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Title and Description
Terveysportti – nationwide access to quality medical information
Reviewed/ candidate case
Quality reviewed case
Short description
The Terveysportti health portal is an online service operated by the Finnish Medical Society - Duodecim. At a single internet address, it provides key medical content to support the work of healthcare professionals.
Objectives and purpose
Busy Clinicians don’t have the time to perform an extensive search to find the best available evidence each time they have a clinical question. Ideally, they only would have to carry out one search, taking not more than one minute to find the right information. This demand seems to be reasonably met by the Terveysportti health portal.
Detailed description
Terveysportti portal is a service for health care professionals. It helps them to find the day-to-day medical information quickly and reliably at one source. The service consists of more than 35 databases. Among the portal’s features are the Physician’s and Nurse’s Databases, Pharmaca Fennica, the ICD-10 international classification of diseases, Current Care guidelines and the major professional journals from Finland and abroad. The portal was initially funded by Duodecim, the Finnish Medical Society, and later commercialized by Duodecim Medical Publications Ltd. When opening in the year 2000 it included Evidence-Based Medicine Guidelines (EBMG) and Current Care guidelines. These guidelines are the most important databases in the medical area in Finland. It is a comprehensive collection of guidelines for primary and ambulatory care. EBMG contains 1200 concise guidelines, and approx 3000 very short evidence summaries describing the evidence supporting individual treatment recommendations. Though neither use nor adherence to the EBMG is mandatory, they are a highly welcomed and frequently used decision support instrument for all physicians. Terveysportti is used nationwide in public health care units, hospitals, private practices and pharmacies as well as medical faculties. Especially in an area like medicine, where the knowledge about diagnosis and treatment of illnesses is rapidly developing, it is essential for physicians to treat at the state of the art. This implies continuing education. Therefore, a permanent search of up-to-date information belongs to the work of physicians. The Terveysportti portal seems to have developed to be the contemporary answer to this need. Since its start in the year 2000 the use of the health portal has increased to a very high level. At present, more than 20 million articles are read every year, and more than 1 million guidelines per month are opened in a country with 5.2 million inhabitants and 17 000 physicians. For physician the use of the Terveysportti portal databases is an established instrument integrated their daily work. In their daily routine it is used mostly immediately before the patient visits, to prepare for the patients treatment. But also during the consultation the portal is used. Physicians often have the relevant databases (e.g. Drug database etc.) permanently opened on their computer in an own browser, to do a quick search if necessary. Physicians can rely on that all information available via the Terveysportti portal is up to date and at the state-of-the-art. Especially the integration of electronic health records (EHR) with Terveysportti improves for example coding the diagnosis in the international classification of diseases (ICD). Uniquely developed concept identifiers ensure that a diagnose is automatically mapped to a guideline. As a result of the aforementioned functionality and embeddedness in clinical working processes, quality and effectiveness of physicians increases. It is assumed that the achieved increase in quality of care will finally lead to increased effectiveness of the overall health system.
Funding
The Finnish Medical Society Duodecim is a scientific association with more than 18,000 members. Duodecim (and the Finnish Medical Foundation, which was set up from its funds) offers grants worth about two million euros annually. Out of these grants the Terveysportti portal was set up. Today the portal belongs to the Duodecim Medical Publications Ltd. The health care system in Finland is publicly funded and before the launch of the service in 2000 all the 20 leaders of the healthcare districts collectively decided to purchase the portal service for their employees. Employers pay for the service.
Interoperability and standards
Duodecim already very early recognized that content management needs efficient supporting tools. For example a centralized guideline production system has been developed since 1989. Presently it consists of an XML-based content management system for all documents, a version control system that enables remote work by editors and authors, and a multi channel publishing technology that converts the contents into print, web, CD and mobile versions automatically; indexing ensures easy finding. All guidelines and a number of other databases have been indexed by hand using MeSH (Medical Subject Headings established by the National Library of Medicine USA) and its Finnish translation, plus a national meta thesaurus of non-MeSH terms and classification codes used in electronic health records (EHR). The national meta thesaurus contains more than 100 000 terms that have been mapped to each other on the basis of unique concept identifiers. Thus, the guidelines can be searched e.g. by diagnostic codes and linked directly to the EHR on the basis of these codes. The incorporation of a selected set of SNOMED CT codes (Systematized Nomenclature of Medicine-Clinical Terms, a comprehensive clinical terminology) is being planned.
