National Kanta Services support clinical work in Finland by providing digital services including a prescription center, patient data repository, and personal health record. Kanta services are implemented in stages to integrate many existing health data systems and bring benefits to citizens, pharmacies, and the healthcare sector by facilitating secure access and exchange of health information. Countries in northern Europe like Finland, Sweden, and Denmark are global leaders in digitalization and implementation of national eHealth strategies.

1. National Kanta Services
Support Clinical Work in
Finland
Vesa Jormanainen
Webinar on Kanta Services
30 October 2019

2. WHO 2016. Global diffusion of eHealth:
making universal health coverage achievable
Electronic health record (EHR) definition

3. European Commission
Secure access and exchange
of health data
Health data pooled for
research and persanalised
medicine
Digital tools and data for
citizen empowerment and
person-centred healthcare

4. 4 30.10.2019Vesa Jormanainen
2014
EU countries
eHealth across 27
EU Member States
Currie WL, Seddon JJJM. A cross-national
analysis of eHealth in the European Union:
some policy and research directions. Inform
Manag 2014;51:783–797.
https://doi.org/10.1016/j.im.2014.04.004

5. 5 30.10.2019Vesa Jormanainen
2017
EU countries
eHealth across 28
EU Member States
Seddon JJJM, Currie WL. Healthcare
Financiaalisation and the digital divide in
the European Union: narrative and numbers.
Inform Manag 2017;54:1084–1096.
https://doi.org/10.1016/j.im.2017.03.002

6. 6 30.10.2019Vesa Jormanainen
2015
WHO
Adoption of e-health
policies or strategies
Atlas of eHealth country profiles: the use
of eHealth in support of universal health
coverage.
Geneva: WHO, Global Observatory for
eHealth; 2016.
Diffusion of eHealth: making universal
health coverage achievable.
Geneva: WHO, Global Observatory for
eHealth; 2016.
Timeline of country adoption of e-health policies
or strategies, 1990–2015.

7. 2016
OECD
Technical and operational
readiness and data
governance readiness

8. Data sets / functions FI FR EE DK NO US AU NZ NL SE Required
Medications ** 7 10
Diagnoses / conditions 7 8
Clinical summary 6 10
Laboratory results 6 9
Medication allergies ** 6 9
Block record 5 6
Visits (time/date/provider) 5 10
Access logs 5 10
Operative reports 4 8
Immunizations ** 3 10
Radiology reports 3 9
Pathology results 3 6
Medical notes 2 8
Referrals 2 8
Condition-specific information 2 7
Professional medical alerts ** 1 8
Status of referrals 1 7
Health declaration forms* ** 1 6
Nursing notes 1 5
Maternity care data 1 4
Community care notes 1 3
Psychiatry notes 0 6
Radiology scans 0 5
Other PACS data 0 4
Number of data types required 16 13 11 11 6 6 3 3 3 1
Data types locally enabled but not required 6 1 13 12 13 9 4 18 10 17
Data types required or enabled (total) 22 14 24 23 19 15 7 21 13 18
The colours illustrate if the display of each of the data sets was at the time of the study:
[dark green] exlicitly required and mandatory by law, or enabled at a national levle
[light green] locally enabled, based on decisions made across regions/care providers/software solutions
[white] unavailable in the country
* = health declaration forms refer to self-documented information from patient to healthcare providers
** = available through additional national solutions
FI = Finland, FR = France, EE = Estonia, DK = Denmark, NO = Norway, US = the U.S.A.,
AU = Australia, NZ = New Zealand, NL = Netherlands, SE = Sweden
Required
or locally
enabled
(total)
2016
Patient accessible
electronic health records
Essén A, Scandurra I, Gerrits R, et al.
Patient access to electronic health records:
differences across ten countries.
Health Pol Technol 2018;7:44–56.
https://doi.org/10.1056/j.hlpt.2017.11.003

9. The Digital Economy and Society Index
DESI 2019
Finland, Sweden, the Netherlands, and Denmark scored the
highest ratings in DESI 2019 and are among the global leaders
in digitalization. These countries are followed by the United
Kingdom, Luxembourg, Ireland, Estonia, and Belgium.
9 30.10.2019Vesa Jormanainen

10. 10 Vesa Jormanainen 30.10.2019

11. 1995
2000
2005
2010
2015
2020
HL7 Finland
founded
First
national
HL7 v2
profiles
ICD-10
adopted in
Finland
Experimental
legislation on
seamless service
chains
PikaXML
specification
for electronic
referral process
Regional hospital
information
systems starting
Finnish profile
for CDA R1
National
code
server
founded
National
health
project
starts
National
core
datasets
defined
Ministry’s decision
on choosing HL7
CDA R2 as the
standard for
national use
Finnish
basic
profile on
CDA R2
CDA R2
becomes
an ANSI
standard
Finnish profile
for HL7 V3
messaging
Legislation on
the national
Kanta system
and supporting
services
HL7 Medical
records
specifications for
ePrescription and
Patient Data
Repository
IHE Special
Interest
Group
established
Pharmaceutical
database founded
Prescription
service and
My Kanta pages
enter production
Revised
legislation on
consents and
patient data
management
service
Patient Data
Repository enters
production
epSOS pilot
between
Finland and
Sweden
IHE-
Finland
founded
Specifications
for structured
records on
dental care
National
imaging
architecture
defined
All public
healthcare
uses the
Patient
Data
Repository
HL7 FHIR
chosen as the
standard for
Kanta PHR
Kelain (web-based
prescription) enters
production
National imaging
infrastructure
enters production
Data repository
for social
services enters
production
Submission of
medical certificates
over the national
data exchange layer
(Suomi.fi)
Personal Health
Record enters
production
Cross-border
prescription
enters
production
Act on
secondary use
of health and
social data,
data lake
founded
National
legislation on
Kanta services
changing
National
medication
list
Finland becomes
a SNOMED
member
Finland became
EU Member State
The 1st eHealth
Strategy in
Finland 2007
The 1st eHealth
Roadmap
2003
2009
Kanta services are implemented at stages
Implementation, Stage 1 (MSAH) 2007-2010
Implementation, Stage 2 (THL) 2011 -

