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Sairaanhoitajien kokemuksia potilas- ja asiakastietojärjestelmistä kartoitettiin nyt toiseen kertaan valtakunnallisella kyselytutkimuksella. Tutkimuksen tavoitteena on tuottaa tietoa kansallisessa Tieto hyvinvoinnin ja uudistuvien palvelujen tukena – Sote-tieto hyötykäyttöön 2020 -strategiassa asetettujen tavoitteiden saavuttamisesta yhden osa-alueen (Kyvykkäille käyttäjille fiksut järjestelmät) osalta sairaanhoitajien näkökulmasta. Näitä strategian osatavoitteita mukailevat tutkimuskysymykset ovat: Miten asiakas- ja potilastietojärjestelmät tukevat hoitajien työtehtäviä, yhteistyötä ja tiedonkulkua? Minkälaiseksi hoitajat arvioivat nykyisen käyttökokemuksensa, koulutuksensa, perehdyttämisen toimintatapojen muutokseen sekä lisäkoulutustarpeensa? Miten hyödylliseksi hoitajat arvioivat asiakas- ja potilastietojärjestelmät työssään? Tutkimusaineisto kerättiin sähköisellä kyselyllä hyödyntäen Sairaanhoitajaliiton, Tehyn sekä Akavan sairaanhoitajat ja Taja ry:n (TAJA) jäsenrekistereitä keväällä 2020. Kyselyyn vastasi hyväksyttävästi 3 610 sairaanhoitajaa, kätilöä tai terveydenhoitajaa, jotka toimivat julkisessa terveydenhuollossa, sosiaalihuollossa tai yksityisellä sektorilla. Vastaajat olivat kokeneita asiakas- ja potilastietojärjestelmien käyttäjiä. Valtaosa heistä kirjautui vähintään yhteen järjestelmään päivittäin, osa jopa viiteen tai sitä useampaan järjestelmään. Tulosten mukaan vastaajat eivät olleet tyytyväisiä järjestelmien tukeen niiden käytön vaatiman pitkän perehdytyksen vuoksi. Tiedonkulkuun hoitajien välillä omassa organisaatiossa oltiin tyytyväisiä, mutta tiedonkulussa eri organisaatioissa toimivien hoitajien välillä sekä hoitajien ja potilaiden välillä koettiin puutteita. Enemmistö vastaajista koki tietotekniset perustaitonsa, taitonsa tehdä kirjaukset asiakas- tai potilastietojärjestelmään, taitonsa tehdä potilaan hoidon kirjaus hoitotyön prosessin mukaisesti sekä tietosuojan ja tietoturvan periaatteiden hyödyntämisensä päivittäisessä työssä hyviksi tai erinomaisiksi kaikissa toimintaympäristöissä. Yli puolet vastaajista ei ilmoittanut lisäkoulutustarpeita. Kuitenkin hoitajat toivoivat työnantajiltaan enemmän täydennyskoulutusta. Vastaajat kokivat ongelmalliseksi järjestelmien kyvyn tai toiminnallisuuden koostaa yhteenvetonäkymiä. Yhteenvetona voidaan todeta sairaanhoitajilla olevan hyvät tai erinomaiset taidot käyttää asiakas- ja potilastietojärjestelmiä, mutta perehdytystä tarvitaan tukemaan digitaalisten palvelujen tuottamissa työprosesseissa. Hoidon jatkuvuus, laatu ja potilasturvallisuus ovat erityisesti hyötyjä, joita tietojärjestelmien käytöllä jo saavutetaan.

Objectives: This paper draws attention to: i) key considerations for evaluating artificial intelligence (AI) enabled clinical decision support; and ii) challenges and practical implications of AI design, development, selection, use, and ongoing surveillance. Method: A narrative review of existing research and evaluation approaches along with expert perspectives drawn from the International Medical Informatics Association (IMIA) Working Group on Technology Assessment and Quality Development in Health Informatics and the European Federation for Medical Informatics (EFMI) Working Group for Assessment of Health Information Systems. Results: There is a rich history and tradition of evaluating AI in healthcare. While evaluators can learn from past efforts, and build on best practice evaluation frameworks and methodologies, questions remain about how to evaluate the safety and effectiveness of AI that dynamically harness vast amounts of genomic, biomarker, phenotype, electronic record, and care delivery data from across health systems. This paper first provides a historical perspective about the evaluation of AI in healthcare. It then examines key challenges of evaluating AI-enabled clinical decision support during design, development, selection, use, and ongoing surveillance. Practical aspects of evaluating AI in healthcare, including approaches to evaluation and indicators to monitor AI are also discussed. Conclusion: Commitment to rigorous initial and ongoing evaluation will be critical to ensuring the safe and effective integration of AI in complex sociotechnical settings. Specific enhancements that are required for the new generation of AI-enabled clinical decision support will emerge through practical application.

Background Health information systems (HIS) have been widely adopted in nursing to increase the efficiency and safety of patient care. Previous studies have shown that low HIS quality is a barrier to obtaining such benefits from HIS use. The association between HIS quality and HIS benefits has not, however, been studied taking into account the characteristics of the work environment, such as job strain. This study examined the joint associations of HIS quality and job strain with the perceived patient care-related benefits of HIS use in nursing. Methods Cross-sectional survey data of 2707 Finnish registered nurses were used to examine the associations of two indicators of HIS quality (ease of use and technical quality) and job strain with the benefits of HIS use. Missing data were addressed with multiple imputation and linear regression was used to examine the associations. All analyses were adjusted for age, gender, and employment sector. Results Together with the covariates, HIS quality explained 14% to 20% of the variance in the perceived benefits of HIS use. The additional variance explained by job strain was only 1%. HIS quality in terms of ease of use interacted with job strain in predicting HIS benefits. Nurses who found HIS difficult to use and experienced high job strain reported the lowest benefits from HIS use. By contrast, nurses who found HIS easy to use considered HIS beneficial for improving patient care even if they experienced high job strain. Conclusions The results suggest that healthcare organizations should focus on ensuring good HIS quality to improve patient care through HIS use in nursing. Exposure to job strain may intensify the association between low HIS quality and lower patient care-related benefits from HIS use. HIS with good quality seem to improve patient care even in a high-strain work environment. Key messages Nurses who work with low-quality health information systems and experience job strain perceive the systems least beneficial for improving patient care. High-quality information systems, by contrast, are perceived to improve patient care even in a high-strain work environment.

BACKGROUND Electronic health records (EHRs) are expected to provide many clinical and organizational benefits. Simultaneously, the end users may face unintended consequences, such as stress and increased cognitive workload, due to poor EHR usability. However, whether the effects of usability depend on end user characteristics, such as career stage or age, remains poorly understood. OBJECTIVE The objective of this study was to examine the associations of EHR usability and user age with stress related to information systems and cognitive failures among registered nurses. METHODS A cross-sectional survey design was employed in Finland in 2017. A total of 3383 registered nurses responded to the nationwide electronic survey. Multiple linear regression was used to examine the associations of EHR usability (eg, how easily information can be found and a patient’s care can be documented) and user age with stress related to information systems and cognitive failures. Interaction effects of EHR usability and age were also tested. Models were adjusted for gender and employment sector. RESULTS Poor EHR usability was associated with higher levels of stress related to information systems (β=.38; PPP CONCLUSIONS Information system stress due to poor EHR usability afflicts younger and older nurses alike. However, younger nurses starting their careers may be more cognitively burdened if they find EHR systems difficult to use compared to older nurses. Adequate support in using the EHRs may be particularly important to young registered nurses, who have a lot to learn and adopt in their early years of practice.

