Photos: iStock

Areas for indicator development

Introduction

In the previous chapters, we have argued that the value of e-health systems extends far beyond its value for clinician end-users providing care. In the first chapter, we introduced the concept of healthcare systems, health ecosystems and value creation and that a health ecosystem has at least three value chains that are intertwined with each other. Compared to previous analyses, the analysis that we present in chapter 2 of this report, we show that policy makers now place a greater emphasis on leveraging the value of healthcare data in research and innovation workflows. This means that research and innovation must be an area for indicator development. The current policies are also shaped by a concern for usability, documentation burden and (implicit) the well-being of healthcare professionals. This concern ultimately relates to professional development, how to build and maintain the competences that are needed and therefore to the education and training value chain.

In this chapter we also present the indicator development areas that were mentioned in the Finnish “Strategy for digitalisation and information management in healthcare and social welfare (2024)” before we outline our suggestion for indicator development areas to cover the scopes of the Nordic e-health policies between 2018 and 2024.

Areas for indicator development mentioned in the national policies

One of the national policies stood out when it comes to describing areas for indicator development to monitor the progress of the implementation of the policy. Table 4 enlist the indicator areas from the Finnish “Strategy for digitisation and information management” and how these relate to the scope of the national policies described in chapter 2.

Area in the Finnish strategy document	Relation to scope in the Nordic e-health policies
Digital health and social services centre and customer and service counselling	Relates to Shifting towards prevention and digital first
From digitalisation of information to digital operating models	Relates to Supporting health operations
Giving customers access to their own data	Relates to Empowering and activating citizens
Customer participation in services	Relates to Empowering and activating citizens
Digital wellbeing operating models and service task	Relates to Empowering and activating citizens
Ensuring data quality	Relates to Supporting health operations and Making health data more available in research and innovation workflows
Interoperability policies and selection of data models	Relates to Doing the groundwork
Evaluating and updating the Kanta information system services	Relates to Supporting health operations
Strengthening the benefits of Kanta data	Relates to Supporting health operations
National and regional steering and management of the service system by developing secondary use of health and social services data	Relates to Supporting health operations and Making health data more available in research and innovation workflows
Use of information in research, development and innovation activities	Relates to Making health data more available in research and innovation workflows
Developing a management and steering model for digitalisation and information management	Not relevant outside Finland
Digital security	Relates to Doing the groundwork

Table 4. Indicator development areas mentioned in the Finnish Strategy for digitisation and information management.

Areas of indicator development to cover the scope of the national e-health policies

By and large, the scope of the policies from the five countries are centred around a) empowering and activating citizens; b) a shift towards prevention and digital first; c) supporting health operations; d) doing the groundwork; e) making health data more available in research and innovation workflows and f) supporting health personnel. Table 5 presents the suggested areas for indicator development and how these relate to the scope of the national policies and to the value chains.

Table 5. Areas for indicator development.

Area for indicator development	Value chain
	Health- care	Education and training	Research and innovation
Scope: Empowering an activating citizens
Patients scheduling and rescheduling of appointments for consultations	x
Patients bringing self-measurements to the consultation	x
Patients’ collection and use of digital health data	x		x
Patients’ belief in own ability to access, understand and make use of digital health data	x
Patients bringing knowledge and reasoning services to the consultation room	x
Patients access to decision support tools including tools for shared decision making	x
Patients’ interaction with digital care pathways in which they are enrolled and are to benefit from	x
Patients’ discovery, inquiry and engagement in clinical trials	x		x
Patients’ attitudes towards the digital healthcare system
Scope: A shift towards prevention and digital first
Citizens and patients use of knowledge sources that are curated and published by health authorities and made available in patient portals	x
Synchronous and asynchronous digital consultations	x	(x)
Next generation digital consultation tools	x		x
Building down the barriers between health information silos that are constrained by geography or by healthcare subsector (for primary use)
Provision of relevant knowledge at Point of care. Knowledge-support Clinical decision support	x	x
Helping health professionals gain an overview of the situation of the patient	x	x
Availability and use of order sets	x
Repertoire of digital care pathways that are available to clinicians and their value as tools to improve quality, completeness and continuity of care	x
Documentation support	x	x
Outcome assessment	x	x	x
Supporting for interprofessional collaboration	x	x
Support for quality and safety monitoring of healthcare performance (including cohort-specific aggregation of healthcare data on national, Nordic and European levels).	x		x
Unresolved health problem to research workflows (e.g. discovery, inclusion into and conductance of clinical trials in oncology)	X		x
Scope: Doing the groundwork
Development, maintenance and expansion of IT-infrastructure and information infrastructure that is specific to the health domain.	x	x	x
Development and implementation of service models that reimburse digitized care	x
Standardisation work	x	x
Work on legislation (e.g. to allow for secondary use of health data)	x	x
Improving procurement practices	x
Information security, cybersecurity.	x	x	x
Scope: Making health data more available in research and innovation workflows
Increasing availability and quality of data (e.g. structured documentation, use of terminology systems)	x	x	x
Data to knowledge workflows, e.g. Number of ethically approved biomedical research projects that utilize data that originates from healthcare or self-care.	x		x
Knowledge to innovation workflows (e.g. multicenter international clinical trials of medicinal products or medical devices).	x		x
Siloed health data to aggregated health data workflows (nationally and internationally) e.g. Nordic or European research registries dedicated to a particular patient cohort such as long Covid, patients with rare diseases.	x		x
Scope: Supporting health personnel
Implementing Healthcare information systems that are easy to learn, easy to memorize and that does not require the development of workarounds	x	x
The governing of knowledge content in Clinical decision-support systems to optimize the relevance of CDS and minimize alert fatigue	x	x
IT support for representing the state of the patient and the care that was provided to ease the documentation burden for health personnel.	x	x
Sufficient and competent IT-support for healthcare personnel	x	x