1 KNOWLEDGE WORK THE TIME HOARDER OF PUBLIC HEALTH CARE ____ Time usage on knowledge work within health care districs 2016 STUDY SUMMARY

 Goal: Examine the role, time usage, and content of knowledge work within Finnish health care districts  Pioneering research  Carried out in February 2016  Funded by Tekes  9 health care districts > 63,7 % of all Finnish health care district employees  The response 9,2 %, statistically significant STUDY IN SHORT

SURVEY SAMPLING respondents 2597 Nurses 455 Department secretaries 557 Doctors 2145 Other health care professionals

HEALTH CARE DISTRICS AND CENTERS 4

5 Nearly 30 % of doctors use OVER 6 HOURS per work shift on computer based knowledge work 557 RESPONSES BY DOCTORS

46 % of nurses use OVER 4 HOURS per work shift on computer based knowledge work 2597 RESPONSES BY NURSES

Over 70 % of nurses and doctors feel that knowledge work takes their time from PATIENT CARE

Over 83 % of doctors feel, that the current IT systems cummunicate POORLY WITH EACHOTHER

Over 67 % of doctors report to register the same data multiple times on DIFFERENT IT SYSTEMS

MOST TIME CONSUMING SHARES OF KNOWLEDGE WORK Doctors Nurses Department secretaries 77,9 % (160 min.) Registering and maintaining patient information 85,5 % (185 min.) Registering and maintaining patient information 69,8 % (80 min.) Internal communications and consultations 47,5 % (87 min.) Statements 35,9 % (64 min.) Referrals 57,6 % (63 min.) Internal communications and consultations 25,9 % (146 min.) Client communications 23,2 % (53 min.) Ordering medicine and other supplies 46,6 % (127 min.) Referrals 38,5 % - (143 min.) Client communications 32,5 % (110 min.) Prints 75,4 % (264 min.) Registering and maintaining patient information

11 DIGITAL WORKFORCE OTHER KNOWLEDGE WORK - NURSES Most mentions OTHER KNOWLEDGE WORK 126 MIN. / SHIFT

MORE THAN A THIRD OF ALL RESPONDENTS REGISTER THE SAME DATA MULTIPLE TIMES ON DIFFERENT SYSTEMS OVER 30 MIN. PER SHIFT

SAVINGS THROUGH AUTOMATION REGISTERING SAME DATA – 9 HEALTH CARE DISTRICTS 30 min = 7 % work shift 31 % doctors 34 % nurses Costs per month 4,5 meur* Costs per year 54 meur* THE COST OF MULTIPLE REGISTRATIONS MEASURED IN PAID SALARY ARE ANNUALLY OVER 54 MEUR BETWEEN THE NINE STUDIED DISTRICS. * The calculations are based on the average salaries and amount of doctors and nurses employed by the studied health care districts.

”Typing, bouncing between sub-windows, and generating statistics about all registrations take excessive amount of time.” ”360min, this number includes all drug descriptions, searching for operation codes and registering the same information on nearly 50 places, waiting for the pages to download, and fighting through different approval forms etc bureaucracy.” ”Main part of the working hour is used to type prescriptions and sorting out e-prescription problems, waiting for information via regional database takes a lot of time.” ”Doctors have become expensive secretaries. I would love to focus on patient care.” ”Moving from appointment book to patient card appears a pop up window. Completely unnecessary! Yet waiting for this window to download takes a long time and during this wait the computer is unusable. Everybody waits. 10 patients x 1-2 min = 15 min per day.” DOCTORS – REGISTERING PATIENT INFORMATION, EXAMPLES

”The amount of routine registrations the nurses need to take care of has increased radically. Many many registrations need to be made multiple times in different systems! Often the information in incomplete and putting together a full file can be like detective work... searching through different systems to put the peaces together.” ”Working in the operating room, patient files are opened on Opera, Web-lab, Impax, Radu and Desktopista. We also use Rafaelaa for registrations. On average it takes 10min /patient...” ”Takes so much time. TOO MUCH, and its all away from patient care! At least half the shift.” ”For safety reasons we need to register a lot of patient information and also to show the work that has been done. Patient appeals have increased in number for this everything that has been done must be recorded. Allergy registrations have become very time consuming and complicated, many leave it undone to cut corners. This is a major risk!” ”Registering patient care, summaries, reading medical statements, recording medicine, making orders, creating patient files, classifications, risk evaluations, and daily computer work take around 6,5 h per day” NURSES – REGISTERING PATIENT INFORMATION, EXAMPLES

”Checking patient registration entries on Oberon 90min, diagnosis information on Obstetrix 60min, copying old patients files and data on Miranda 180min.” ”Scrolling through patient files checking for prescriptions to make orders on. Lab. + examination orders take the longest. We have to scroll through all files constantly because there is no notifications in place.” DEPARTMENT SECRETARIES – EXAMPLES

THIS IS HOW COMPUTER BASED KNOWLEDGE WORK IS PERCEIVED BY HEALTH CARE PROFESSIONALS

SUMMARY  Half the work time of health care professionals is consumed by knowledge work routines.  Time spent on the computer is perceived to be away from patient care.  Main issues are relaited to poor communications between IT systems and multiple registrations of same data, which occupies a third of health care professionals over 30 min per shift.  The costs of multiple registrations measured in paid salary are 54 million euros between the studied organizations > the money could be saved through automation.  Software robotics can be used to automate 2-10% of knowledge work in health care districts.  The savings potential for automating knowledge work routines in Finnish public health care is approximately million euros per year.

19 ADDITIONAL INFORMATION Heikki Länsisyrjä, CEO Digital Workforce Nordic Oy , ____ Time usage on knowledge work within health care districs 2016 STUDY SUMMARY