Objectives: The paper draws attention to: i) key considerations involving the confidentiality, privacy, and security of shared data; and ii) the requirements needed to build collaborative arrangements encompassing all stakeholders with the goal of ensuring safe, secure, and quality use of shared data. Method: A narrative review of existing research and policy approaches along with expert perspectives drawn from the International Medical Informatics Association (IMIA) Working Group on Technology Assessment and Quality Development in Health Care and the European Federation for Medical Informatics (EFMI) Working Group for Assessment of Health Information Systems. Results: The technological ability to merge, link, re-use, and exchange data has outpaced the establishment of policies, procedures, and processes to monitor the ethics and legality of shared use of data. Questions remain about how to guarantee the security of shared data, and how to establish and maintain public trust across large-scale shared data enterprises. This paper identifies the importance of data governance frameworks (incorporating engagement with all stakeholders) to underpin the management of the ethics and legality of shared data use. The paper also provides some key considerations for the establishment of national approaches and measures to monitor compliance with best practice. Conclusion: Data sharing endeavours can help to underpin new collaborative models of health care which provide shared information, engagement, and accountability amongst all stakeholders. We believe that commitment to rigorous evaluation and stakeholder engagement will be critical to delivering health data benefits and the establishment of collaborative models of health care into the future.

Terveydenhuollon ammattilaisten kokemuksia potilastietojärjestelmistään on maailmanlaajuisesti kartoitettu vähän, vaikka käyttäjäkokemukset ovat keskeinen osa järjestelmien kehitystä ja arviointia. Sairaanhoitajien kokemusten valtakunnallinen kartoitus tehtiin ensimmäistä kertaa Suomessa alkuvuodesta 2017. Kohteena olivat työikäiset sairaanhoitajat, terveydenhoitajat ja kätilöt Sairaanhoitajaliiton ja Tehyn jäsenrekisteristä. Vastaava tutkimus on tehty lääkäreille vuosina 2010, 2014 ja 2017. Menetelmänä oli lääkärikyselyn pohjalta muokattu sähköinen kyselylomake, jonka Sairaanhoitajaliitto ja Tehy lähettivät jäsenilleen. Yhteensä 3607 sairaanhoitajaa vastasi kyselyyn. Vastaukset ryhmiteltiin Sote-tieto hyötykäyttöön -strategian aihealueen ”Kyvykkäille käyttäjille fiksut järjestelmät” tavoitteiden mukaisiin osa-alueisiin. Kaikissa osa-alueissa todettiin eroja sekä potilastietojärjestelmien tuotemerkkien että vastaajien toimintaympäristöjen välillä. Yksi keskeisimpiä korjattavista ongelmista oli saman asian kirjaaminen moneen paikkaan. Sen voidaan katsoa altistavan virheille ja osoittavan huonosti onnistunutta tietojärjestelmäintegraatiota. Kehittämiskohteiksi nousivat myös tietojärjestelmien käyttökatkot, jotka on aiemmassa kirjallisuudessa todettu riskiksi potilasturvallisuudelle. Tutkimuksessa löytyi eroja tuotemerkkien välillä tietojärjestelmien käytettävyydessä ja potilaan hoidossa tarvittavan, ajantasaisen ja laadukkaan tiedon saamisessa paikallisesti, alueellisesti ja kansallisesti. Vastaajat kokivat tietojärjestelmien edellyttämien toimintatapojen muutosten käyttökoulutuksen riittämättömäksi. Tietojärjestelmien kehittämistyöhön aktiivisesti osallistuvat antoivat muita paremman kouluarvosanan tietojärjestelmälleen. Tätä selvitetään tarkemmin erillisessä artikkelissa. Osallistuminen tietojärjestelmien kehittämistyöhön ja koulutus vievät alkuun aikaa asiakas- ja potilastyöltä, mutta hyvän käytettävyyden ja käyttötaidon voidaan myöhemmin odottaa säästävän ammattilaisten aikaa tietojärjestelmien käytöltä suoraan asiakas- ja potilastyöhön. Tunnistetut erot potilastietojärjestelmien käytettävyydessä ja tuessa työlle sekä hoidon laadulle auttavat tunnistamaan hyviä käytäntöjä eri toimintaympäristöissä sairaanhoitajan ajankäytön tehostamiseksi ja potilasturvallisuuden ja yhteistyön lisäämiseksi. Sairaanhoitajia on kuultava paremmin tietojärjestelmiä kehitettäessä. Organisaatioiden on syytä suunnitella tietojärjestelmäkoulutukset niin, että ammattilaisten osaaminen pysyy ajan tasalla tietojärjestelmien ja niiden käyttötapojen kehittyessä. Myös sairaanhoitajaliiton sähköisten terveyspalveluiden strategia korostaa digiosaamista ja kehitystyöhön osallistumista., Globally, there are only a few studies on healthcare professionals' experiences of their patient information systems, although user experiences are a key component of system development and assessment. A nationwide survey of nurses' experiences was conducted for the first time in Finland in early 2017. The survey was targeted to working-age nurses, community nurses and midwives from the Membership Registers of the Nursing Association and the Tehy. A similar study has been conducted for physicians in 2010, 2014 and 2017. An electronic questionnaire, based on the physicians’ questionnaire, was sent by the Nursing Association and Tehy to their members. A total of 3607 nurses responded to the questionnaire. The results were grouped using the objectives of the Finnish eHealth and eSocial 2020 Strategy theme "Smart Systems for Capable Users". Responses differed by patient information system brands and by the respondents' operating environments. One of the most prominent problems was the need to record the same thing in many places, which can expose to errors and indicates poor information system integration. Poor stability of information systems was also identified as a common problem; identified as a risk to patient safety in previous literature. There were differences between brands in usability of information systems and availability of up-to-date and high quality information in patient care locally, regionally and nationally. Respondents felt that in-service training was inadequate with regard to changes in operating methods required by information systems. Active user participation in the development of information systems was associated with better school grades given by the respondent for the information system. This will be studied in more detail in a separate article. Participation in the development of information systems and training take initially time from direct customer and patient work, but good usability and usage skills can later be expected to save time due to fluent use of information systems. The system and context specific differences in the information system usability and support to work as well as quality of care identified in this study can be used to pinpoint good design practices in different contexts of use. This is needed to improve efficiency of the nurses’ work and to increase patient safety and co-operation. Nurses need to be better consulted when developing information systems. Organizations need to design information system training so that the skills of the professionals remain up to date as information systems and their usage patterns evolve. The Nursing Association's e-Health Strategy also emphasizes the user eHealth competence and participation in development work.

