University of Oulu

Haverinen, J., Keränen, N., Tuovinen, T., Ruotanen, R., & Reponen, J. (2022). National development and regional differences in ehealth maturity in finnish public health care: Survey study. JMIR Medical Informatics, 10(8), e35612.

National development and regional differences in eHealth maturity in Finnish public health care : survey study

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Author: Haverinen, Jari1,2; Keränen, Niina1,3; Tuovinen, Timo1,3;
Organizations: 1FinnTelemedicum, Research Unit of Medical Imaging, Physics and Technology, Faculty of Medicine, University of Oulu, Oulu, Finland
2Finnish Coordinating Center for Health Technology Assessment, Oulu University Hospital, Oulu, Finland
3Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
Format: article
Version: published version
Access: open
Online Access: PDF Full Text (PDF, 0.7 MB)
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Language: English
Published: JMIR Publications, 2022
Publish Date: 2023-02-09


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.

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Series: JMIR medical informatics
ISSN: 2291-9694
ISSN-E: 2291-9694
ISSN-L: 2291-9694
Volume: 10
Issue: 8
Article number: e35612
DOI: 10.2196/35612
Type of Publication: A1 Journal article – refereed
Field of Science: 3142 Public health care science, environmental and occupational health
113 Computer and information sciences
Funding: The study is part of the national Monitoring and Evaluation of Social and Health Care Information System Services research project, which is cofunded by the Ministry of Social Affairs and Health (Sosiaali-ja terveysministeriö), and the participants are coordinated by the National Institute for Health and Welfare (Terveyden ja hyvinvoinnin laitos).
Copyright information: © Jari Haverinen, Niina Keränen, Timo Tuovinen, Ronja Ruotanen, Jarmo Reponen. This is an open-access article distributed under the terms of the Creative Commons Attribution License (, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in JMIR Medical Informatics, is properly cited. The complete bibliographic information, a link to the original publication on, as well as this copyright and license information must be included.