12. 2007

13. Other national services
Prescription centre
Prescriptions Dispensations
Renewals Reservations
Pharmaceutical database
Medicinal products details Prices
Substitution rules Reimbursement rules
Patient data repository
Health records Imaging infrastructure Archive of old patient data
Encounter data Imaging data Old health records
Structured health records
Personal Health Record (PHR) Observations Questionnaire responses
Other data stored by citizens
Healthcare service providers
Primary care organizations
Hospital districts
Private healthcare providers
Pharmacies
Healthcare professionals
eHealth Digital
Service Infrastructure
Receivers of
medical certificates
Citizens
and apps used by them
Providers of social services
Data repository for social services Customer relationships Service items
Customer documents Legacy data
My Kanta
pages
Data
lake
for
health
and
social
welfar
e
Kantamessaginglayer
Data management service Summary service
Problems Vaccinations Risks
Procedures Imaging studies
Lab results Physiological findings
Customer summary for social services
Consent data Will expressions
Information notices Living wills
Consents Organ donation wills
Consent restrictions
Suomi.fi HCP and SCP
register
Professional rights
Certificatio
n service
Certificates
Smart cards
National code
server
Code systems Terminologies
Pharmacy register Data structures
Organization register
Authentication
e-Authorizations
Message exchange
Populatio
n register
Demographic
data
Main standards
HL7 V3: CDA R2 L3 and Medical Records
HL7 FHIR (Kanta Personal Health Record)
JSON, XHTML (PHR and social services)
PDF/A (old patient data and social services)
IHE IT-I Profiles (imaging and eHDSI)
W3C XML DSig
WS Addressing, WS-I
TLS, X.509
User groups Kanta services
Kelain
Web-based
prescription service
National
Contact Point
for eHealth
National
service bus

14. 100% Coverage
Public primary healthcare centres
Public Hospitals
Community pharmacies
e-Prescriptions
Medicine dispensing data

15. Proportion (%) of adults
Hospital district border
2017 2018
# Users 1.876M 2.187M
% Adults 42.2% 49.2%
Adults = at least 18-year-old persons
Age group 2018
<18 years 1.9%
18–35 years 50.7%
36–50 years 48.9%
51–65 years 51.1%
>65 years 36.7%
Proportion
of My Kanta
Pages
users in
age groups
Working-age
groups
Use (%) of My Kanta Pages by adults
by primary healthcare organizer areas
and hospital districts in 2018

16. Kanta services to be implemented at
pharmacies and primary healthcare
Hospital District
Mean (range: min–max)
Specific
Cantchment Area
Mean (range: min–max)
Nationally
Prescription Centre, pharmacies 0.6 (0.1–2.0) yr 1.3 (0.9–2.0) yr 2.4 yr
Prescription Centre, PHCs 0.6 (<0.01–2.0) yr 2.0 (0.9–3.4) yr 3.4 yr
Prescription Centre, pharmacies +
PHCs
1.1 (0.02–2.4) yr 2.3 (1.8–3.4) yr 3.4 yr
Patient Data Repository, PHCs 0.6 (<0.01–1.6) yr 1.5 (1.1–2.0) yr 2.0 yr
ePC + PDR, PHCs 3.0 (1.6–5.1) yr 4.3 (3.6–5.1) yr 5.5 yr
ePC + PDR, pharmacies + PHCs 3.6 (2.5–4.3) yr 4.6 (4.4–5.1) yr 5.5 yr
PHC = Primary Healthcare Centre (terveyskeskus)
ePC = Prescription Centre (resepti-palvelu)
PDR = Patient Data Repository (Potilastiedon arkisto)
Implementation of Kanta services
16 Vesa Jormanainen 30.10.2019
Mean number of years from the 1st implementation start
to the last implementation start
Larger area
Morecomplex

17. Many data systems are in use
17 Vesa Jormanainen 30.10.2019

18. 30.10.2019Vesa Jormanainen18
National
Kanta
Services
18 30.10.2019
2010
2010
2010
Prescription
Centre
Patient
Data
Repository
Oral
Health
Care
Imaging
Data
Emergency
Medical
Services
Pharma-
ceutical
Database
Healthcare
Certificate
Client
Test
Service
Old
Patient
Data
2016
2013
2017
2018
2018
2018
2018
2018
2019
(2021)
(2020)
My Kanta
Pages
Client Data
Archive for
Social Welfare
Services
SOTE
Reform
Changes
Cross-
border
Prescription
Kanta
PHR
Kanta is an entity
of digital services,
which brings benefits
for citizens, pharmacies
and the social welfare
and healthcare sector
The Kanta services
are implemented and
adopted in stages
2010

19. Kanta.fi/en
Vesa Jormanainen
M.D., M.Sc., Specialist in Public Health
Chief Specialist
Social and Health Care Research
t. +358 29 524 7778
e. vesa.jormanainen[at]thl.fi