Citizen Experiences of E-Health Services

CITIZEN
EXPERIENCES OF
E-HEALTH
SERVICES
Willing and able?
12.3.2018
Citizen experiences of eHealth / Hannele Hyppönen/ eHealth and Telemedicine Viking Mariella 15-
17.3.2018
1

WHAT ARE E-HEALTH SERVICES FOR
CITIZENS?
 Electronic services and applications used by citizens/ patients for 1) promoting
their own health/ welfare, selfcare 2) improving access to HC services 3)
enhancing information flow between patients and carers and patient participation
in care
 Owned (in Finland) by health care organisations or national bodies – e.g.
Omakanta (or citizens themselves)
personal health records PHR = e-access + storing of own clinical data (Omakanta) +
client-produced health data (pending in Omakanta), and making it available to carers.
patient portals include one or several of following functionalities (in Finland):
E-access to own clinical notes, including prescriptions (Omakanta)
E-access to own test results (currently lab tests in Omakanta)
Printing or storing own clinical data (storing in Omakanta)
Access to generic health and selfcare data (Organisational portals)
Booking (Organisational portals)
Electronic Prescription renewal request (Omakanta)
Secure communication between clients and carers (Organisational portals)
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PHR
-
servi
ces
Access
serv.
Comm.
serv.

WHY ARE E-SERVICES DEVELOPED/ STUDIED?
Growing evidence that patient engagement improves health outcomes and reduces health care costs
[1]
Government reforms to promote efficiency, quality, and safety of care [2], e.g. the Finnish eHealth
strategy [7]
=>health providers’ focus on patient portals as the primary access point for personal health information and
patient-provider communication [3].
Consumer adoption of patient portals is becoming increasingly critical for receipt of quality health care
including interactions with health providers outside of clinical visits, quick access to one’s personal
health information and promotion of patient engagement [8]
Numerous large-scale survey studies have demonstrated that especially older adults are less likely to
adopt portals even though they utilize the greatest proportion of health care resources [4-6].
More information is needed on what works (and what not) for whom in which circumstances to steer
the development
– We studied, what e-services are available, to what extent are they needed/ used, by whom, who has and what
kind of barriers to prevent use?
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STRATEGIC OBJECTIVES IN FINLAND
 Information on the quality and availability of services
is available in all parts of Finland
 Reliable information on well-being and services
supporting its utilisation are available and
 Citizens use online services and produce data for
their own use and for the professionals
 assist citizens in life management and in promoting
their own well-being or that of their family and
friends.
 Online self-management services support the
prevention of health problems, self-assessment of
the need for services and independent coping.
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MONITORING E-HEALTH IN FINLAND
 Social and health care organisation surveys: what e-health/welfare
services are available and where for the citizens
– Data collection from private and public organisations providing health and social care
services in Finland
 Citizen survey: use, barriers, benefits, needs of e-health/welfare
services
– based on Danish, Norwegian, USA and Canada surveys.
– Conducted in 2017 as one module in a yearly national ”Adults health, wellbeing and
services” (ATH) –survey* (which provides a wealth of background data) www.thl.fi/ath
– In 2014 was conducted as a stand-alone survey using ATH variables to provide
background data
– in 2017 stratified sample of 10 000 people Target population: People aged 20+ living
in Finland, (response rate 45 %).
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AVAILABILITY OF E-SERVICES IN
2017 (% OF PRIMARY CARE ORGS)
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USE OF E-SERVICES IN 2017 68%, IN
2014 58% OF POPULATION
Local PHR services are giving way to national ones, usage of national PHR services rapidly increasing
Self care and service access e-services availability increasing, most commonly used group of e-services
Data exchange, telecare and will expression e-services availability also increasing, but usage still modest

REGIONAL DIFFERENCES EXIST IN
USE OF E-HEALTH/WELFARE
SERVICES (E.G. DUE TO DIFFERENCES IN E-
SERVICE AVAILABILITY, USABILITY, CUSTOMER
SUPPORT, TRAINING, CLIENTELE ETC.)
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” GOOD DIGI-COMPETENCE” AND
DISAGREEING WITH ”ABILITY/ATTITUDE AS
BARRIER” STRONGEST PREDICTORS OF E-
HEALTH/WELFARE SERVICE USE – AGE NOT A
PREDICTOR!
Dependent:Usedatleastone ofe-health/welfare services electronicallyduringpastyear: 0=no,1=yes
Independents: Wald Sig. Exp(B) Lower Upper
Area:Ref:Southern Finland 12.463 0.052
Lappi 9.529 0.002 0.177 0.059 0.531
Language:Ref:Suomi 17.590 0.000
Language Russian 15.841 0.000 0.235 0.115 0.479
Education level:Ref:Low 7.768 0.021
Education level:High 6.526 0.011 1.401 1.082 1.815
Long term illness:No (compared to Yes) 56.514 0.000 0.419 0.334 0.526
Digi-competence:ref:zero 92.733 0.000
Digi-competence:novice 26.737 0.000 4.240 2.452 7.331
Digi-competence:basic 67.924 0.000 9.391 5.513 15.997
Digi-competence:fluent 77.306 0.000 13.327 7.482 23.738
Digi-competence:expert 83.832 0.000 18.298 9.821 34.091
Ability/attitude to use e-services as a barrier(1=fullyagree,5=fullydisagree) 118.028 0.000 2.931 2.414 3.559
Availabilityofe-services as a barrier(1=fullyagree,5=fullydisagree) 10.068 0.002 0.773 0.659 0.906
95% C.I.forEXP(B)
model explained 37% of the variation

