PROJECT BRIEF: NEUVOLA
NEUVOLA
Address
Vallilan terveysasema, neuvola
(Vallila health centre, prenatal and child health unit)
Rautalammintie 2
Contact
Marjo Lepistö, Projektikoordinaattori
Helsingin Terveyskeskus
Neuvolatyön ja terveyden edistämisen yksikkö
marjo.lepisto@hel.fi
040-1527107
COURSE PROJECT BRIEF
Design a solution for a health data self-service portal in the neuvola context – an online
branch of the pre/neonatal health care unit. This service should enable pregnant women
and new mothers to take care of routine tasks in between and related to their regular
appointments, such as body measures, urine sample testing etc.
In addition, conceptual input would be welcome regarding possible improvements to
the neuvolas’ time booking practice (providing means to the clients to book
appointments online, possibly integrated with the self-service portal), as this eats up a
lot of productivity.
Formulate your own brief for the project based on the preliminary case information
provided here and your own fieldwork and inquiries.
PROJECT CONTEXT
Prenatal and neonatal care in Finland
The services provided by the prenatal and child health centres are defined by law, but at
the same time, have a very low priority in the system as a whole. This is partly reflecting
the fact that Finland has the world’s healthiest neonates and the neonatal check-ups,
required by law, are very frequent and the quality of care provided is very high.
The relatively low priority for the health centre operations is visible in e.g. only 7
doctors doing neonatal clinic exclusively and another 280 doctors doing it as a side job
along their other duties. This leads to e.g. high variation of doctors; usually the prenatal
and child health centres are assigned temporary workers or other part-time staff. This is
partly due to the fact that most check-ups are apparently just check-ups where
everything is fine, whereas the pressure of sick people needing attention in health
centres is considerable.
Some might claim that the way neonatal care is organized compromises the quality in
relation to the legal role of the service. One could, however, just as validly assert that
judged by the core indicator – the condition of young mothers and neonates – neonatal
care exceeds the requirements of the statute.
Facts about the unit
Vallila is one of 25 prenatal and child health centres (neuvola) in Helsinki; usually one
such neuvola is located within each health centre (except for Kannelmäki, covered by
Malminkartano health centre). The smallest has 3 nurses, the biggest 14, and all
together 180 nurses. The neuvola operations rely on 7 own doctors, plus 280 doctors
from ambulant health care units who do 2-5% of their working time for neuvola units.
E-mail communication with clients is forbidden (applies to all of public health care).
Incoming e-mail must be replied by phone or a very general e-mail with no personal
data. A two-directional messaging is currently being built into Pegasos (the IT system
used in public healthcare) which enables secure communication through a protected
web service. Participating citizens are notified by SMS about incoming messages. A twoway asynchronous communication would be felt to be optimal solution by the nurses.
IT skills of staff are limited. Some only do on the computer what absolutely has to be
done, and many in the older staff do not want to have more computer work. This is
partly related to not-so-optimal usability of electronic patient record systems in use.
Self-service in the neuvola context
Currently health care and the neuvola system is based on face-to-face service. Ideally, a
virtual clinic could replace some of it, naturally always offering the clients a choice
between f2f and virtual.
Already today, the current practice at the neuvola units involves tasks carried out by the
mothers themselves: They collect health data of themselves (and could also collect to
some extent for their babies) like their weight and blood pressure, as well as a urine
sample using a test stick (stiksaaminen) for protein and glucose. They bring the data
along to the appointment where it is added to the system. The urine stick test is very
reliable (no risk that a nurse would misinterpret the result), but mothers are often
concerned of doing it right. This could for example be solved by providing clear visual
instructions how to read the result.
There is no system for self-reporting that data, but that could be possible using a
terminal at the health station or a web service. There is already some space being
reserved for such self-measuring system at the new health station in Kalasatama, but
ideally this should also be possible to implement with existing stations.
“Open neuvola” is a pilot project at Herttoniemi: On Wednesdays from 8.30am-10.30am,
no time booking is required to come for weighing or other control visits. Some of these
procedures could easily be replaced with self-service at home and/or “open neuvola”
could benefit from improved digital services.
The challenges with appointment management
The neuvola operations are facing a series of problems:
 First of all, most doctors are not part of the neuvola unit, which makes the time
booking very complicated.


The Helsinki Health Care Centre does not have ANY centralized time booking.
Time booking is done by nurse/doctor teams.
Clients don’t have the freedom of choice (e.g. if their nurse is on holiday) they
should have, they have only one designated backup person.
Regular check-ups
Some regular check-ups are done for the whole population at certain intervals: At halftime of pregnancy, for 4 month-olds, for 1.5 year-olds, for 4 year-olds and for 40 yearold males. Each client is covered by individually assigned nurse.
Invitations for these are sent by nurses, manually, by mail (for the 40y-old males, health
centre orders address stickers from national person register, with costs, as these are not
their regular clients as mothers/children). The invitation letter asks to “reserve a time”
(no slot pre-assigned).
In theory, it would be possible that the recipients would be invited by SMS and/or email
and then go online and book themselves a time, but the regular check-ups carried out
for the entire population include either both nurse and doctor appointments in close
timing to each other or are combined nurse-doctor check-ups. The law obliges to
provide doctor appointments close to the date of the nurse check-up, but doctors’ times
are not bookable automatically (sometimes appointments are already combined doctornurse slots).
Invitations to parents are sent out by mail in a manual process, invitations are handled
by a nurse, searching the prospective invitees from the Pegasos IT system. It would
basically be possible also by SMS, but only for clients who have given permission
(sähköisen asioinnin sopimus). Sometimes a nurse might also call the client.
Outdated data in the database is a problem: Pregnant women and children are served by
one health station. If moving within Helsinki, a transfer (siirto) to the new health station
is done; if moving away from Helsinki, the client is “checked-out” (poiskirjaus). These
changes are visible only in each nurses list of clients (this needs to be verified). If a
change of address occurs between check-ups, old data might be in the system – while
addresses are auto-updated once per week in national people register, the national
people register and HHCC neonatal database do not automatically cross check. An autoupdate happens silently in metadata, but does not trigger any alerts or info.