Browsing by Author "Reponen, Jarmo"

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Associations of perceived changes in work due to digitalization and the amount of digital work with job strain among physicians : a national representative sample
(2023-12) Virtanen, Lotta; Kaihlanen, Anu Marja; Saukkonen, Petra; Reponen, Jarmo; Lääveri, Tinja; Vehko, Tuulikki; Saastamoinen, Peppiina; Viitanen, Johanna; Heponiemi, Tarja
A1 Alkuperäisartikkeli tieteellisessä aikakauslehdessä
Background: Physicians’ work is often stressful. The digitalization of healthcare aims to streamline work, but not all physicians have experienced its realization. We examined associations of perceived changes in work due to digitalization and the amount of digital work with job strain among physicians. The moderating role of the length of work experience was investigated for these associations. Methods: We used representative survey data on Finnish physicians’ (N = 4271) experiences of digitalization from 2021. The independent variables included perceptions on statements about work transformations aligned with digitalization goals, and the extent that information systems and teleconsultations were utilized. Stress related to information systems (SRIS), time pressure, and psychological stress were the dependent variables. We analyzed the associations using multivariable linear and logistic regressions. Results: Respondents had a mean SRIS score of 3.5 and a mean time pressure score of 3.7 on a scale of 1–5. Psychological stress was experienced by 60%. Perceptions associated with higher SRIS comprised disagreements with statements asserting that digitalization accelerates clinical encounters (b =.23 [95% CI:.16–.30]), facilitates access to patient information (b =.15 [.07–.23]), and supports decision-making (b =.11 [.05–.18]). Disagreement with accelerated clinical encounters (b =.12 [.04–.20]), and agreements with patients’ more active role in care (b =.11 [.04–.19]) and interprofessional collaboration (b =.10 [.02–.18]) were opinions associated with greater time pressure. Disagreeing with supported decision-making (OR = 1.26 [1.06–1.48]) and agreeing with patients’ active role (OR = 1.19 [1.02–1.40]) were associated with greater psychological stress. However, perceiving improvements in the pace of clinical encounters and access to patient information appeared to alleviate job strain. Additionally, extensive digital work was consistently linked to higher strain. Those respondents who held teleconsultations frequently and had less than 6 years of work experience reported the greatest levels of time pressure. Conclusions: Physicians seem to be strained by frequent teleconsultations and work that does not meet the goals of digitalization. Improving physicians’ satisfaction with digitalization through training specific to the stage of career and system development can be crucial for their well-being. Schedules for digital tasks should be planned and allocated to prevent strain related to achieving the digitalization goals.
Closing the Loop for Controlled Substances Surveillance : A Field Study of the Usability and User Experience of an Integrated Electronic Narcotic Consumption
(2024-05-05) Häkkinen, Annika; Viitanen, Johanna; Savolainen, Kaisa; Mäkinen, Ville-Matti; Siven, Mia; Tolonen, Hanna; Lääveri, Tinja
A3 Kirjan tai muun kokoomateoksen osa
The distribution and handling of controlled substances (CSs), i.e., narcotics, is strictly regulated to decrease the risk of abuse and drug diversion. In Finland, hospital pharmacies are mandated to keep records of CS distribution and consumption in healthcare through a labor-intensive paper-based process. After implementing a new electronic health record (EHR) system, a large university hospital started to streamline the process by transferring the CS documentation process from paper to digital format. Although the benefits of digital archiving, surveillance, and consumption monitoring are self-evident from the hospital pharmacy’s perspective the advantages at wards remain less explored. Therefore, our goal was to explore the usability and user experience (UX) of the recently implemented electronic narcotic consumption card (eNCC) solution built into the EHR system, and the related workflows of nurses, pharmacists, and physicians. The field study consisted of two parts and was conducted using observation, interviews, and survey methods in two wards. Our findings suggest that the digitalized process enables reliable real-time documentation of CSs and improves process efficiency, particularly for oral tablets and capsules. Considering diverse end-users’ perspectives is crucial when assessing the practical benefits of newly implemented digital solutions targeted at several healthcare professional groups. This approach enables a broader understanding of UX; supports development efforts, including usability improvements; and facilitates broader implementation. More research is needed to analyze the long-term impacts of the digital CSs’ consumption documentation workflow and surveillance at different healthcare units.
