My experiences with digitalisation

I graduated as a practical nurse in 2008. My first summer job was in home nursing where we wrote our daily summaries about the patients condition and observations into a patient information system. After that I worked nearly two years in a nursing home where practical nurses only kept documentation on paper. Medications were divided from normal medication packages into pill dispensers, the same ones used at homes. When I studied to become a radiographer I did short term jobs as a practical nurse before graduation and a lot had changed. Patient information systems were a lot more comprehensive and also complicated. Nowadays home nursing has documentation possibilities in their mobile phones and they can do patient documentation while on the move. My grandmother has daily remote video conversations with her home care nurses. Digitalisation has increased health care’s flexibility, increased quicker and wider access to data and enabled more home treatment as people can be telemonitored, remotely contacted and in someways treated also.

For the last four and a half years I have worked in IT. First as an application specialist for patient information systems, and for the last year as a solutions specialist focused on digital solutions. During this IT career I have seen digitalisation in the increase of speech recognition, digital care paths, remote video appointments, telemonitoring, robotics and automation, mobile health applications especially in the private sector, and Kanta-archiving and it’s benefits in data sharing. I think we still have a lot more to advantages to come out of digitalisation, but we are steadily getting better and more agile. Digitalisation has also offered support to desicion making, and this is one sector I think will and should develop more in the future. With the digitalisation, Big Data and machine learning we can help clinicians in treatment planning, support peoples wellbeing and staying healthier.

In the TED talk by Kenneth Cukier (2014) he talked about how data and especially big data is going to change the world around us. He talked about how data and machine learning will also lead to similar results as the industrial revolution did, and it will cause some jobs to not exist in the future. I can relate this topic to my work as an application specialist and the time when I was the trainer for clinicians in speech recognition. Many clinicians feared how it would affect the jobs of the hospitals secretaries, who were a important part of the hospital but who also spend time in typing traditional dictations into patient texts. One doctor refused to use to speech recognition, because they didn’t want to lose secretaries. The amount of traditional dictations dropped but the secretaries jobs stayed, because they had other administrative tasks they could do with he time freed from typing. So I think in our future we need to take into account the psychological meaning these innovations and digitalisation has to people.  It is natural for people to also fear these changes because for some people it might mean it has straight effects in their livelihood. Especially artificial intelligence and machine learning in my experience creates quite big prejudices and fears for the possibilities of error, when in fact humans are a lot more likely to make errors or act incorrectly. Still rare people fear this and the trust towards humans and their actions is much greater.

Digitalisation in the future

The COVID-19 pandemic speed digitalisation in some parts, but at the same time caused a lot of harm in the ways that we are struggling with resources and finances because the pandemic caused especially polyclinic functions to shut down and there is lots of catching up to do. Also I feel that the rushed legislation and short transform time to change our current hospital districts into well being services counties will cause even more delay in progressing health and social cares digitalisation. The counties are forced to focus on the absolute must do -tasks like getting the information systems with the correct information changed, data transferred under the wright owner and billing and invoicing functioning so that the health workers can operate. A one year time to plan and execute all this is a very short time when we are talking about our whole nation. Also the financial aid the counties received to execute these mandatory changes to the systems included a notation that the funding cannot be used to develop, or it will be withdrawed. My personal and professional opinion is that this should have been done very differently. First, we should have developed the nationwide mandatory interoperability standards, into which the patient information system manufacturers would have needed to comply in order to stay as a viable producer. Then I think there should have been a longer transformation period, so that counties could have planned further ahead and unified systems in their area. Now, they were faced with the obligation to not develop, which meant that the funding is poured into old systems that probably require change, consolidation or update in the very near future in order to fit the counties needs. Because the truth is that with our current systems efficiency and digitalisation cannot proceed much further. We need tools that support the digital workflow better, so that the work can become more fluent. If we keep implementing tools to current workflows they in many cases increase the amount the health worker.

So I think after we survive the mandatory changes phase in setting up our wellbeing counties, I think digitalisation will advance more rapidly. There clearly is need and a demand for more solutions as our finnish population is aging and our age depency ratio is going to start to decrease due to our aging population and decreasing birthrates. In addition to this we are already struggling with labour shortage, and with the aging population we are also facing times where we are going to loose big amounts of workers and the amount of graduates is not going to be enough to replace them. To help with these challenges we need digital tools to support health and social workers to help them carry out their jobs so that the digital tools help with tasks, and leave more time for the human to do the tasks that need human interaction and human touch.

