Paulus Torkki

Background: Health care systems increasingly promote patient engagement and self-management through digital health services. Digital care pathways, which support coordinated care delivery across the patient journey, have emerged as a promising approach, although evidence regarding their impact on resource use and costs remains limited. Objective: The aim of this study was to examine the implementation and impact of digital care pathways specifically designed to reduce or replace physical contacts or phone consultations in specialized health care. Methods: We analyzed the 10 most widely used digital care pathways by user volume. The selection criteria were (1) more than 1500 users per digital care pathway and (2) the aim of replacing or reducing in-person contacts. Descriptive analyses quantified digital contact volumes, average contacts and costs per patient, and inflation-adjusted expenditures using the consumer price index, both overall and by patient group. Ecologic group-level correlations were examined to assess whether the 2024 proportion of digital contacts was associated with changes in physical contacts and total costs from 2018 to 2024. Results: Digital care pathways were progressively adopted between 2018 and 2024, increasing from no use to accounting for 19.1% (34,837/182,188) of all outpatient contacts among the studied patient groups. Physical visits declined from 74.8% (99,201/132,622) to 54.1% (98,642/182,188), while contacts per patient rose by 7.6% on average. Conditions with the highest uptake of digital pathways showed the strongest reductions in the share of physical visits per patient, with declines of up to 39.7% (0.73/0.44). Average outpatient costs per patient decreased by 18.2% (€421/€515; €1=US $1.12 as of Oct 16, 2026) in real terms, with a 39.3% (€233/€384) reduction in the costs of physical contacts and a 15.4% (€135/€117) increase in the costs of phone visits. Digital pathway contacts accounted for 12.6% (€53/€421 per patient) of total outpatient costs in 2024; however, only 8.8% of the variance in total cost levels was explained by digital pathway adoption, suggesting that the shift toward digital care pathways did not substantially drive overall cost changes. Conclusions: Digital care pathways expanded rapidly, reaching nearly one-fifth of all outpatient contacts by 2024 in the included patient groups and contributing to a notable reduction in physical visits. However, their overall cost impact remains uncertain, as there have also been other factors impacting the development of outpatient costs.

Introduction: The growing number of older adults with multiple long-term conditions increases the need for better vertical integration of providers, especially in home care. Ensuring information continuity and care coordination is essential but remains time-consuming for home care professionals (HCPs).Methodology: This study aimed to quantify HCPs’ time on health information management (HIM) and examine factors associated with this time use. We conducted an exploratory cross-sectional survey in four Finnish home care organizations. Respondents estimated weekly time use for five predefined tasks related to information retrieval, care coordination, and communication. Descriptive statistics, ANOVA, and multiple linear regression examined total HIM time variation.Results: Based on 625 responses, HCPs averaged 258 minutes weekly on HIM tasks. On average, highest time use was reported by registered nurses (518 minutes) and physicians (336 minutes). Across measured tasks, the largest share of the total time was spent on information retrieval (32.0–46.5%). Profession and direct patient care were the only factors associated with time use, regardless of the region’s integration maturity.Conclusion: HCPs spend substantial time managing care information. Our findings highlight the critical need for better-integrated systems to enhance care coordination, reduce administrative burden, and enable professionals to devote more time to direct care.

The aim of the study was to describe how the implementation of a digital health and social care center affected registered nurses’ work. The study was conducted as a qualitative descriptive study in primary care, and the data were collected through semi structured remote interviews with 12 nurses. The data were analyzed using inductive content analysis. A total of three impacts and main categories were recognized, namely 1) impacts on patient care work, 2) impacts on interprofessional communication and work processes, and 3) impacts on nurses’ and other professionals’ work, workload, and wellbeing. Regarding the impacts on patient care, the digital health and social center increased the availability of digital services but also generated failure demand originating from patients. Interprofessional communication and work processes improved due to enhanced information flow, yet this simultaneously led to a substantial increase in both the volume and speed of information. While some processes and operations became more efficient, interviewees also reported instances of incompleteness. Finally, the digital health and social center affected professionals’ work and wellbeing by enabling remote work and reshaping work tasks, but it also contributed to an increased workload. In conclusion, the digital health and social care center was found to provide significant benefits for patient service accessibility and professional collaboration. However, its successful implementation requires clear operational practices, sufficient onboarding, standardized processes, and close collaboration between system developers and end users. Poor organizational preparedness and multichannel service use may increase nurses’ workload and hinder work-flow efficiency.