Dual-Perspective Modeling of Patient Pathways: A Case Study on Kidney Cancer
(2024) Grøndahl Larsen, Anna; Halvorsrud, Ragnhild; Berg, Rolf Eigil; Vesinurm, Märt
A4 Artikkeli konferenssijulkaisussa
Patient pathway has become a key concept in the organization of healthcare. However, the materialization and operationalization of pathways often focus on work processes of health personnel, clinical decision-making, and deadlines, contradicting the strong patient-oriented perspective that is inherent in their definition. In this paper, we introduce a patient-centered perspective of kidney cancer pathways, reporting on a dual-perspective strategy to map and model patient pathways. Utilizing a multi-method approach, we map and model pathways from the perspectives of both healthcare personnel and patients and investigate the feasibility of the Customer Journey Modeling Language (CJML) for modeling patient pathways. To prevent confusion, the planned pathway as seen from the hospital perspective and the actual pathway experienced by the patient are referred to as ‘pathway’ and ‘journey’, respectively. In the paper, we describe methods to engage with healthcare professionals and patients to collect the necessary information to create precise models, and we show how precise modeling of patient pathways requires the integration of several information sources. Moreover, the study underlines the value of examining pathways from a dual perspective, as the two perspectives corroborate and supplement each other, illustrating the complexity of patient journeys. Finally, the findings provide insights into the feasibility of CJML, firstly underlining that the usefulness of visual models is context-dependent, and secondly, suggesting that the methods and subsequent visualizations may be useful as organizational, instructional, and communicative tools.
Health information exchange in Finland: Usage of different access types and predictors of paper use
(2019-02-01) Hyppönen, Hannele; Lumme, Sonja; Reponen, Jarmo; Vänskä, Jukka; Kaipio, Johanna; Heponiemi, Tarja; Lääveri, Tinja
A1 Alkuperäisartikkeli tieteellisessä aikakauslehdessä
Introduction: Timely, complete and accurate patient data is needed in care decisions along the continuum of care. To access patient data from other organizations, there are three types of regional health information exchange systems (RHIS) in use In Finland. Some regions use multiple RHISs while others do not have a RHIS available. The recently introduced National Patient Data Repository (Kanta) is increasingly used for health information exchange (HIE). Objectives: The purpose of this study was to assess usage of paper, RHISs and Kanta by context in 2017; evolution of paper use over the years; and predictors of paper use in 2017 among Finnish physicians for HIE system development. Methods: Data from national electronic health record (EHR) usage and user experience surveys were taken from 2010 (prior to ePrescription system implementation), 2014 (prior to implementation of Kanta) and 2017 (Kanta was in full use in the public sector and in large private organizations). The web-based surveys were targeted to all physicians engaged in clinical work in Finland. Results: Kanta was the most frequently used means of HIE in 2017. Paper use had reduced significantly from 2010 to 2014. The trend continued in 2017. Still, up to half of the physicians reported using paper daily or weekly in 2017. There were great variations in paper use by healthcare sector, available RHIS type and EHR system used. In multivariable analysis (with all other variables constant), predictors of more frequent use of paper than electronic means for HIE were: private sector or hospital, access to Master Patient Index RHIS (type 1), multiple RHIS (type 4) or no RHIS (type 5), two particular EHR systems, older age, less experience, operative, psychiatric or diagnostic specialties, and male gender. Conclusions: Usability of HIE systems including EHRs as access points to HIE need to be improved to facilitate usage of electronic HIE. Usage ensures more timely and complete patient data for safe, coordinated care. Specialty-specific needs and requirements call for more user participation in HIE design. Especially older professionals need training to better exploit HIS for HIE.