Factors influencing the reporting of patient safety incidents that result from health information technology (HIT) failure are poorly understood. We examined whether organizational justice is associated with the non-reporting of HIT system-related safety incidents among registered nurses. Cross-sectional survey data were collected from nurses (N = 1399) who reported encountering a HIT system-related patient safety incident within the past 12 months. Selecting one or more reasons for not filing an incident report from a predefined list of potential reasons was used as an indicator for non-reporting. Logistic regression models were fit to predict the reason-specific likelihood of non-reporting with organizational justice. High organizational justice was associated with a reduced likelihood of non-reporting if non-reporting occurred because reporting was too hard or took too much time (OR = 0.81, 95% CI 0.67 to 0.96), because the reporting had no impact on the organization's processes (OR = 0.63, 95% CI 0.53 to 0.76), because the respondent was worried about the consequences (OR = 0.61, 95% CI 0.43 to 0.87), or because the respondent was not required to file a report (OR = 0.67, 95% CI 0.51 to 0.89). Justice was not associated with non-reporting if it occurred due to the lack of access to a reporting system, because no actual harm was caused to the patient, or some other, non-specified reason. The associations were robust to adjustment for several nurse and work characteristics. The results suggest that non-reporting of HIT system-related safety incidents is less common in a high-justice work environment. Fair treatment of nurses may encourage their reporting of safety incidents.

In recent years, digital health care and social welfare services have been spreading rapidly and partly replacing face-to-face services, particularly in developed countries. This may lead to a pronounced digital inequality. This population-based study of Finnish adults ( N = 4495) examined the associations of offline resources with perceived benefits from online services and the mediating effects of access, skills and attitudes in these associations. The results indicated that those with lower personal, economic and social offline resources perceived online services as less beneficial. This was largely explained by poor access to the services, poor digital skills and negative attitudes towards online services. To increase equality, it would be important to improve Internet access and digital skills and implement means to address negative attitudes, especially among vulnerable groups. Moreover, online health and social welfare services should be designed to be more inclusive.

Purpose To explore the impacts that structuring of electronic health records (EHRs) has had from the perspective of secondary use of patient data as reflected in currently published literature. This paper presents the results of a systematic literature review aimed at answering the following questions; (1) what are the common methods of structuring patient data to serve secondary use purposes; (2) what are the common methods of evaluating patient data structuring in the secondary use context, and (3) what impacts or outcomes of EHR structuring have been reported from the secondary use perspective. Methods The reported study forms part of a wider systematic literature review on the impacts of EHR structuring methods and evaluations of their impact. The review was based on a 12-step systematic review protocol adapted from the Cochrane methodology. Original articles included in the study were divided into three groups for analysis and reporting based on their use focus: nursing documentation, medical use and secondary use (presented in this paper). The analysis from the perspective of secondary use of data includes 85 original articles from 1975 to 2010 retrieved from 15 bibliographic databases. Results The implementation of structured EHRs can be roughly divided into applications for documenting patient data at the point of care and application for retrieval of patient data (post hoc structuring). Two thirds of the secondary use articles concern EHR structuring methods which were still under development or in the testing phase. Methods of structuring patient data such as codes, terminologies, reference information models, forms or templates and documentation standards were usually applied in combination. Most of the identified benefits of utilizing structured EHR data for secondary use purposes concentrated on information content and quality or on technical quality and reliability, particularly in the case of Natural Language Processing (NLP) studies. A few individual articles evaluated impacts on care processes, productivity and costs, patient safety, care quality or other health impacts. In most articles these endpoints were usually discussed as goals of secondary use and less as evidence-supported impacts, resulting from the use of structured EHR data for secondary purposes. Conclusions Further studies and more sound evaluation methods are needed for evidence on how EHRs are utilized for secondary purposes, and how structured documentation methods can serve different users’ needs, e.g. administration, statistics and research and development, in parallel to medical use purposes.

Summary Objectives: To set the scientific context and then suggest principles for an evidence-based approach to secondary uses of clinical data, covering both evaluation of the secondary uses of data and evaluation of health systems and services based upon secondary uses of data. Method: Working Group review of selected literature and policy approaches. Results: We present important considerations in the evaluation of secondary uses of clinical data from the angles of governance and trust, theory, semantics, and policy. We make the case for a multi-level and multi-factorial approach to the evaluation of secondary uses of clinical data and describe a methodological framework for best practice. We emphasise the importance of evaluating the governance of secondary uses of health data in maintaining trust, which is essential for such uses. We also offer examples of the re-use of routine health data to demonstrate how it can support evaluation of clinical performance and optimize health IT system design. Conclusions: Great expectations are resting upon “Big Data” and innovative analytics. However, to build and maintain public trust, improve data reliability, and assure the validity of analytic inferences, there must be independent and transparent evaluation. A mature and evidence-based approach needs not merely data science, but must be guided by the broader concerns of applied health informatics.

BACKGROUND The number of online services in health care is increasing rapidly in developed countries. Users are expected to take a more skilled and active role in taking care of their health and prevention of ill health. This induces risks that users (especially those who need the services the most) will drop out of digital services, resulting in a digital divide or exclusion. To ensure wide and equal use of online services, all users must experience them as beneficial. OBJECTIVE This study aimed to examine associations of (1) demographics (age, gender, and degree of urbanization), (2) self-rated health, (3) socioeconomic position (education, experienced financial hardship, labor market position, and living alone), (4) social participation (voting, satisfaction with relationships, and keeping in touch with friends and family members), and (5) access, skills, and extent of use of information and communication technologies (ICT) with perceived benefits of online health care and social welfare services. Associations were examined separately for perceived health, economic, and collaboration benefits. METHODS We used a large random sample representative of the Finnish population including 4495 (56.77% women) respondents aged between 20 and 97 years. Analyses of covariance were used to examine the associations of independent variables with perceived benefits. RESULTS Access to online services, ICT skills, and extent of use were associated with all examined benefits of online services. ICT skills seemed to be the most important factor. Poor self-rated health was also consistently associated with lower levels of perceived benefits. Similarly, those who were keeping in touch with their friends and relatives at least once a week perceived online services more often beneficial in all the examined dimensions. Those who had experienced financial hardship perceived fewer health and economic benefits than others. Those who were satisfied with their relationships reported higher levels of health and collaboration benefits compared with their counterparts. Also age, education, and degree of urbanization had some statistically significant associations with benefits but they seemed to be at least partly explained by differences in access, skills, and extent of use of online services. CONCLUSIONS According to our results, providing health care services online has the potential to reinforce existing social and health inequalities. Our findings suggest that access to online services, skills to use them, and extent of use play crucial roles in perceiving them as beneficial. Moreover, there is a risk of digital exclusion among those who are socioeconomically disadvantaged, in poor health, or socially isolated. In times when health and social services are increasingly offered online, this digital divide may predispose people with high needs for services to exclusion from them.