The aim of this scoping review was to synthesize and map recommended evaluation methods for the clinical investigation of health technologies. A database search was conducted in January 2025 in the Scopus, Ovid MEDLINE, and CINAHL databases, and grey literature was searched in the Mednar database. Publications from 2015–2024 were included if they described the clinical investigation of health technologies at various maturity levels, as assessed using the Technology Readiness Level (TRL) framework. Nine studies were included in the review. Recommended evaluation methods varied across different TRLs, with considerable overlap observed between evaluation domains. In addition, these methods exhibited an evolutionary progression, becoming increasingly rigorous and incorporating broader contextual and social considerations as technological maturity advanced. At TRLs 5–6, clinical investigations focused on efficacy; at TRLs 7–8, on effectiveness and clinical validity; and at the highest maturity level, on implementation and clinical utility. Notably, evaluation methods were not recommended by device risk class. The clinical investigations of health technologies remains fragmented, and no consistent approach has been established. The application of the TRL framework provided a novel and structured approach to map evaluation methods according to the stage of maturity. There is a need for harmonized evaluation frameworks that support clinical investigations in line with EU regulations.

Cost pressures and limited access challenge the sustainability of Finnish primary care. Multidisciplinary team (MDT) models have been introduced, but evidence on cost and quality in Nordic settings remains limited. To describe healthcare costs and glycaemic control in primary care centres implementing an MDT model versus usual care. This quasi-experimental study included 11,124 patients from five intervention and three control health centres in Espoo, Finland. The MDT model redistributed tasks between nurses and physicians, emphasising remote consultations and proactive management. Retrospective data from primary and secondary care electronic health records (2021-2023) were analysed. Outcomes were annual per-patient costs (€) and the proportion of type 2 diabetes patients with HbA1c >53 mmol/mol. Differences over time were examined using regression models. Baseline costs (2021) were similar between groups. Costs increased in both groups, but by 2023 combined per-patient costs were lower in MDT centres (4902 €) than in controls (6213 €). Primary care costs decreased slightly in intervention centres and increased in controls. Secondary care costs rose in both groups, with a steeper increase observed in control centres. Intervention centres showed a shift toward nurse-led and remote contacts with fewer physician visits. Glycaemic control remained stable in both groups. No clear differences were observed in continuity of care or avoidable hospital admissions. MDT implementation was associated with lower cost growth over three years without compromising glycaemic control.

BACKGROUND Health care systems increasingly promote patient engagement and self-management through digital health services. Digital care pathways, which support coordinated care delivery across the patient journey, have emerged as a promising approach, although evidence regarding their impact on resource use and costs remains limited. OBJECTIVE The aim of this study was to examine the implementation and impact of digital care pathways specifically designed to reduce or replace physical contacts or phone consultations in specialized health care. METHODS We analyzed the 10 most widely used digital care pathways by user volume. The selection criteria were (1) more than 1500 users per digital care pathway and (2) the aim of replacing or reducing in-person contacts. Descriptive analyses quantified digital contact volumes, average contacts and costs per patient, and inflation-adjusted expenditures using the consumer price index, both overall and by patient group. Ecologic group-level correlations were examined to assess whether the 2024 proportion of digital contacts was associated with changes in physical contacts and total costs from 2018 to 2024. RESULTS Digital care pathways were progressively adopted between 2018 and 2024, increasing from no use to accounting for 19.1% (34,837/182,188) of all outpatient contacts among the studied patient groups. Physical visits declined from 74.8% (99,201/132,622) to 54.1% (98,642/182,188), while contacts per patient rose by 7.6% on average. Conditions with the highest uptake of digital pathways showed the strongest reductions in the share of physical visits per patient, with declines of up to 39.7% (0.73/0.44). Average outpatient costs per patient decreased by 18.2% (€421/€515; €1=US $1.12 as of Oct 16, 2026) in real terms, with a 39.3% (€233/€384) reduction in the costs of physical contacts and a 15.4% (€135/€117) increase in the costs of phone visits. Digital pathway contacts accounted for 12.6% (€53/€421 per patient) of total outpatient costs in 2024; however, only 8.8% of the variance in total cost levels was explained by digital pathway adoption, suggesting that the shift toward digital care pathways did not substantially drive overall cost changes. CONCLUSIONS Digital care pathways expanded rapidly, reaching nearly one-fifth of all outpatient contacts by 2024 in the included patient groups and contributing to a notable reduction in physical visits. However, their overall cost impact remains uncertain, as there have also been other factors impacting the development of outpatient costs. CLINICALTRIAL

