The productivity benefits of digital clinics are a hot topic in public debate, but there is still little research-based evidence. Where can productivity gains come from, and how do digital clinics differ from one another?
When well implemented, a digital clinic can enable higher professional productivity compared with phone or in-person contacts. Let’s first think about assessment of the need for care conducted by phone. Phone contacts are inherently linear: the professional interacts with one customer at a time. In call-back systems, the professional calls the customer back and waits for them to answer (or not). The patient then explains the issue (possibly including details that are unnecessary from the professional’s perspective), and the professional asks questions to assess the need for care. Some of these questions are routine. Finally, the nurse gives self-care instructions or directs the patient to follow-up care. Entries in the electronic record are made manually by the professional.
Digitalisation enables efficiency improvements at many points in this process. First, the customer can complete routine pre-questionnaires in a mobile app, and the matter only enters the professional’s queue once the patient has finished providing this information. In practice, well-designed intake questionnaires can, at best, generate almost all the necessary information for the professional in a structured format. This frees the professional’s time from routine questioning to clarifying questions and actual care. Standardised intake questionnaires can also improve and harmonise service quality by ensuring that every clinically important question is asked every time. In addition, a well-functioning intake solution can partly speed up record-keeping through automation.
Second, a chat interface enables a non-linear way of working in which a professional can handle several patients simultaneously. After the professional asks a clarifying question in one conversation, they can move on to read the patient’s reply in another conversation instead of waiting for the first customer to respond.
Third, a chat interface enables benefits from specialisation and practice. Non-linear work suits some professionals better than others. Using keyboard shortcuts or interface features, professionals can also reduce typing by using ready-made phrases that recur routinely in conversations. Professionals for whom non-linearity is a good fit—and who learn to use the interface efficiently—can be very productive in a digital clinic, measured by the number of customers managed per hour.
Service organisation and professional incentives differ across digital clinics
Comparing digital clinics across wellbeing services counties is often not straightforward, because there is no single, unambiguous “digital clinic,” but rather a variety of digital service solutions. Digital clinics often differ in how services are organised, what incentives the workforce has, and what features the digital-clinic platform offers. We believe these factors can lead to significant differences in customer experience, access to services, and the (cost-)effectiveness and efficiency of digital-clinic operations.
Let’s start with service organisation. In public primary health care—such as brick-and-mortar health-centre services—an assessment of the need for care by a nurse (the so-called nurse-gatekeeper model) has traditionally been required. Early in the digital-clinic transition, however, in both Meri-Lappi and Päijät-Häme the public digital clinic initially operated so that the customer could contact a doctor or a nurse directly without a need-for-care assessment.1 In 2023, both areas adopted the nurse-gatekeeper model in the digital clinic, familiar from traditional health-centre services.2 As we understand it, public digital clinics launched in 2023 or later—such as in North Ostrobothnia, Kanta-Häme, East Uusimaa, Central Finland, Pirkanmaa, North Karelia, or Satakunta—have used the nurse-gatekeeper model.
There is also variation between wellbeing services counties in whether the digital clinic’s workforce is in-house or contracted. While an in-house workforce presumably knows the local service system and customers best, external staff specialised in digital services and chat interfaces may be able to work more productively in a digital clinic—at least at first. For example, in Päijät-Häme, the digital clinic’s services are produced by Mehiläinen’s Telemedicine Centre, whereas in East Uusimaa, for example, the services are produced in-house. In some areas, such as Pirkanmaa and North Ostrobothnia, there is a hybrid model in which service production is partly in-house and partly contracted. In South Karelia and Kymenlaakso, the wellbeing services counties produce services together with Kaiku24, which they partly own.
Organising digital services and embedding them into the wellbeing services county’s other services poses its own challenge, which can significantly affect the care pathway and its efficiency. For example: Can the receiving professional see the result of the digital symptom assessment and the intake information, or is it visible only to the nurse who performed the need-for-care assessment? Can the customer’s digital pathway be cut short so that they are told to contact place X by phone—worst-case after they have completed a digital symptom assessment that is not visible to the professionals at the call destination?
Professional incentives can also vary considerably. A professional paid per output has a clear incentive to handle many patients quickly. A salaried professional, on the other hand, may have more leeway to focus on a single customer. We already know that digital-clinic professionals differ markedly in the number of patients handled per hour. Key questions include whether digital channels widen productivity differences between professionals compared with brick-and-mortar work, and how much practice, experience, and appropriate incentives help increase professionals’ productivity in digital settings.
From the perspective of boosting professional productivity, key questions are whether
1) smart, practically validated intake questionnaires are integrated/available on the platform,
2) the professional can use ready-made phrases (e.g., self-care instructions) via keyboard shortcuts or the interface to reduce typing, and
3) the platform automates documentation into the electronic patient record system.
As we understand it, there is considerable variation between wellbeing services counties on each of these points,3 and thus untapped potential.
Fragmented electronic patient record systems challenge counties’ digital services
The market for digital-clinic platforms has been lively in recent years. At least four different vendors’ platforms are in use in wellbeing services counties: BeeHealthy, Terveystalo, SAG Flowmedik, and VideoVisit. Measured by number of counties, the most common is BeeHealthy (Päijät-Häme, South Savo, North Karelia, Pirkanmaa, Kymenlaakso, South Karelia, Central Uusimaa, Central Finland, and North Savo). Terveystalo serves three counties (South Ostrobothnia, Satakunta, and Southwest Finland). SAG Flowmedik (North Ostrobothnia and Kanta-Häme) and VideoVisit (for now Central Finland and East Uusimaa) also have established digital-clinic operations.
One factor that has slowed the digital-clinic transition has been the varying starting point of wellbeing services counties with respect to electronic patient record systems. Some counties had a single system in primary care even before the counties were established, while others had numerous systems (different vendors, different versions, or different databases). From the professional’s perspective, the situation is challenging if entries must be made in multiple different systems.
Counties have solved the problem in different ways. In some, the rollout schedule for digital-clinic operations has (partly) followed the timeline for standardising systems. In Pirkanmaa, the aim was to introduce the digital clinic across the entire county at the same time, even though several record systems were still in use. The solution was that professionals would document in only one electronic record system, and professionals using other systems would view the entries via the national Kanta services. In a few years, it is likely that each wellbeing services county will use only one patient record system, which will also facilitate centralised digital-clinic operations provided for the entire county. After that, a key development area for productivity will be how automatically the digital-clinic professional can complete documentation into the patient record system—for example, with AI-based intake solutions.
Beyond productivity, the effects of digital clinics on the health-care system and its customers are broad. But who, exactly, are the customers of digital clinics? We’ll delve into this in future blog posts.
Authors: Tapio Haaga, Vivi Mauno, Tanja Saxell, Alex Kivimäki, Kaisa Kujansivu, Oskari Nokso-Koivisto, What is Kortelainen, Lauri Sääksvuori
- For example, during the first year of the health of Harju in the Päijät-Häme wellness area in 2021, more than half of the digital clinic contacts were for doctors. Source: https://harjunterveys.fi/wp-content/uploads/2022/06/202206_EHMA_Paijat_Sote_Digital-solutions-1.pdf , read on 4 November 2024[↩]
- Source: https://yle.fi/a/74-20028754, read on 5 November 2024.[↩]
- See e.g.: https://omahame.fi/fi/w/Älykäs-esitietolomake, read on 4 November 2024.[↩]