Terveystalo – Best Use of Digital Health WINNER– 2017

Terveystalo is the largest private-owned health care provider in Finland. In 2015, the total revenue was 506 Meur. Terveystalo consists of 170 outpatient clinics and 17 units with hospital services. We deliver 2.5 million physicians’ visit annually, which is about 10% of all visits Finland. The staff consists of 7000 HCP’s of which half are private practicioners.

Every day, thousands of patients use Terveystalo’s services – they visit the physician, have laboratory tests taken, participate in screenings. On every encounter, data is massively gathered, but in health care this data is rarely used to improve the effectiveness of the system. Our innovation is to use the real world data as continous, real-time feedback of clinical quality for our physicians. For the last three years, Terveystalo has improved prevention and care of type 2 diabetes through measuring both process and outcome indicators of type 2 diabetes prevention and care in our occupational health care setting. The indicators are shown to every physician, team and clinic, and everyone knows where they stand in perspective to high quality care. For type 2 diabetes, we use a set of validated indicators that show the effectiveness of our preventive and care processes: number of individuals in high risk for type 2 diabetes, number of individuals with diagnosed (and undiagnosed!) type 2 diabetes, and a set of indicators that measure the compliance to care guidelines when treating type 2 diabetes (HbA1c long time sugar control, LDL-cholesterol levels, blood pressure, weight, microalbuminuria control, sick leaves etc). All this data is gathered automatically from the electronic medical record and shown to each physician, team and unit in real time. A physician, team or unit thus knows how well they are performing and which parts of the process they need to improve. 

We chose type 2 diabetes for the first disease group to measure and improve in this fashion for a number of reasons. First, currently half a million Finns have diabetes (10% of population). The disease is becoming increasingly common; moreover, the number of Finns with diabetes is projected to double within the next 10–15 years. Increasing the focus on early identification as well as supporting lifestyle change at a sufficiently early stage reduces the risk of type 2 diabetes and can often help to prevent the disease. Diabetes prevention is inexpensive and there is substantial scientific evidence for its efficacy. Already, diabetes treatment accounts for approximately 15 percent of Finnish healthcare costs. In addition to treatment costs, Finnish society loses approximately a billion euros per annum due to early retirement and sickness absences caused by diabetes. Treating diseases associated with untreated diabetes is especially expensive, accounting for approximately 70 percent of diabetes treatment costs. The bulk of the costs could be avoided if those at risk and those who already have diabetes could be identified in time, and our innovation helps us achive this goal.

Diabetes can be treated well, and the effectiveness of care can be monitored with indicators as descibed earlier. Terveystalo has developed this in-house tool, “Etydi”, which allows physicians to monitor the effectiveness of care. It allows physicians to identify patients at risk, track the course of the treatment and assess whether the current treatment is effective. The tool has already allowed Terveystalo physicians to identify more than 40,000 cases of diabetes or people at risk of diabetes among the company’s half a million occupational healthcare customers. The tool has also improved diabetes treatment results.

This year, we launch a personalized digital care plan in our patient portal (used by half a milloin individuals) that keeps track of care; it reminds and supports the patient and also tells whether the patient is recieving top quality care and achieving optimal results. 

The ‘Dose Excellence Project’ (DEP) is the largest radiation dose management program globally. The purpose of DEP is to optimise the dose of radiation a patient receives by a computed tomography scan of diagnostic image quality. It is operating in 12 countries, involving 67 CT systems from four vendors. The DEP involves more than 80 radiologists, 120 radiographers and 12 country project leaders. 75 standardised CT protocols have been developed, unifying the way in which CT scans are performed. Data from an average of 65,000 examinations per month are analysed in real time to ensure that pre-defined dose limits are not exceeded, and then compared to the group to identify best practice and optimise care. We call this ‘balanced radiography’ – not too much radiation to cause harm, but not so little that image quality is negatively effected.

The innovation, “Etydi”, is an in-house developed reporting system that gathers information from our electronic medical record, Dynamic Health (Tieto healthcare & welfare ltd) . We applied a Data Warehouse (DW) solution (developed primarily for business controlling purposes) on top of the raw data to analyse tens of millions of rows of data. This in-house developed DW solution allows rapid development and easy modification of the data model.

For the user interface layer, a dedicated web application was developed to support special reporting needs which commercial business intelligence tools were not able to provide
These parameters, shown for each health care professional, team or unit and compared to Terveystalo averages, include
– number of diagnosed type 2 diabetics (uses the ICD10-code E11)
– number of patients that already have diabetic lab results, but have not been diagnosed with E11 (or E10, type 1 diabetes)
– number of patients with high risk of type 2 diabetes (lab results, diabetes risk assessment questionnaire)
– lab results in all of the above-mentioned groups, according to national diabetes care guidelines
– shows the percentage of patients in good/bad blood sugar balance, blood pressure balance, the balance of cholesterol level
– shows total days of sick leave
– etc

Month : November
Year : 2013

We measure:
– the use of this tool, Etydi, by professional and unit. The number has increased from the first year’s 300 users to current 2400 active users.
– the number of individuals the tool has found in different groups (risk of diabetes, diagnosed diabetes). In the first year, we had recognized 23 000 individuals at risk for diabetes and 9000 diabetics, now the numbers are 35 000 and 12 000, respectively.
– the process indicators for good diabetes care (how often we do follow the care guidelines).
– the outcome indicators for good diabetes care (how well we meet the aims of diabetes treatment)
– days of sick leave in every group recognized

By implementing this reporting tool and continually improving our type 2 diabetes prevention and care processes, we have:
– identified a growing number of individuals in risk of type 2 diabetes, thus allowing us to deliver preventive interventions that are shown to be effective at a very low cost. By effective prevention, we hinder or delay the onset of type 2 diabetes
– identified a growing number of type 2 diabetes patients. This means that without our tool, they would have gone undiagnosed and denied effective care
– transparently shown the results of diabetes prevention and care for every individual health care professional, team and unit. Everyone has been able to correct their own care processes which create a continuous cycle of improvement.

In 2015, a study performed by University of Vaasa and VTT Technical Research Centre of Finland Ltd showed that if all healthcare providers in Finland would use the same model in recognizing and taking care of those at risk of diabetes or diagnosed with diabetes, it would save 31 000 years of labour and 2 billion euros from health care expenses – per annum. (this is explained in supporting document “diabeteksen hoidon vaikuttavuus Terveystalossa”