Managing chronic diseases with unpredictable care demand creates significant operational challenges for healthcare systems. Mapping long-term care trajectories is crucial for improving resource allocation, anticipating service needs, and designing efficient care pathways. We used a data-driven approach to map six-year care trajectories for 962 newly diagnosed multiple sclerosis patients, identify utilization clusters, and determine predictors of high utilization. We analyzed Event logs of remote, outpatient, emergency, and inpatient contacts from one year pre- to five years post-diagnosis using K-means clustering to identify utilization clusters, logistic regression to identify predictors of high utilization, and process mining to model variation between care trajectories. We identified two distinctive utilization clusters: a high-utilization cluster (14.1 % of patients) with persistently elevated annual encounter volumes across all care settings and low-utilization cluster (85.9 % of patients) with lower and declining use. Median service costs were €18,736 vs. €6,052 in high- and low-utilization clusters, respectively. Two or more early relapses were the strongest predictor of high utilization (OR = 6.33, 95 % CI 3.49-11.50, p < 0.001), with number of planned early remote and outpatient care contacts being also associated with future service utilization (OR = 1.07, 95 % CI 1.04–1.10, p < 0.001). High-utilization trajectories were approximately three times longer (82.4 vs 25.9 events) and more variable (3.1 vs 2.4 unique events per patient). These utilization clusters and their distinct trajectories provide a pragmatic segmentation of multiple sclerosis patients to support early identification of high-utilization subgroups and more robust capacity planning in specialist care. Highlights: We tracked the care trajectories of 962 people with relapsing–remitting multiple sclerosis using a Finnish population-based specialist-care datalake covering both inpatient and outpatient neurology services. Patients fell into two distinct utilization clusters: a high-utilization cluster with frequent contacts across all care settings and a low-utilization cluster with lower and declining use. Two or more early relapses, and the number of early outpatient and remote contacts were strong predictors of a patient’s long-term affiliation in the high-utilization cluster. Segmented care trajectories showed that high-utilization patients followed longer, more varied, and acute-oriented care patterns and had much higher service encounter costs. These findings can help clinicians and managers identify potential high-utilization patients early, target resources more effectively, and plan for future healthcare demand.

Background: The rapid expansion of digital health services (DHS) highlights the need to assess their accessibility and effectiveness, particularly among older adults. Despite increasing digitalization, many older individuals still face barriers, including limitations in digital competence and access. Objective: This study examines the use, barriers, and perceived benefits of DHS among individuals aged 75 and older in Finland. Methods: A nationwide survey was conducted in March 2023 using both electronic and paper questionnaires. In addition to descriptive analysis, regression analysis was performed to identify variables associated with perceived benefits of digital health services. Results: Of the 1124 responses (1011 electronic, 113 paper), 1100 were fully completed. Overall, 84% of respondents had used DHS, with usage being higher among those under 85 years (87%) than those over 85 (57%). The majority of respondents (82%) reported using the national Omakanta service, which grants access to personal health information. Digital competence and the number of services used were the strongest predictors of perceived benefits, alongside higher satisfaction, service frequency, and female gender. Conclusions: DHS adoption among older adults, especially in Finland, may be higher than previously reported. However, digital social services remain underdeveloped. Addressing the digital divide is essential to ensuring equitable access.