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Citizen Experiences of E-Health Services

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Hannele Hyppönen at eHealth and Telemedicine conference 15.-17.3.2018.

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Citizen Experiences of E-Health Services

  1. 1. 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
  2. 2. 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) 12.3.2018 Citizen experiences of eHealth / Hannele Hyppönen/ eHealth and Telemedicine Viking Mariella 15- 17.3.2018 2 PHR - servi ces Access serv. Comm. serv.
  3. 3. 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? 12.3.2018 Citizen experiences of eHealth / Hannele Hyppönen/ eHealth and Telemedicine Viking Mariella 15- 17.3.2018 3
  4. 4. 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. 12.3.2018 Citizen experiences of eHealth / Hannele Hyppönen/ eHealth and Telemedicine Viking Mariella 15- 17.3.2018 4
  5. 5. 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 %). 12.3.2018 Citizen experiences of eHealth / Hannele Hyppönen/ eHealth and Telemedicine Viking Mariella 15- 17.3.2018 5
  6. 6. AVAILABILITY OF E-SERVICES IN 2017 (% OF PRIMARY CARE ORGS) 12.3.2018 Citizen experiences of eHealth / Hannele Hyppönen/ eHealth and Telemedicine Viking Mariella 15- 17.3.2018 6 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
  7. 7. 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.) 12.3.2018 Citizen experiences of eHealth / Hannele Hyppönen/ eHealth and Telemedicine Viking Mariella 15- 17.3.2018 7 ” 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
  8. 8. BELIEF OF LOWER QUALITY OF E-SERVICES A BIGGEST BARRIER (BUT NOT STRONG PREDICTOR OF NONUSE) 12.3.2018 Citizen experiences of eHealth / Hannele Hyppönen/ eHealth and Telemedicine Viking Mariella 15- 17.3.2018 8
  9. 9. LOWER DIGI-COMPETENCE AND HIGHER AGE STRONGEST PREDICTORS OF EXPERIENCING BARRIERS 12.3.2018 Citizen experiences of eHealth / Hannele Hyppönen/ eHealth and Telemedicine Viking Mariella 15- 17.3.2018 9 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
  10. 10. 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 12.3.2018 Citizen experiences of eHealth / Hannele Hyppönen/ eHealth and Telemedicine Viking Mariella 15- 17.3.2018 10
  11. 11. RESULTS BECOMING AVAILABLE IN DATABASE REPORTS 12.3.2018 Citizen experiences of eHealth / Hannele Hyppönen/ eHealth and Telemedicine Viking Mariella 15- 17.3.2018 11
  12. 12. 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 12.3.2018 Citizen experiences of eHealth / Hannele Hyppönen/ eHealth and Telemedicine Viking Mariella 15- 17.3.2018 12
  13. 13. 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. 12.3.2018 Citizen experiences of eHealth / Hannele Hyppönen/ eHealth and Telemedicine Viking Mariella 15- 17.3.2018 13
  14. 14. 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 12.3.2018 Citizen experiences of eHealth / Hannele Hyppönen/ eHealth and Telemedicine Viking Mariella 15- 17.3.2018 14

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