Usability associates with patient safety and quality of care. This article reports results from nation-wide usability-focused survey studies for physicians and nurses in Finland. Earlier research has shown dissatisfaction and serious deficiencies, which hamper the efficient use of health information systems (HIS); however, evaluation studies covering the viewpoints of both user groups are practically lacking. Our study aimed at comparing end-users' experiences on the usability of electronic health record (EHR) systems by employment sector and EHR brand.To measure usability, we used the validated National Usability-focused HIS Scale (NuHISS). For this study, we selected 11 usability statements that relate to technical quality (n = 3), ease of use (n = 6), benefits (n = 1) and collaboration (n = 1), and were identical in both surveys. We report the responses from 3013 physicians and 2560 nurses working in public sector hospitals or primary care health centers in 2017.Results in total and by healthcare sector showed notable differences between nurses' and physicians' experiences on usability of their EHR systems. Physicians were more satisfied than nurses on technical quality and learnability of the EHR-systems, while nurses experienced the ease of use better and were more satisfied with collaboration aspects than physicians. Two EHR brands used in hospitals appeared to have succeeded in supporting physician workflows, while two others used in health centers were more suitable for nurses' needs.Nurses' and physicians' experiences on EHR usability appear to vary more by EHR brand and employment sector rather than either professional group being generally more satisfied. Development of EHR systems should consider the perspectives of these two main user groups and their working contexts.

The interest towards monitoring and guiding the development of healthcare information systems on a national level is increasing. In this paper, we report results from the three cross-sectional surveys on physicians' experiences on usability of their electronic health record (EHR) systems in Finland. The research question was: How have physicians' experiences on usability of their EHR systems evolved between 2010 and 2017? The data consists of responses to six usability statements from Finnish physicians working in public healthcare centres and hospitals. Among physicians working in healthcare centres, results between 2010 and 2017 show change for the worse. Among their colleagues in hospitals, results indicate slight improvement only in the domain of ease of use of the systems. In general, contrary to general expectations, the results do not show improvements between the years 2010, 2014 and 2017. In the future, we will continue the monitoring work in Finland on a national level from the viewpoint of physicians and other professional groups.

BackgroundConstantly changing and difficult-to-use information systems have arisen as a significant source of stress in physicians’ work. Physicians have reported several usability problems, system failures, and a lack of integration between the systems and have experienced that systems poorly support the documentation and retrieval of patient data. This stress has kept rising in the 21st century, and it seems that it may also affect physicians’ well-being.ObjectiveThis study aimed to examine the associations of (1) usability variables (perceived benefits, technical problems, support for feedback, and user-friendliness), (2) the number of systems in daily use, (3) experience of using information systems, and (4) participation in information systems development work with physicians’ distress and levels of stress related to information systems (SRIS) levels.MethodsA cross-sectional survey was conducted among 4018 Finnish physicians (64.82%, 2572 out of 3968 women) aged between 24 and 64 years (mean 46.8 years) in 2017. The analyses of covariance were used to examine the association of independent variables with SRIS and distress (using the General Health Questionnaire) adjusted for age, gender, employment sector, specialization status, and the electronic health record system in use.ResultsHigh levels of technical problems and a high number of systems in daily use were associated with high levels of SRIS, whereas high levels of user-friendliness, perceived benefits, and support for feedback were associated with low levels of SRIS. Moreover, high levels of technical problems were associated with high levels of psychological distress, whereas high levels of user-friendliness were associated with low distress levels. Those who considered themselves experienced users of information systems had low levels of both SRIS and distress.ConclusionsIt seems that by investing in user-friendly systems with better technical quality and good support for feedback that professionals perceive as being beneficial would improve the work-related well-being and overall well-being of physicians. Moreover, improving physicians’ skills related to information systems by giving them training could help to lessen the stress that results from poorly functioning information systems and improve physicians’ well-being.

BACKGROUND Constantly changing and difficult-to-use information systems have arisen as a significant source of stress in physicians’ work. Physicians have reported several usability problems, system failures, and a lack of integration between the systems and have experienced that systems poorly support the documentation and retrieval of patient data. This stress has kept rising in the 21st century, and it seems that it may also affect physicians’ well-being. OBJECTIVE This study aimed to examine the associations of (1) usability variables (perceived benefits, technical problems, support for feedback, and user-friendliness), (2) the number of systems in daily use, (3) experience of using information systems, and (4) participation in information systems development work with physicians’ distress and levels of stress related to information systems (SRIS) levels. METHODS A cross-sectional survey was conducted among 4018 Finnish physicians (64.82%, 2572 out of 3968 women) aged between 24 and 64 years (mean 46.8 years) in 2017. The analyses of covariance were used to examine the association of independent variables with SRIS and distress (using the General Health Questionnaire) adjusted for age, gender, employment sector, specialization status, and the electronic health record system in use. RESULTS High levels of technical problems and a high number of systems in daily use were associated with high levels of SRIS, whereas high levels of user-friendliness, perceived benefits, and support for feedback were associated with low levels of SRIS. Moreover, high levels of technical problems were associated with high levels of psychological distress, whereas high levels of user-friendliness were associated with low distress levels. Those who considered themselves experienced users of information systems had low levels of both SRIS and distress. CONCLUSIONS It seems that by investing in user-friendly systems with better technical quality and good support for feedback that professionals perceive as being beneficial would improve the work-related well-being and overall well-being of physicians. Moreover, improving physicians’ skills related to information systems by giving them training could help to lessen the stress that results from poorly functioning information systems and improve physicians’ well-being.

Objective: To pilot benchmark measures of health information and communication technology (ICT) availability and use to facilitate cross-country learning. Materials and Methods: A prior Organization for Economic Cooperation and Development–led effort involving 30 countries selected and defined functionality-based measures for availability and use of electronic health records, health information exchange, personal health records, and telehealth. In this pilot, an Organization for Economic Cooperation and Development Working Group compiled results for 38 countries for a subset of measures with broad coverage using new and/or adapted country-specific or multinational surveys and other sources from 2012 to 2015. We also synthesized country learnings to inform future benchmarking. Results: While electronic records are widely used to store and manage patient information at the point of care—all but 2 pilot countries reported use by at least half of primary care physicians; many had rates above 75%—patient information exchange across organizations/settings is less common. Large variations in the availability and use of telehealth and personal health records also exist. Discussion: Pilot participation demonstrated interest in cross-national benchmarking. Using the most comparable measures available to date, it showed substantial diversity in health ICT availability and use in all domains. The project also identified methodological considerations (e.g., structural and health systems issues that can affect measurement) important for future comparisons. Conclusion: While health policies and priorities differ, many nations aim to increase access, quality, and/or efficiency of care through effective ICT use. By identifying variations and describing key contextual factors, benchmarking offers the potential to facilitate cross-national learning and accelerate the progress of individual countries.

