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Expert: Health care reform law makes hundred-million-euro patient data system partly unusable

If proposed social and health care legislation is passed, a new digital patient data system which cost government hundreds of millions of euros will not be used in the manner originally intended.

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Image: Eeva Kuivas / Yle

Proposed new laws related to government’s social and health care reform will render part of a newly-developed patient data system unusable for primary health care, according to an expert from the Helsinki and Uusimaa HUS hospital district.

According to HUS liaison manager Janne Aaltonen, the system, which has been in the works for several years, will be impossible to use fully once government’s expansive health and social care reform programme – also known as sote – comes into force.

When Apotti was originally planned, developers envisioned it would be used in primary health care, specialist health care and social work. However Aaltonen pointed out that current social and health care reform legislation would omit primary health services from the system’s user base.

That’s because the government’s vision is to include the private sector in the delivery of primary health care. The Apotti system on the other hand, has been designed exclusively for use in the public sector.

“In the current situation where some of sote’s central services will be delivered by private providers, then this part of the operation will be left out from Apotti, unless the law is changed,” Aaltonen explained.

Apotti has been designed to be a single system in which patient information travels seamlessly across different elements in the health care system. In the capital region there are currently hundreds of different IT systems that are not all inter-connected.

Extra costs for specialist hospital and social care

According to Aaltonen, two things follow from the government’s draft bill. First, social services and specialist hospital care providers will be left with the bill for the cost of designing the system, since primary health services will not use Apotti at all.

Second, a single system designed to ensure the seamless transfer of patient data to all health service providers would not include all players.

“Now one-third of providers will remain on the outside, so that creates a rather big functional problem,” Aaltonen noted.

Domino effect expected

In the Uusimaa region, the public sector already provides other ancillary services that will face the same problem of access to patient data. According to Aaltonen, the easiest solution would be to amend the law so that social and health care centres have the right to use auxiliary services produced by commercial providers. The sote expert said that this should apply to both private and public sector centres.

At present, HUS provides laboratory, imaging and laundry services for the primary health care system. If the bill becomes law in its present form, it would result in additional costs to these services, Aaltonen commented.

Aaltonen said that the ambitious reform programme is such a major undertaking that there may still be many other surprises with related consequences ahead.

“I personally think that the change that’s needed should be implemented in rather small steps and through trial and error,” Aaltonen advised.

Final decision still to come

Apotti CEO Hannu Välimäki said however that he doesn’t believe that sote’s legislative changes will prove to be the system’s undoing.

“At the moment I don’t see how the bill in its present form will be a problem,” he added.

“My current view is that there would be no barriers if pricing is transparent and market-based,” Välimäki said.

According to the system head, there would be no problems when new provincial administrations take on responsibility for the reform. He declared that Apotti would continue to be developed in its current form as long as no new decisions about its structure are made.

“We cannot change any approaches until the facts are on the table,” Välimäki said in reference to the final laws that will pave the way for implementing the social and health care reform.

“We will soon be on the way to the first deployment in Vantaa,” Välimäki continued.

The first phase of implementation of the patient data system will involve primary health care in Vantaa, some social care services and HUS’ Peijaksi hospital.

Apotti will cover HUS regional hospitals in Helsinki, Vantaa, Kirkkonummi, Kauniainen and Tuusula.

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