The Interplay of Work, Digital Health Usage, and the Perceived Effects of Digitalization on Physicians' Work: Network Analysis Approach
(2022-08-22) Saukkonen, Petra; Elovainio, Marko; Virtanen, Lotta; Kaihlanen, Anu Marja; Nadav, Janna; Laaveri, Tinja; Vanska, Jukka; Viitanen, Johanna; Reponen, Jarmo; Heponiemi, Tarja
A1 Alkuperäisartikkeli tieteellisessä aikakauslehdessä
Background: In health care, the benefits of digitalization need to outweigh the risks, but there is limited knowledge about the factors affecting this balance in the work environment of physicians. To achieve the benefits of digitalization, a more comprehensive understanding of this complex phenomenon related to the digitalization of physicians'work is needed. Objective: The aim of this study was to examine physicians' perceptions of the effects of health care digitalization on their work and to analyze how these perceptions are associated with multiple factors related to work and digital health usage. Methods: A representative sample of 4630 (response rate 24.46%) Finnish physicians (2960/4617, 64.11% women) was used. Statements measuring the perceived effects of digitalization on work included the patients' active role, preventive work, interprofessional cooperation, decision support, access to patient information, and faster consultations. Network analysis of the perceived effects of digitalization and factors related to work and digital health usage was conducted using mixed graphical modeling. Adjusted and standardized regression coefficients are denoted by b. Centrality statistics were examined to evaluate the relative influence of each variable in terms of node strength. Results: Nearly half of physicians considered that digitalization has promoted an active role for patients in their own care (2104/4537, 46.37%) and easier access to patient information (1986/4551, 43.64%), but only 1 in 10 (445/4529, 9.82%) felt that the impact has been positive on consultation times with patients. Almost half of the respondents estimated that digitalization has neither increased nor decreased the possibilities for preventive work (2036/4506, 45.18%) and supportiveness of clinical decision support systems (1941/4458, 43.54%). When all variables were integrated into the network, the most influential variables were purpose of using health information systems, employment sector, and specialization status. However, the grade given to the electronic health record (EHR) system that was primarily used had the strongest direct links to faster consultations (b=0.32) and facilitated access to patient information (b=0.28). At least 6 months of use of the main EHR was associated with facilitated access to patient information (b=0.18). Conclusions: The results highlight the complex interdependence of multiple factors associated with the perceived effects of digitalization on physicians'work. It seems that a high-quality EHR system is critical for promoting smooth clinical practice. In addition, work-related factors may influence other factors that affect digital health success. These factors should be considered when developing and implementing new digital health technologies or services for physicians' work. The adoption of digital health is not just a technological project but a project that changes existing work practices.
Older Adults' Emotional User Experiences with Digital Health Services
(2024) Valkonen, Paula; Kujala, Sari
A4 Artikkeli konferenssijulkaisussa
Older adults are at risk of being excluded from digital society. They do not always find digital health services appealing, or they may have challenges with them. We investigated older adults´ emotional user experiences with digital health services and aimed to give designers tools to make digital health services more appealing for older adults. We interviewed 16 older adults about their experiences with digital health services. The use of digital health services brought joy and increased self-confidence. On the other hand, older adults had many negative emotional user experiences, including fear of pressing buttons and embarrassment of incompetence. In the future, designers should actively look for solutions that alleviate older adults´ fears and further encourage them to use digital health services. To enable that, proposals are made for designing digital health services.
Physicians' Experiences of EHR Technical Quality : Results from Four Large Cross-Sectional Surveys in 2010-2021
(2024-08-22) Lääveri, Tinja; Viitanen, Johanna; Reponen, Jarmo; Renko, Jari
A4 Artikkeli konferenssijulkaisussa
Unexpected downtime and long response times of electronic health record (EHR) systems not only impact user satisfaction and clinicians' work efficiency but also bring about potential harm for patients. Despite improvements in the performance of EHR systems' architecture, hardware, and networks, technical challenges continue to cause problems. We explored the end-user experiences of EHR technical functionality and quality from four large national cross-sectional surveys conducted among Finnish physicians in 2010-21. The results were analyzed by healthcare sector/specialty groups. In most groups, the experiences of stability and reaction speed became worse in 2010-17, which is readily explained by the implementation of the national patient data repository services, but improvements were seen in 2021, suggesting that EHR vendors have solved at least some of the slowness problems. The proportion of physicians reporting having experienced faulty system function with potential or actualized harm for the patient had decreased in operative and medical specialties and in the private sector but remained stable in other groups. Our findings underline the importance of continuing to develop technical qualities - including the implementations of national integrations.
