In March this year, the town of Hämeenlinna in southern Finland began providing a remote 24/7 health diagnosis and prescription service. The aim is to de-congest the town’s health centres and improve healthcare without reducing people’s access to the national health service. This first step is due to be followed by a wider initiative to enable patients to take their own readings at home.
In Finland, most of the healthcare sector is state-run, giving people access to basic care and a general practitioner based at a health centre financed by the local authority, usually from the taxes paid by residents. ‟However, we’re on the verge of some big changes. The current system is short of funds, and we urgently need to rethink our public services so that they can continue to benefit our citizens,” Jari Numminen, Service Designer for the town of Hämeenlinna, told L’Atelier on the sidelines of the Arctic15 conference, held in Helsinki on 26-27 May. In March the town launched a virtual clinic service designed to meet the residents’ needs. The new system comprises a website, to which the 70,000 inhabitants of the town can go if they have any health problems and input their symptoms.
Remote diagnosis and prescriptions
The service combines a medical database with all the personal details that citizens enter on the website or feed in from connected objects, plus the patient’s personal electronic health records, a system which was launched on a country-wide level in 2012. Not long afterwards, the enquirer receives an analysis, together with recommendations, such as to stay at home, have some tests done at the laboratory, go and see a doctor, or go to the Accident and Emergency department at the local hospital. If the enquirer believes that the diagnosis is reliable and no visit to a doctor/lab/hospital is deemed necessary, the patient may authorise it to be sent to his/her health centre. If s/he needs medicine, s/he can then obtain an e-prescription as soon as the centre opens, at 8 o’clock in the morning, written by one of the doctors at the medical centre.
‟We’re on the verge of some big changes. The current system is short of funds, and we urgently need to rethink our public services so that they can continue to benefit our citizens.”
Making savings without skimping on healthcare quality
‟With virtual communication tools plus available data we can obtain more information, analyse it, and suggest tailor-made treatment at a lower cost,” underlined Jari Numminen. The basic aim is to reduce the number of calls and visits made to health centres, which represent a considerable cost to the system. Of course the issue of healthcare quality was a major concern. ‟At the moment very few people are using the service. We still need to raise awareness about it. The more people use the service, the more savings we’ll be able to make, but first and foremost we’ll be able to concentrate more on the patients who really need a face-to-face consultation,” Numminen explained.
Raising general awareness
Meanwhile work is also needed to teach healthcare practitioners about how the new system works. Remuneration is not the issue here – public sector doctors and nurses are paid a monthly salary – but many still believe that sifting through an online diagnosis and writing prescriptions are tasks that will add to their daily workload. However, as far as Jari Numminen is concerned, this is merely a transition period, after which this kind of service will become the norm and the number of people coming to the health centres will fall as a result. The new system is also likely to be more time-efficient since having access to a patient’s medical history should help to improve the quality of the patient-doctor consultation and refine the diagnosis.
‟The more people use the service, the more savings we’ll be able to make, but first and foremost we’ll be able to concentrate more on the patients who really need a face-to-face consultation.”
Doctor morphing into a lifestyle coach?
As part of the drive towards patient empowerment and customised treatment, the town of Hämeenlinna is also working on another service, a Virtual Health Check. This involves working out a person’s average life span on the basis of the data s/he has input, plus other relevant information. The online system will also be able to calculate the effect on the person’s health of giving up a particular ‘bad’ habit and will offer advice along these lines. One interesting aspect of the service is that the aim is to focus on the overall human picture rather than taking a narrow medical view. Rather than suggesting exercises to help you get fit or advice relevant to your condition, the online service will ask you about your wishes and aspirations and will then set out a step-by-step programme to help you achieve the level of health and fitness required to do what you want to do in life. Each step can be agreed via messages with your doctor. This is a way of keeping the system focused on the person but it is also intended as a first step towards implementing a wider initiative. The idea is that patients should be able to take their own readings so as to obtain reliable, usable data. For instance, a patient can learn how to take his/her own blood pressure and blood sugar level, weigh him/herself and input the information into the software programme on the website, thus ensuring greater precision in making a risk analysis or proposing any potential treatment.