BELIEF OF LOWER QUALITY OF E-SERVICES A BIGGEST
BARRIER (BUT NOT STRONG PREDICTOR OF NONUSE)
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LOWER DIGI-COMPETENCE AND HIGHER AGE
STRONGEST PREDICTORS OF EXPERIENCING
BARRIERS
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Dependent: Fully agree with at least one barrier 0=no, 1=yes Wald Sig. Exp(B) 95%C.I.for EXP(B)
Independents: Lower Upper
Area: Ref: Southern Finland 9.048 0.171
Area: Eastern Finland 4.214 0.040 1.211 1.009 1.453
Health status: Good (compared to Bad) 5.448 0.020 0.731 0.562 0.951
Quality of life: Good (compared to Bad) 4.625 0.032 0.643 0.430 0.962
Age group: ref: 20-54 12.881 0.002
Age group: 55-74 (1) 4.055 0.044 1.186 1.005 1.400
Age group: 75+ (2) 12.197 0.000 1.821 1.301 2.550
Long term illness: No (compared to Yes) 10.575 0.001 0.790 0.685 0.911
Digi-competence: ref: zero 119.914 0.000
Digi-competence: basic 25.090 0.000 0.464 0.344 0.627
Digi-competence: fluent 58.017 0.000 0.304 0.223 0.413
Digi-competence: expert 63.000 0.000 0.256 0.183 0.358

SOME BENEFITS OF E-SERVICES
 Biggest experienced benefit (52% fully agree): help remind of
appointments
 Help save f2f visits (=>time and money) 41% fully agree, nr of saved
visits depends on client group and service used
 Measuring and communicating own health parameters (e.g. RR, HbA1c, INR)
potentially biggest saver
 Access to good quality data on health, illnesses and selfcare
 Participation in online support groups also saves many f2f-visits
 Support in finding and choosing suitable e-services (34% fully agree)
 Enhance participation in care – 23% fully agree
 Support self-care – 23% fully agree
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RESULTS BECOMING AVAILABLE IN DATABASE REPORTS
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CONCLUSIONS
 To meet the strategy objectives:
– Availability of e-services need to be improved and regional differences evened
out.
– Citizens still need f2f-contact, so e-services cannot entirely replace exsisting
services
– Potential for savings big, service providers need to focus on developing e-service
paths for specific patient groups in collaboration with patients, ensuring renewal of
business processes
– Service providers must ensure as purchasers and technology companies as
providers that e-services are accessible, easy-to-use, safe and secure
– Service providers must ensure that there is adequate support for patients for using
organisation’s e-services
– Improving citizens’ digi-competence needs to be focused on national level
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LITERATURE
 1. Forbat L, Cayless S, Knighting K, Cornwell J, Kearney N. Engaging patients in health care: an empirical study of the role of engagement on attitudes
and action. Patient Educ Couns. 2009 Jan;74(1):84–90. doi: 10.1016/j.pec.2008.07.055. [PubMed] [Cross Ref]
 2. Ferman JH. Healthcare reform: Medicare & Medicaid Innovation Center. CMS provision will test new payment and service delivery models. Healthc
Exec. 2010;25(4):58, 60. [PubMed]
 3. GPO. [2016-11-26]. Medicare and Medicaid programs; electronic health record incentive program https://www.gpo.gov/fdsys/pkg/FR-2010-07-
28/pdf/2010-17207.pdf webcite.
 4. Smith SG, O'Conor R, Aitken W, Curtis LM, Wolf MS, Goel MS. Disparities in registration and use of an online patient portal among older adults:
findings from the LitCog cohort. J Am Med Inform Assoc. 2015 Apr 25;22(4):888–95. doi: 10.1093/jamia/ocv025. [PMC free article] [PubMed] [Cross
Ref]
 5. Sarkar U, Karter AJ, Liu JY, Adler NE, Nguyen R, López A, Schillinger D. Social disparities in internet patient portal use in diabetes: evidence that the
digital divide extends beyond access. J Am Med Inform Assoc. 2011 May 01;18(3):318–21. doi: 10.1136/jamia.2010.006015.
http://europepmc.org/abstract/MED/21262921. [PMC free article] [PubMed] [Cross Ref]
 6. Graetz I, Gordon N, Fung V, Hamity C, Reed ME. The digital divide and patient portals: internet access explained differences in patient portal use for
secure messaging by age, race, and income. Med Care. 2016 Aug;54(8):772–9. doi: 10.1097/MLR.0000000000000560. [PubMed] [Cross Ref]
 7. INFORMATION TO SUPPORT WELL-BEING AND SERVICE RENEWAL eHEALTH AND eSOCIAL STRATEGY 2020. Ministry of Social affairs and
health, Finland. Published in 2015, available at http://urn.fi/URN:ISBN:978-952-00-3575-4
 8. Taya Irizarry, Jocelyn Shoemake, Marci Lee Nilsen, Sara Czaja, Scott Beach, and Annette DeVito Dabbs. Patient Portals as a Tool for Health Care
Engagement: A Mixed-Method Study of Older Adults With Varying Levels of Health Literacy and Prior Patient Portal Use. J Med Internet Res. 2017 Mar;
19(3): e99.
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THANK YOU!
For more information:
Hannele.hypponen@thl.fi
https://thl.fi/en/web/thlfi-en/research-and-expertwork/projects-
and-programmes/monitoring-and-assessment-of-social-welfare-
and-health-care-information-system-services-steps-2.0-
https://sampo.thl.fi/pivot/beta/en/steps/kansalais/summary_tiivist
e1
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Citizen Experiences of E-Health Services

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