Electronic health care (e-health) services intended for Finnish citizens have been recently developed nationally, regionally, and locally through several projects and programs. This study aimed to investigate the development and availability of e-health services for Finnish citizens in specialized and primary health care and private medical service providers from 2011 to 2020. In addition, the differences between the availability of services in different sectors and regional differences between hospital districts were investigated. Data were collected using web-based questionnaires in 2011, 2014, 2017, and 2020 from “Use of information and communication technology surveys in Finnish health care”. This study covers all 21 hospital districts, nearly all primary health care centers, and a sample of private medical service providers. Quantitative data were analyzed using SPSS software (version 25). The availability of an e-health service was calculated as a percentage of all respondents in each sector. The results of this study show that public and private health care organizations extensively offered health care services on their websites. Almost all organizations had information on well-being, provided services, contact methods, and locations, as well as options to send electronic feedback. Remote consultation, electronic appointment booking services, and telephone counseling were also extensively offered. This study revealed that the volume of e-health services increased from 2011 to 2020. For instance, remote consultation services and information exchange through encrypted email increased rapidly during follow-up periods in all service sectors. Comparing service sectors revealed that specialized health care covers e-health services more extensively than do primary health care and private service providers. According to this study, there are also clear differences in the availability of services between hospital districts and no hospital district offered all studied services. These results suggest the need to clarify national and regional development responsibilities and standardize the availability of e-health services within and between hospital districts.

Background eHealth increasingly affects the delivery of health care around the world and the quest for more efficient health systems. In Finland, the development of eHealth maturity has been systematically studied since 2003, through surveys conducted every 3 years. It has also been monitored in several international studies. The indicators used in these studies examined the availability of the electronic patient record, picture archiving and communication system, health information exchange, and other key eHealth functionalities. Objective The first aim is to study the national development in the maturity level of eHealth in primary health care and specialized care between 2011 and 2020 in Finland. The second aim is to clarify the regional differences in the maturity level of eHealth among Finnish hospital districts in 2020. Methods Data for this study were collected in 2011, 2014, 2017, and 2020, using web-based questionnaires from the Use of information and communication technology surveys in Finnish health care project. In total, 16 indicators were selected to describe the status of eHealth, and they were based on international eHealth studies and Finnish eHealth surveys in 3 areas: applications, regional integration, and data security and information and communications technology skills. The indicators remain the same in all the study years; therefore, the results are comparable. Results All the specialized care organizations (21/21, 100%) in 2011, 2014, 2017, and 2020 participated in the study. The response rate among primary health care organizations was 86.3% (139/161) in 2011, 88.2% (135/153) in 2014, 85.8% (121/141) in 2017, and 95.6% (130/136) in 2020. At the national level, the biggest developments in eHealth maturity occurred between 2011 and 2014. The development has since continued, and some indicators have been saturated. Primary health care lags behind specialized care organizations, as measured by all the indicators and throughout the period under review. Regionally, there are differences among different types of organizations. Conclusions eHealth maturity has steadily progressed in Finland nationally, and its implementation has also been promoted through various national strategies and legislative changes. Some eHealth indicators have already been saturated and achieved an intensity of use rate of 100%. However, the scope for development remains, especially in primary health care. As Finland has long been a pioneer in the digitalization of health care, the results of this study show that the functionalities of eHealth will be adopted in stages, and deployment will take time; therefore, national eHealth strategies and legislative changes need to be implemented in a timely manner. The comprehensive sample size used in this study allows a regional comparison in the country, compared with previous country-specific international studies.

Health information exchange (HIE) is the mobilization of health care information electronically across organizations within a region, community, or hospital system. Nordic countries have been developing their health portals including national HIE services systematically. In Finland HIE begun with various regional health information exchange (RHIE) pilots in since 1998. The Kanta patient data repository component in the national HIE has been adopted in routine use since 2012. The current role of non-Kanta RHIE in relation to Kanta services is somewhat unclear. Our research questions are following: 1) Has the availability of RHIE services changed during 2017-2020? 2) What functional types of RHIE are there in Finland in 2020? 3) From the point of view of healthcare provider organizations, at what level is the availability to combine regional information seamlessly into the same view of local patient record systems? Data used in this study were collected using web-based questionnaires in 2017 and 2020 as part of the surveys for monitoring and assessment of social welfare and health care information system services in Finland. This study reported in this article covers all 21 public hospital districts and nearly all public primary health care centers. The quantitative data provided by the organizations were analyzed using SPSS software (version 25). The availability of a particular service or function was calculated as a percentage of all respondents in each sector. The results of this study show that the overall availability of RHIE services has not markedly changed 2017-2020. Functional types of RHIE meaning the role, use and types of RHIE in hospital districts in Finland varies greatly in 2020. We recognized three different types of non-Kanta RHIE in the non-combination organizations (one-way, symmetrical, full symmetrical). Seamless integration of at least some Kanta data into the same view as the main patient health record system data was more common than seamless integration of at least some non-Kanta regional data.