Background The number of online services in health care is increasing rapidly in developed countries. Users are expected to take a more skilled and active role in taking care of their health and prevention of ill health. This induces risks that users (especially those who need the services the most) will drop out of digital services, resulting in a digital divide or exclusion. To ensure wide and equal use of online services, all users must experience them as beneficial. Objective This study aimed to examine associations of (1) demographics (age, gender, and degree of urbanization), (2) self-rated health, (3) socioeconomic position (education, experienced financial hardship, labor market position, and living alone), (4) social participation (voting, satisfaction with relationships, and keeping in touch with friends and family members), and (5) access, skills, and extent of use of information and communication technologies (ICT) with perceived benefits of online health care and social welfare services. Associations were examined separately for perceived health, economic, and collaboration benefits. Methods We used a large random sample representative of the Finnish population including 4495 (56.77% women) respondents aged between 20 and 97 years. Analyses of covariance were used to examine the associations of independent variables with perceived benefits. Results Access to online services, ICT skills, and extent of use were associated with all examined benefits of online services. ICT skills seemed to be the most important factor. Poor self-rated health was also consistently associated with lower levels of perceived benefits. Similarly, those who were keeping in touch with their friends and relatives at least once a week perceived online services more often beneficial in all the examined dimensions. Those who had experienced financial hardship perceived fewer health and economic benefits than others. Those who were satisfied with their relationships reported higher levels of health and collaboration benefits compared with their counterparts. Also age, education, and degree of urbanization had some statistically significant associations with benefits but they seemed to be at least partly explained by differences in access, skills, and extent of use of online services. Conclusions According to our results, providing health care services online has the potential to reinforce existing social and health inequalities. Our findings suggest that access to online services, skills to use them, and extent of use play crucial roles in perceiving them as beneficial. Moreover, there is a risk of digital exclusion among those who are socioeconomically disadvantaged, in poor health, or socially isolated. In times when health and social services are increasingly offered online, this digital divide may predispose people with high needs for services to exclusion from them.

BACKGROUND Problems in the usability of health information systems (HISs) are well acknowledged, but research still lacks a validated questionnaire for measuring and monitoring different dimensions of usability of HISs. Such questionnaires are needed not only for research but also for developing usability of HISs from the viewpoint of end-user experiences. OBJECTIVE This study aimed to develop and test the validity of the questionnaire measuring the National Usability-Focused HIS-Scale (NuHISS) among a nationally representative sample of Finnish physicians. METHODS We utilized 2 cross-sectional data collected from a random sample of Finnish physicians in 2014 (N=3781; of which 2340 [61.9%] were women) and 2017 (N=4018; of which 2604 [64.8%] were women). Exploratory and confirmatory factor analyses (structural equation modeling [SEM]) were applied to test the structural validity of the NuHISS. As the concurrent validity measure, we used the self-reported overall quality of the electronic health record system (school grade) provided by the participants using marginal structural models. RESULTS The exploratory factor analyses with Varimax rotation suggested that the 7-factor solution did offer a good fit to the data in both samples (C2=2136.14 in 2014 and C2=2109.83 in 2017, both P CONCLUSIONS NuHISS provides a useful tool for measuring usability of HISs among physicians and offers a valid measure for monitoring the long-term development of HISs on a large scale. The relative importance of items needs to be assessed against national electronic health policy goals and complemented with items that have remained outside the NuHISS from the questionnaire when appropriate.

The Nordic eHealth Research Network, a subgroup of the Nordic Council of Ministers eHealth group, is working on developing indicators to monitor progress in availability, use and outcome of eHealth applications in the Nordic countries. This paper reports on the consecutive analysis of National eHealth policies in the Nordic countries from 2012 to 2016. Furthermore, it discusses the consequences for the development of indicators that can measure changes in the eHealth environment arising from the policies. The main change in policies is reflected in a shift towards more stakeholder involvement and intensified focus on clinical infrastructure. This change suggests developing indicators that can monitor understandability and usability of eHealth systems, and the use and utility of shared information infrastructure from the perspective of the end-users - citizens/patients and clinicians in particular.

Background: Among the important stress factors for physicians nowadays are poorly functioning, time consuming and inadequate information systems. The present study examined the predictors of physicians' stress related to information systems (SRIS) among Finnish physicians. The examined predictors were cognitive workload, staffing problems, time pressure, problems in teamwork and job satisfaction, adjusted for baseline levels of SRIS, age, gender and employment sector. Methods: The study has a follow-up design with two survey data collection waves, one in 2006 and one in 2015, based on a random sample of Finnish physicians was used. The present study used a sample that included 1109 physicians (61.9% women; mean age in 2015 was 54.5; range 34-72) who provided data on the SRIS in both waves. The effects of a) predictor variable levels in 2006 on SRIS in 2015 and b) the change in the predictor variables from 2006 to 2015 on SRIS in 2015 were analysed with linear regression analyses. Results: Regression analyses showed that the higher level of cognitive workload in 2006 significantly predicted higher level of SRIS in 2015 (beta = 0.08). The reciprocity of this association was tested with cross-lagged structural equation model analyses which showed that the direction of the association was from cognitive workload to SRIS, not from SRIS to cognitive workload. Moreover, increases in time pressure (beta = 0.16) and problems in teamwork (beta = 0.10) were associated with higher levels of SRIS in 2015, whereas job satisfaction increase was associated with lower SRIS (beta = -0.06). Conclusions: According to our results, physicians' cognitive workload may have long-lasting negative ramifications in regard to how stressful physicians experience their health information systems to be. Thus, organisations should pay attention to physicians workload if they wish physicians to master all the systems they need to use. It is also important to provide physicians with enough time and collegial support in their system-related problems, and in learning new systems and system updates.

Summary Objectives: To review the potential contribution of Information and Communication Technology (ICT) to enable patient-centric and coordinated care, and in particular to explore the role of patient portals as a developing ICT tool, to assess the available evidence, and to describe the evaluation challenges. Methods: Reviews of IMIA, EFMI, and other initiatives, together with literature reviews. Results: We present the progression from care coordination to care integration, and from patient-centric to person-centric approaches. We describe the different roles of ICT as an enabler of the effective presentation of information as and when needed. We focus on the patient‘s role as a co-producer of health as well as the focus and purpose of care. We discuss the need for changing organisational processes as well as the current mixed evidence regarding patient portals as a logical tool, and the reasons for this dichotomy, together with the evaluation principles supported by theoretical frameworks so as to yield robust evidence. Conclusions: There is expressed commitment to coordinated care and to putting the patient in the centre. However to achieve this, new interactive patient portals will be needed to enable peer communication by all stakeholders including patients and professionals. Few portals capable of this exist to date. The evaluation of these portals as enablers of system change, rather than as simple windows into electronic records, is at an early stage and novel evaluation approaches are needed.

Background and Objective Finnish physicians have been increasingly dissatisfied with poor usability of the electronic patient record (EPR) systems, which they have identified as an overload factor in their work. Our aim is to specify which factors in EPRs are associated with work-related well-being of physicians. Methods A web-based questionnaire was sent to Finnish physicians younger than 65 years; the responses (n = 3,781) represent one-fourth of these. This was a repetition of a survey in 2010, where this questionnaire was used for the first time. In addition to statements assessing usability, there were questions measuring time pressure and job control. The relation between usability and work well-being was investigated with hierarchical multivariate regression analyses: With time pressure and job control as dependent variables, EPR usability assessments and physicians' background information were used as independent variables. Results In the multivariate analyses, technical problems that are often experienced in the EPR were related to higher time pressure and lower job control. Active participation in the development of the EPR system was related to stronger time pressure and stronger job control. In addition, use of several systems daily and the experience of time-consuming documentation of patient information for statistical purposes (billing, national registries, and reporting) were related to higher time pressure, while those with longer experience with the EPR system and those experiencing easy-to-read nursing records reported higher job control. Conclusion To relieve time pressure and increase sense of job control experienced by physicians, usability, integrations, and stability of the EPR systems should be improved: fewer login procedures, easier readability of nursing records, and decreased need for separate documentation for statistical purposes. Physician participation in the EPR development would increase the feeling of job control, but would add the time pressure. Hence, time for developmental work should be arranged.