In the bachelor’s thesis by Veid (2021, 34) she raises a very important note that with digitalisation there is a high risk of digital bifurcation and inequality. Veid explains that when we collect data we need to acknowledge the user groups that are left outside the data collection. People in more misfortune socioeconomic positions are being left outside data collection because their lifestyles differ so much from the people who are in better socioeconomic states. Veid concludes that this means that in our Big Data the less fortune people are underrepresented and for that reason the decisions based on Big Data will likely prefer people in better socioeconomic states and deteriorate the position of the underprivileged or disadvantaged. By digital bifurcation Veid refers to the reality that not all people have equal possibilities to take advantage of technology or equal skills to use digital technologies.

I watched the video Watch your day in 2020, that was added to YouTube eleven years ago. Many of the things in the video are today’s realities, but for people in higher socioeconomic positions. I cant help to think that how many years will it take for these things to reach also less fortunate people with our current finance crisis. The energy crisis and accelerated inflation will decrease the possibilities to invest in new technologies.

GDPR

The general data protection regulation in the EU was most visible to me in my work with the changes it caused to our patient information system. In order for the system to be compliant with the GDPR, it had a version update. This update included for example the functions that in the patient information system it is possible to execute the patients right to be forgotten and also the users right to be forgotten. It also included a lot more comprehensive logging of professionals actions in the patient files and enabled better traceability of functions in the system. GDPR also affected the reporting services and and in all applications brought visible the privacy statement. I think it very good that data security is increasing and that there is a EU wide regulation to ensure that these regulations are obeyed. From the eyes of an application specialist and from the feedback I heard from health workers, the patients right to be forgotten in the patient information system is quite troubling. If the patient in the system is set as passive (forgotten), this means that they no longer are visible in the patient search screen, but they can be found when the search definitions are opened and chosen an alternative option “show also passive patients”. After this the patients data is accessible but only the data that involves their consent forms and the setting to execute “emergency-situation”. This emergency-situation function brings all the data visible regardless of the patients possible data restrictions. This is of course mandatory, if we are talking about an emergency situation. So there are ways to work around the passive-mode, but in a emergency, will the health worker remember to go and find search definitions and change them in order to bring the patient visible? I think when we are talking about the health and social sector, the patient right to be forgotten is very difficult, and should not exist.

In my personal life GDPR mostly is visible through news and the privacy statements in websites and services. I believe that in Finland our data protection was in quite good hands even before the regulation, but I think it is good that it is EU wide and enables us better visibility to our data and how it is used. I think it is especially important that service providers have to clarify what data they collect and how they use it. I am glad we have the EU wide general data protection regulation. There are many risks of misuse if the data protection is not taken care of. One important risk was stated by Amanda Veid (2021, 34) in her bachelor’s thesis. Veid raised the possibilities of unauthorized data collection and advantages taken from the data to being from the start unethical action. She also states that even if people read the privacy statements, they might not always have the required knowledge to understand the statement adequately.

Self-evaluation

I thought many of the topics in this part where very relevant and important. It was quite suprising to see that same topics had been promoted highly about ten years ago, but at least to me and the public health and social sector the progress in digitalisation I think has been rather slow. There could be so much more done, but in many cases the public side suffers from tight funding. And I do not see the well-being counties bringing any help with this sector, on the contrary.

I have always been into technology and liked computers and using software and applications. But I have awakened to the fact that even though they bring lots of advantages to us, they take their toll also. A human needs also human contact and interaction and we have very basic needs like enough outdoors and sunlight. My point in this is, that while we can digitize a lot, we will also suffer if we do not stay in balance with the other sectors of life. We see also topics like technostress, addictions to mobile phones and the unhealthy sides of social media and how it affects especially our children and youth. Today’s children will grow up in a world experienced by no other generation and with some fear I fear the future and how these amounts of technologies and digital tools will affect the well being and growth of future generations.

References

Cukeir, Kenneth 2014. Big data is better data. TED Talks. Video. https://www.ted.com/talks/kenneth_cukier_big_data_is_better_data. Accessed 17.12.2022.

El-Eraky, Ahmed 2011. Watch your day in 2020. Video. YouTube video service, published 3.3.2011. https://youtu.be/OptqxagZDfM. Accessed 17.12.2022.

European Council 2022. Data protection in the EU. Internet publication. Updated 1.9.2022. https://www.consilium.europa.eu/en/policies/data-protection/#gdpr. Accessed 17.12.2022.

Veid, Amanda 2021. Massadata terveydenhuollossa: mahdollisuudet ja haasteet. Bachelor’s Thesis. University of Jyväskylä. https://jyx.jyu.fi/bitstream/handle/123456789/76725/URN%3ANBN%3Afi%3Ajyu-202106213919.pdf?sequence=1&isAllowed=y. Accessed 17.12.2022.

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