Timescale
Start of planning
1999
1st milestone
In the year 1989 the Finnish Medical Society Duodecim published a first medical information database available on floppy disc. From the year 1991 this database was made available on CD-ROM. In the year 1999 the fist idea for an internet portal came up. The initial idea was to create an electronic medical journal. First plans for funding were made initiated by the Finnish Medical Society. Finish public organisations responsible for a public funding were not very responsive, therefore the Finnish Medical Society decided to take over the initial funding. Before the commercial service started in 2001 a public beta period was conducted.
2nd milestone
In 2000 all the 20 leaders of the healthcare districts collectively decided to purchase the portal service for their employees.
3rd milestone
At the same time (2001) the Pharmaca Fennica, a Finnish pharmaceutical information system, started and was included in the Terveysportti portal.
Start of routine operation
2001
Evaluation
Ongoing
Characteristic of the application
Country
Finland
Part in the healthcare chain
Diagnosis
Therapy
Professional education and training
Level of Implementation
Country-wide
Technology
Bespoke/ locally build solutions
Details on Technology
The portal runs in a Linux environment, all articles are implemented in an Oracle database, all text is available in XML format and indexed. The indexing is essential for matching the search items and follows semantic rules.
Results
Outcomes
The Terveysportti portal comprehensive content consists of: EBM Guidelines (> 1000 guidelines), physicians database (> 20 000 articles), pharmacopoeia and related data bases, medical journals, news-service, ICD-10 (International Statistical Classification of Diseases and Related Health Problems 10th Revision) search engine, nursing database, intensive care guidelines, Cochrane Library and a drug interactions database. The portal allows the users to effectively retrieve information due to its ease of use. The high usage of the portals content confirms this. During one month (1.9.2008 - 31.9.2008) in total 956 445 documents were accessed in the physician’s databases of the Terveysportti portal. From all accessed documents 43.7% were medical guidelines, 18.2% medical journal databases, 15.1% related to imaging (skin, eyes, x-rays), 11.6% related to patients. The remaining 11.4% of accessed documents are spread over the other eight databases.
Wider impact
The usage of the Physician’s Databases of the Terveysportti portal improves the performance of the health care professionals. Therefore it reduces costs within the Finish health care sector and increases the quality of the health care in Finland.
Success factors
The initial launch of the portal service was planned in close cooperation with the 21 health care districts of Finland. Also the service has been continuously developed according to the feedback from the communities and health care districts. User-training has been organized by using e.g. medical students as teachers. Pricing of the service has been reasonable (not-for-profit). Furthermore, some country-specific aspects facilitated the acceptance of electronic guidelines in Finland. These are: * the overall high national penetration of ICT in health care, * the single municipal ownership of (public) health care, * one respected scientific society (Duodecim) responsible for developing and producing the service * the commercial nature of the service plays an important role, as employers pay a bill and “motivate” the employees to use the service.
Failure factors
There were no major obstacles, apart from the fact that customers questioned the high licensing fee. Therefore Duodecim had to invest some time in explaining the fee structure to overcome this resistance. Justification again was need when the price had to be raised.
References
References and dissemination
Dodecim Medical Publications Ltd. Web site: http://www.duodecimpublications.com/
Languages
English
Finish
Organisation implementing
Title
Forename
Pekka
Surname
Mustonen
Organisation
Dodecim Medical Publications Ltd.
Department
Occupational background
CEO, CIO, CTO
Address of organisation
PO Box 874, Kalevankatu 20 A, 00101 Helsinki, Finland
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