This report proposes a long-term management of earlier NeRN work to be utilized also in the European and OECD context, and indicators on patients and citizens' use and experiences of eHealth servic ...

Aim The study aims to describe the impacts of different data structuring methods used in nursing records or care plans. This systematic review examines what kinds of structuring methods have been evaluated and the effects of data structures on healthcare input, processes and outcomes in previous studies. Materials and Methods Retrieval from 15 databases yielded 143 papers. Based on Population (Participants), Intervention, Comparators, Outcomes elements and exclusion and inclusion criteria, the search produced 61 studies. A data extraction tool and analysis for empirical articles were used to classify the data referring to the study aim. Thirty-eight studies were included in the final analysis. Findings The study design most often used was a single measurement without any control. The studies were conducted mostly in secondary or tertiary care in institutional care contexts. The standards used in documentation were nursing classifications or the nursing process model in clinical use. The use of standardised nursing language (SNL) increased descriptions of nursing interventions and outcomes supporting daily care, and improving patient safety and information reuse. Discussion The nursing process model and classifications are used internationally as nursing data structures in nursing records and care plans. The use of SNL revealed various positive impacts. Unexpected outcomes were most often related to lack of resources. Limitations Indexing of SNL studies has not been consistent. That might cause bias in database retrieval, and important articles may be lacking. The study design of the studies analysed varied widely. Further, the time frame of papers was quite long, causing confusion in descriptions of nursing data structures. Conclusion The value of SNL is proven by its support of daily workflow, delivery of nursing care and data reuse. This facilitates continuity of care, thus contributing to patient safety. Nurses need more education and managerial support in order to be able to benefit from SNL.

Summary Objectives: To present the importance of Evidence-based Health Informatics (EBHI) and the ethical imperative of this approach; to highlight the work of the IMIA Working Group on Technology Assessment and Quality Improvement and the EFMI Working Group on Assessment of Health Information Systems; and to introduce the further important evaluation and evidence aspects being addressed. Methods: Reviews of IMIA, EFMA and other initiatives, together with literature reviews on evaluation methods and on published systematic reviews. Results: Presentation of the rationale for the health informatics domain to adopt a scientific approach by assessing impact, avoiding harm, and empirically demonstrating benefit and best use; reporting of the origins and rationale of the IMIA- and EQUATOR-endorsed Statement on Reporting of Evaluation Studies in Health Informatics (STARE-HI) and of the IMIA WG's Guideline for Good Evaluation Practice in Health Informatics (GEP-HI); presentation of other initiatives for objective evaluation; and outlining of further work in hand on usability and indicators; together with the case for development of relevant evaluation methods in newer applications such as telemedicine. The focus is on scientific evaluation as a reliable source of evidence, and on structured presentation of results to enable easy retrieval of evidence. Conclusions: EBHI is feasible, necessary for efficiency and safety, and ethically essential. Given the significant impact of health informatics on health systems, care delivery and personal health, it is vital that cultures change to insist on evidence-based policies and investment, and that emergent global moves for this are supported.

The Finnish Patient Data Repository is a nationwide electronic health record (EHR) system collecting patient data from all healthcare providers. The usefulness of the large amount of data stored in the system depends on the underlying data structures, and thus a solid understanding of these structures is in focus in further development of the data repository. This study seeks to improve that understanding by a systematic literature review. The review takes the physician's perspective to the use and usefulness of the data structures. The articles included in this review study data structures intended to be used in the actual care process. Secondary use and nursing aspects have been covered in separate reviews. After applying the predefined inclusion and exclusion criteria only 40 articles were included in the review. The research on widespread systems in everyday use was especially scarce, most studies concentrated on narrow fields. Majority of these studies were primarily developed for specialist use in secondary care units. Most structures or applications studied were at an early stage of development. In many applications the use of structured data was found to improve the completeness of the documented data and facilitate its automated use. However, there seem to be some applications where narrative text cannot be easily replaced by structured data. Usability results regarding structured representation were conflicting. The scattered nature and paucity of research hinders the generalizability of the findings, and from the system design or implementation point of view the practical value of the scientific literature reviewed is limited.

Governments around the world are actively promoting citizens electronic access to their health data as one of a number of ways to respond to the challenges of health care delivery in the 21st century. While numerous approaches have been utilized it is evident from cross-country comparisons that there are different conceptualizations of: both the expected and desired roles for citizens in the management of their own health; the benefits that will be delivered by citizen access and how these benefits should be measured and benchmarked over-time. This paper presents comparative analyses of the methods by which citizens are provided with access to their own health data across 11 countries. The paper aims to stimulate debate on electronic citizen access to health data and the challenges of measuring benefit as well as reflection on capacity of different citizens to engage with e-health.

A scientific approach to health informatics requires sound theoretical foundations. Health informatics implementation would be more effective if evidence-based and guided by theories about what is likely to work in what circumstances. We report on a Medinfo 2015 workshop on this topic jointly organized by the EFMI Working Group on Assessment of Health Information Systems and the IMIA Working Group on Technology Assessment and Quality Development. We discuss the findings of the workshop and propose an approach to consolidate empirical knowledge into testable middle-range theories.

Health Information Systems (HISs) are expected to have a positive impact on quality and efficiency of health care. Rapid investment in and diffusion of HISs has increased the importance of monitoring the adoption and impacts of them in order to learn from the initiatives, and to provide decision makers evidence on the role of HISs in improving health care. However, reliable and comparable data across initiatives in various countries are rarely available. A four-phase approach is used to compare different HIS indicator methodologies in order to move ahead in defining HIS indicators for monitoring effects of HIS on health care performance. Assessed approaches are strong on different aspects, which provide some opportunities for learning across them but also some challenges. As yet, all of the approaches do not define goals for monitoring formally. Most focus on health care structural and process indicators (HIS availability and intensity of use). However, many approaches are generic in description of HIS functionalities and context as well as their impact mechanisms on health care for HIS benchmarking. The conclusion is that, though structural and process indicators of HIS interventions are prerequisites for monitoring HIS impacts on health care outputs and outcomes, more explicit definition is needed of HIS contexts, goals, functionalities and their impact mechanisms in order to move towards common process and outcome indicators. A bottom-up-approach (participation of users) could improve development and use of context-sensitive HIS indicators.