Towards Accountable E-Health Policies in the Nordic Countries
(2024-08-22) Faxvaag, Arild; Reponen, Jarmo; Hardardottir, Gudrun Audur; Vehko, Tuulikki; Viitanen, Johanna; Eriksen, Jeppe; Koch, Sabine; Nøhr, Christian
A4 Artikkeli konferenssijulkaisussa
The Nordic Countries are seen as forerunners in the field of digital health technologies and national implementation has been guided by sector specific strategies for many years. In the context of new European legislation such as the European Health Data Space (EHDS), a review of the existing strategies is indicated. The objective of this policy analysis is to assess and compare the scope, ambitions and extent of accountability in national-level digital health policies in the Nordic countries. The scope of the policies from the five countries were largely centred around a) empowering and activating citizens; b) a shift towards prevention and digital first; c) supporting health operations; d) doing the groundwork; e) making health data more available in research and innovation workflows and f) supporting health personnel. Finland comes out as the most ambitious country with the aim to transform their health system by means of digitalisation. Both Finland and Iceland work towards prevention and the digital first ambition due to large populations in rural areas. These two countries also present the most accountable policies, meaning that their policy documents are the most transparent as to how they arrived at the conclusions and how they are to evaluate the achievements.
Usability problems do not heal by themselves: National survey on physicians’ experiences with EHRs in Finland
(2017-01-01) Kaipio, Johanna; Lääveri, Tinja; Hyppönen, Hannele; Vainiomäki, Suvi; Reponen, Jarmo; Kushniruk, Andre; Borycki, Elizabeth; Vänskä, Jukka
A1 Alkuperäisartikkeli tieteellisessä aikakauslehdessä
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.
Virtual Reality in Rehabilitation of Executive Functions in Children (VREALFUN) – Study Protocols for Randomized Control Trials
(2024-05-05) Nikula, Merja; Mäntymaa, Mirjami; LaValle, Steven M.; Pouttu, Ari; Jaekel, Julia; Aronen, Eeva T.; Pokka, Tytti; Salmi, Juha; Uusimaa, Johanna
A4 Artikkeli konferenssijulkaisussa
Children with attention and executive function disabilities often have a long-lasting need for rehabilitation to support their functional ability. Yet the availability of rehabilitation services is insufficient, regionally unevenly distributed, and unequal in terms of access to rehabilitation. There is a need for easily accessible services. In this paper, we present the VREALFUN project where the major aim is to develop a novel Virtual Reality (VR) rehabilitation method for children with deficits in attention and executive functions. This ongoing Randomized Control Study (RCT) includes two arms, one in children with attention deficit hyperactivity disorder (ADHD) and the other in children with mild to moderate traumatic brain injury (TBI).
Wearable Motion Sensors in the Detection of ADHD: A Critical Review
(2024) Basic, Jakov; Uusimaa, Johanna; Salmi, Juha
A4 Artikkeli konferenssijulkaisussa
Attention deficit hyperactivity disorder (ADHD) is a neurodevelopmental disorder with inattention, hyperactivity, and impulsivity as core symptoms. Current diagnostic methods of ADHD consisting of interviews and self-ratings come with a risk of subjective bias and are dependent on the limited availability of healthcare professionals. However, recent technological advances have opened new opportunities to develop objective and scalable methods for precision diagnostics. The present critical review covers the current literature concerning one of the promising technologies, the use of motion sensors or accelometers for detecting ADHD, particularly evaluating the related clinical potential. Several studies in this field, especially recent studies with advanced computational methods, have demonstrated excellent accuracy in detecting individual participants with ADHD. Machine learning methods provide several benefits in the analysis of rich sensor data, but the existing studies still have critical limitations in explaining the underlying cognitive functions and demonstrating the capacity for differential diagnostics is still underway. Clinical utility of sensor-based diagnostic methods could be improved by conducting rigorous cross-validation against other methods in representative samples and employing multi-sensor solutions with sophisticated analysis methods to improve interpretation of the symptom manifestation. We conclude that motion sensors provide cost-effective and easy-to-use solutions with strong potential to increase the precision and availability of ADHD diagnostics. Nevertheless, these methods should be employed with caution, as only a fraction of ADHD symptoms relate to hyperactivity captured by motion sensors. At best, this technique could complement the existing assessment methods or be used along with other digital tools such as virtual reality.