Affairs and Health and the National Institute for

Health and Welfare is accompanied by a financial agreement for 2011 (STM/153/2011, project 514911001,

agreement 001/STO/EER/2011 of 10 January 2011). According to the financial agreement, the National Institute

for Health and Welfare can spend EUR 8.11 million of the appropriations assigned to item 33.01.25 (national

electronic customer information systems for social services and health care; 3-year carry-over term) in the 2011

state budget according to the associated itemisation. The National Institute for Health and Welfare must enter

any value added tax accrued as a result of spending appropriations in item 33.01.29.

The following table summarises the estimated use of appropriations according to the 2011 financial agreement

and the appropriations spent by 31 December 2011:


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Total 2011 financial agreement Spent by 31 December 2011

Salaries and operating costs of the Unit for the Operational


1,000,000 643,310.56

Producing and maintaining national specifications 4,010,000 1,180,601.04

epSOS 77,519.86

State aid towards improving local and regional information

system infrastructure

3,100,000 330,242.72

Total 8,110,000 2,231,674.28

The appropriations spent by 31 December 2011 were spent as follows:

Spent by 31 December 2011 Total EUR %

Materials and supplies 19,628.34 < 1.00

Personnel costs 649,332.61 29.10

Rents 2,443.05 < 1.00

Service procurement 1,152,425.07 51.64

Travel expenses 71,558.76 3.21

Other expenses 647.26 < 1.00

Financial expenses 25.10 < 1.00

Transfer expenses (state aid) 330,242.72 14.80

VAT expenses 5,371.37 < 1.00

Total 2,231,674.28 100.0

A total of EUR 2,231,674.28 of the EUR 8.11 million budgeted in the 2011 financial agreement was spent by

31 December 2011 (EUR 5,878,325.72 remaining). The term of the 2011 financial agreement associated with the

framework agreement of the Finnish Ministry of Social Affairs and Health and the National Institute for Health

and Welfare was consequently extended until 30 October 2013 (19 December 2011).

Financial reports are produced according to the reporting procedure of the National Institute for Health and

Welfare and the reporting obligations specified in the framework agreement with the Finnish Ministry of Social

Affairs and Health.

10. PROCUREMENT OF THE UNIT FOR THE OPERATIONAL MANAGEMENT OF HEALTH

AND WELFARE INFORMATION

To support its own know-how, the Unit for the Operational Management of Health and Welfare Information

procures development expertise (mostly for specifications) from the other units of the Information Department

of the National Institute for Health and Welfare and from the institute’s other divisions by means of internal

procurement (according to agreements). The Unit for the Operational Management of Health and Welfare

Information also procures know-how and consultancy from its partners and from the market by means of

competitive tendering or, in special circumstances, directly according to the Finnish Act on Public Contracts.

Most of the procurement of the Unit for the Operational Management of Health and Welfare Information relates

to development services, which do generally not only benefit the Unit for the Operational Management of Health

and Welfare Information or the National Institute for Health and Welfare internally. The outputs of development

services are published on open websites where they are also available for all other interested parties to use

freely. The outputs are designed to be used freely by service providers and producers as well as information

system suppliers.

Issues factored into procurement and partnership agreements include the gradual transfer of the responsibilities

of the Municipal Project Coordination Office to the Unit for the Operational Management of Health and Welfare

Information by 31 December 2011, the continuation of efforts to develop information management in social

services under the guidance of the Unit for the Operational Management of Health and Welfare Information as


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of 1 January 2012 and development initiatives carried out in connection with the Action Programme on eServices

and eDemocracy.


Competitive tendering of different kinds of IT services and contracts are an important part of the work of the

Unit for the Operational Management of Health and Welfare Information. As of 1 June 2011, any competitive

tendering and contracts of the Unit for the Operational Management of Health and Welfare Information are the

responsibility of a procurement manager whose salary is paid between the Unit for the Operational Management

of Health and Welfare Information and the Financial Administration Unit of the National Institute for Health and

Welfare. As part of its efforts to improve procurement processes, the Unit for the Operational Management of

Health and Welfare Information organised two events with experts from the Finnish Government’s central

procurement unit to familiarise the personnel of the Unit for the Operational Management of Health and

Welfare Information with framework agreements as well as competitive tendering procedures in general and IT

purchases in particular (2 December 2011, 9 December 2011).

The National Institute for Health and Welfare adopted new procurement guidelines (THL 1493/2.09.00/2011)

and guidelines for small purchases (less than EUR 30,000) (THL 1494/2.09.00/2011) at the beginning of 2012,

which the Unit for the Operational Management of Health and Welfare Information also follows.


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What did the Unit for the Operational Management of Health and Welfare Information

achieve in 2011?

A new unit was established at the National Institute for Health and Welfare in January 2011,

which was officially named the Unit for the Operational Management of Health and Welfare

Information.

During its first year in business, the Unit for the Operational Management of Health and

Welfare Information focused on building the unit’s operational preparedness. The new

responsibilities were harmonised with ongoing development processes and a new

management system established. While the primary objective was to ensure the continuity of

previously launched initiatives, the unit also took a bold approach to developing new

procedures and operating models.

The unit’s national coordination model requires a clear and comprehensive understanding of

the role, scope and responsibilities relating to strategic and operational management. The

Unit for the Operational Management of Health and Welfare Information strives to be

proactive in promoting dialogue between health care and social welfare organisations, the

most important national interest groups and information system developers, for example.

The law sets a challenging task to the Unit for the Operational Management of Health and

Welfare Information: to develop an ePrescriptions service, an eArchive service, an eAccess

portal for allowing citizens to access their own medical records and, most recently, an

information management service. The Unit for the Operational Management of Health and

Welfare Information is responsible for overseeing, monitoring and steering first public sector

health care providers and then private sector health care providers in adopting the

ePrescriptions service by 2014 and the eArchive service by 2015. The actions and decisions

taken and the operating models developed by the Unit for the Operational Management of

Health and Welfare Information will have an impact on every Finn.