In the health informatics field, usability studies typically focus on evaluating a single information system and involve a rather small group of end-users. However, little is known about the usability of clinical information and communication technology (ICT) environment in which healthcare professionals work daily. This paper aims at contributing to usability research and user-oriented development of healthcare technologies with three objectives: inform researchers and practitioners about the current state of usability of clinical ICT systems, increase the understanding of usability aspects specific for clinical context, and encourage a more holistic approach on studying usability issues in health informatics field.A national web questionnaire study was conducted in Finland in spring 2010 with 3929 physicians actively working in patient care. For the purposes of the study, we described three dimensions of clinical ICT system usability that reflect the physicians' viewpoint on system usage: (1) compatibility between clinical ICT systems and physicians' tasks, (2) ICT support for information exchange, communication and collaboration in clinical work, and (3) interoperability and reliability. The dimensions derive from the definitions of usability and clinical context of use analysis, and reflect the ability of ICT systems to have a positive impact on patient care by supporting physicians in achieving their goals with a pleasant user experience. The research data incorporated 32 statements with a five-point Likert-scale on physicians' experiences on usability of their currently used ICT systems and a summative question about school grade given to electronic health record (EHR) systems.Physicians' estimates of their EHR systems were very critical. With the rating scale from 4 or fail to 10 or excellent, the average of the grades varied from 6.1 to 8.4 dependent on the kind of facility the physician is working. Questionnaire results indicated several usability problems and deficiencies which considerably hindered the efficiency of clinical ICT use and physician's routine work. Systems lacked the appropriate features to support typical clinical tasks, such as decision making, prevention of medical errors, and review of a patient's treatment chart. The systems also required physicians to perform fixed sequences of steps and tasks, and poorly supported the documentation and retrieval of patient data. The findings on ICT support for collaboration showed mainly negative results, aside from collaboration between co-located physicians. In addition, the study results pointed out physicians suffering from system failures and a lack of integration between the systems.The described study and related results are unique in several ways. A national usability study with nearly 4000 respondents had not been conducted in other countries in which healthcare technologies are widely adopted. The questionnaire study provided a generalized picture about the usability problems, however, it should be noted that there were significant differences between legacy systems in use. Previously, researchers had not approached contextual aspects of usability the context of clinical work, where numerous systems are in use. The described usability dimensions and the presented study results can be considered as the first step towards conceptualizing ICT usability in the unique setting of clinical work.

Purpose: Survey studies of health information systems use tend to focus on availability of functionalities, adoption and intensity of use. Usability surveys have not been systematically conducted by any healthcare professional groups on a national scale on a repeated basis. This paper presents results from two cross-sectional surveys of physicians' experiences with the usability of currently used EHR systems in Finland. The research questions were: To what extent has the overall situation improved between 2010 and 2014? What differences are there between healthcare sectors? Methods: In the spring of 2014, a survey was conducted in Finland using a questionnaire that measures usability and respondents' user experiences with electronic health record (EHR) systems. The survey was targeted to physicians who were actively doing clinical work. Twenty-four usability-related statements, that were identical in 2010 and 2014, were analysed from the survey. The respondents were also asked to give an overall rating of the EHR system they used. The study data comprised responses from 3081 physicians from the year 2014 and from 3223 physicians in the year 2010, who were using the nine most commonly used EHR system brands in Finland. Results: Physicians' assessments of the usability of their EHR system remain as critical as they were in 2010. On a scale from 1 ('fail') to 7 ('excellent') the average of overall ratings of their principally used EHR systems varied from 3.2 to 4.4 in 2014 (and in 2010 from 2.5 to 4.3). The results show some improvements in the following EHR functionalities and characteristics: summary view of patient's health status, prevention of errors associated with medication ordering, patient's medication list as well as support for collaboration and information exchange between the physician and the nurses. Even so, support for cross-organizational collaboration between physicians and for physician-patient collaboration were still considered inadequate. Satisfaction with technical features had not improved in four years. The results show marked differences between the EHR system brands as well as between healthcare sectors (private sector, public hospitals, primary healthcare). Compared to responses from the public sector, physicians working in the private sector were more satisfied with their EHR systems with regards to statements about user interface characteristics and support for routine tasks. Overall, the study findings are similar to our previous study conducted in 2010. Conclusions: Surveys about the usability of EHR systems are needed to monitor their development at regional and national levels. To our knowledge, this study is the first national eHealth observatory questionnaire that focuses on usability and is used to monitor the long-term development of EHRs. The results do not show notable improvements in physician's ratings for their EHRs between the years 2010 and 2014 in Finland. Instead, the results indicate the existence of serious problems and deficiencies which considerably hinder the efficiency of EHR use and physician's routine work. The survey results call for considerable amount of development work in order to achieve the expected benefits of EHR systems and to avoid technology-induced errors which may endanger patient safety. The findings of repeated surveys can be used to inform healthcare providers, decision makers and politicians about the current state of EHR usability and differences between brands as well as for improvements of EHR usability. This survey will be repeated in 2017 and there is a plan to include other healthcare professional groups in future surveys. (C) 2016 The Authors. Published by Elsevier Ireland Ltd.

In addition to patient care, EHR data are increasingly in demand for secondary purposes, e.g. administration, research and enterprise resource planning. We conducted a systematic literature review and subsequent analysis of 85 articles focusing on the secondary use of structured patient records. We grounded the analysis on how patient records have been structured, how these structures have been evaluated and what are the main results achieved from the secondary use viewpoint. We conclude that secondary use requires complete and interoperable patient records, which in turn depend on better alignment of primary and secondary users' needs and benefits.

The report presents results of the Nordic eHealth Research Network, a subgroup of the eNordic Council of Ministers Health group. The network defined and collected data for altogether 49 common eHealth indicators from the Nordic Countries. Health information was quite comprehensively electronically available from other organisations in all the Nordic countries by end of 2014. Intensity of use of nationally stored data remained low except in Denmark. Sweden had best availability of the Patient portal functionalities. Patients used patient portal functionalities rarely except in Denmark. Doctors in Iceland had most positive experiences of their health information systems. Even with limitations, the current work presents a solid basis for working towards the goal of the eHealth network: generating comparable information to support development of Nordic welfare.

Development of multinational variables for monitoring eHealth policy implementations is a complex task and requires multidisciplinary, knowledge-based international collaboration. Experts in an interdisciplinary workshop identified useful data and pitfalls for comparative variable development. The results are presented and discussed in this paper.

Summary Objectives: The objective of this paper is to explore approaches to understanding the usability of health information systems at regional and national levels. Methods: Several different methods are discussed in case studies from Denmark, Finland and Canada. They range from small scale qualitative studies involving usability testing of systems to larger scale national level questionnaire studies aimed at assessing the use and usability of health information systems by entire groups of health professionals. Results: It was found that regional and national usability studies can complement smaller scale usability studies, and that they are needed in order to understand larger trends regarding system usability. Despite adoption of EHRs, many health professionals rate the usability of the systems as low. A range of usability issues have been noted when data is collected on a large scale through use of widely distributed questionnaires and websites designed to monitor user perceptions of usability. Conclusion: As health information systems are deployed on a widespread basis, studies that examine systems used regionally or nationally are required. In addition, collection of large scale data on the usability of specific IT products is needed in order to complement smaller scale studies of specific systems.

eHealth indicator and benchmarking activities are rapidly increasing nationally and internationally. The work is rarely based on a transparent methodology for indicator definition. This article describes first results of testing an indicator methodology for defining eHealth indicators, which was reported at the Medical Informatics Europe conference in 2012. The core elements of the methodology are illustrated, demonstrating validation of each of them in the context of Nordic eHealth Indicator work. Validation proved the importance of conducting each of the steps of the methodology, with several scientific as well as practical outcomes. The article is based on a report to be published by the Nordic Council of Ministers [4].

Indicators provide a practical method to monitor and benchmark eHealth progress towards objectives set in local, national and international policies, and to offer evidence for eHealth management. There is no agreed methodology to develop and define these indicators. The purpose of this paper is to present a proposal for an indicator development methodology and indicator classification. This proposal combines expert-led top-down and community-based bottom-up approaches. It offers a holistic approach for developing indicators for measuring progress and impacts of eHealth development consisting of four phases: (1) defining the context for measurement, (2) defining the goal of measurement, (3) defining the methods for indicator selection and indicator categorization and (4) defining the data to be collected and analyzed to calculate the indicator. Our preliminary results will be used as a starting point for developing a more detailed description of methods for indicator development and for identifying and classifying eHealth indicators and on testing them in practice.

eHealth indicators are needed to measure defined aspects of national eHealth implementations. However, until now, eHealth indicators are ambiguous or unclear. Therefore, an expert workshop "Towards an International Minimum Dataset for Monitoring National Health Information System Implementations" was organized. The objective was to develop ideas for a minimum eHealth indicator set. The proposed ideas for indicators were classified based on EUnetHTA and De-Loneamp; McClean, and classification was compared with health IT evaluation criteria classification by Ammenwerthamp; Keizer. Analysis of the workshop results emphasized the need for a common methodological framework for defining and classifying eHealth indicators. It also showed the importance of setting the indicators into context. The results will benefit policy makers, developers and researchers in pursuit of provision and use of evidence in management of eHealth systems.

E-health systems are increasingly important and widespread, but their selection and implementation are still frequently based on belief, rather than scientific evidence, and adverse effects are not systematically addressed. Progress is being made in promoting generic evaluation methodologies as a source of scientific evidence, but effort is now needed to consider methods for special situations.Review of five evaluation contexts - national e-health plans, telemedicine, Health Informatics 3.0, usability and economics.Identification of requirements for approaches to be developed in these five settings.

Most EU Member States have a documented policy on eHealth. Documented follow-up and evaluation strategies for assessing whether national level systems have reached their set aims and outcomes are, however, rare. Methodologies for large scale information system assessment and evaluation are poorly established. This article describes the approach used to generate the Finnish National Health Information System (NHIS) evaluation plan. The core elements of the plan are illustrated, discussing also challenges and solutions in implementation. The article is based on NHIS evaluation planning project [15] and its presentation in the MIE workshop in Sarajevo in 2009 [16], where core issues and challenges of large-scale evaluations were discussed using the Finnish NHIS evaluation plan as a frame of reference.The Finnish plan offers other countries tools with which to assess their own plans and generate national methodologies for NHIS evaluation.

Most EU member states have a documented policy on eHealth. Documented follow-up and evaluation policies to assess reaching of the set aims, as well as evaluating outcomes of implemented systems at a national level are, however, rare. Methodologies for large scale information system assessment and evaluation are poorly established. In the workshop, the Finnish evaluation plans for the National Health Information System (NHIS) are used as a case in the workshop to reflect on core issues and challenges in large-scale evaluation for supporting system development, implementation and positive impacts. The results of the discussions are documented to be used in further refinement of the Finnish evaluation methodology and for enhancing networking of respective parties in different countries. The results will also benefit participants including policy makers, developers and researchers of national eHealth systems in pursuit of national evaluation activities.

This article describes a multidisciplinary framework and its use in the evaluation of a national medical e-;Prescription system pilot in Finland. The framework was based on three theoretical concepts: activity system, actor network and development life cycle. These concepts have been developed within activity theory, developmental work research and sociology of technology. The framework was used to guide the constructive evaluation of the co-;development of technology and services from different stakeholders' perspectives.

Vertaisarvioitu Lähtökohdat Yksityissektorin lääkärit ovat aiemmissa tutkimuksissa olleet melko tyytyväisiä käyttämiinsä potilastietojärjestelmiin, ja nyt selvitettiin tilannetta vuonna 2017. Edellisen tutkimuskerran jälkeen yksityissektori on liittynyt kansallisiin tietojärjestelmäpalveluihin. Menetelmät Tiedot kerättiin sähköisellä kyselyllä vuonna 2017. Artikkelissa esitetään yksityissektorilla työskentelevien vastaajien (n = 793) arviot kolmesta eniten käytetystä tuotemerkistä. Lisäksi arvioidaan muutosta vuodesta 2014. Tulokset DynamicHealthin käyttäjät ovat edelleen tyytyväisimpiä. Acuten käyttäjien arviot olivat ennallaan ja Softmedicin käyttäjien huonontuneet. Arviot teknisestä vakaudesta ja nopeudesta olivat muuttuneet kriittisemmiksi. Tiedon saatavuuteen muista organisaatiosta koettiin yhä liittyvän ongelmia. Päätelmät Kansalliset tietojärjestelmäpalvelut eivät ole ratkaisseet tiedonvaihdon haasteita, mutta ne ovat tuoneet uusia hitausongelmia. Tietojärjestelmät kaipaavat vielä kehittämistä sote-uudistusta ajatellen.

Vertaisarvioitu LÄHTÖKOHDAT: Lääkärien arvioita potilastietojärjestelmistä on kartoitettu vuosina 2010 ja 2014. Tämä tutkimus jatkaa seurantaa ja tarkastelee lisäksi organisaatioiden välistä tiedonkulkua. MENETELMÄT: Sähköinen kyselylomake lähetettiin keväällä 2017 alle 65-vuotiaille Suomessa asuville lääkäreille. Potilastietojärjestelmiä arvioitiin kouluarvosanoin (4–10) ja tiedonkulkua seitsemän väittämän avulla. TULOKSET: Arvosanojen keskiarvo oli parantunut edelliseen tutkimukseen verrattuna; sairaaloissa työskentelevien lääkärien antamat arvosanat olivat korkeampia kuin aiemmin. Tietojen saatavuus toisesta organisaatiosta koettiin edelleen heikoksi lukuun ottamatta laboratorio- ja radiologisia tuloksia. Tilanne ei ole juuri parantunut vuodesta 2014, vaikka Kanta-palvelut ovat tulleet laajalti käyttöön. PÄÄTELMÄT: Potilastietojärjestelmissä on havaittavissa pientä parannusta. Kehittämistyötä on kuitenkin jatkettava ja potilastietojen saatavuutta sujuvoitettava, jotta terveydenhuoltojärjestelmä toimii tehokkaasti, erityisesti tulevan sote-uudistuksen jälkeen.

Several researchers share the concern of healthcare information systems failing to support communication and collaboration in clinical practices. The objective of this paper is to investigate the current state of computer–supported patient information exchange and associated communication between clinicians. We report findings from a national survey on Finnish physicians? experiences with their currently used clinical information systems with regard to patient information documentation, retrieval, management and exchange–related tasks. The questionnaire study with 3929 physicians indicated the main concern being cross–organisational patient information delivery. In addition, physicians argued computer usage increasingly steals time and attention from caring activities and even disturbs physician?nurse collaboration. Problems in information management were particularly emphasised among those physicians working in hospitals and wards. The survey findings indicated that collaborative applications and mobile or wireless solutions have not been widely adapted in Finnish healthcare and suggested an urgent need for adopting appropriate information and communication technology applications to support information exchange and communication between physicians, and physicians and nurses.