Finland is internationally one of the top countries in healthcare digitalization. The Finnish Ministry of Social Affairs and Health has outlined that people are the most important part in the digitali- zation of health care. Digitalization opens better access to information so that people can make better choices and get better services. It enables client-oriented approaches and equal services to everyone regardless of where they live. Digitalization changes the world in fast cycles by cre- ating completely new options for old and familiar functions. (Digitalisaatio n.d; Jaettu ymmärrys työn murroksesta 2017, 20–31.) It changes the ways and content of our work in more and more quickly as we go ahead. Also, clients demand more from public services and the use of public money needs to be justified well. For younger generations digitalization is a default value, not just an extension to current services. (Owen 2015, 2556; Digitalisaatio terveyden ja hyvinvoinnin tukena 2016, 4.)
The most significant benefits of digitalization in the social and health care sector are increased service homogeneity and cost-efficiency. In addition, digitalization enables availability and acces- sibility of services. On the other hand, there is a risk for a new form of inequality, if digitalization is driven too aggressively. The most significant factors affecting the growth of digital services are positive attitudes towards the change as well as the increase in mobile and sensor technologies. The biggest factor in the propagation of digital solutions is change resistance among citizens and professionals. (Pohjola 2016, 50.)
In health care, it is important to have a personal contact with clients. Therefore, not all clinical services can be implemented via the Internet. Digitalization can be used to develop services, such as online forums and services, that specifically support nursing. eHealth services that need to be developed should be carefully considered and adequate. Digitalization tools provide opportuni- ties for the development of counselling work where health communication and health infor- mation are essential. (Hakulinen-Viitanen, Vallimies-Patomäki & Pelkonen 2013, 31.)
The Health 4 Baby innovation is a tool for developing health care services. With Health 4 Baby public health nurses can monitor fetal heart sounds remotely. Listening to fetal heart sounds is an important part of monitoring the development of the fetus during pregnancy. Fetal heart sounds have been monitored by listening since the 16th century. At first fetal heart sounds were listened by putting an ear on the mother’s abdomen. Since then various devices have been de- veloped to make fetal heart sounds easier to register. Normal fetal heart sounds mean that the
fetus gets enough oxygen from the mother’s bloodstream through the umbilical cord and pla- centa. Abnormal heart sounds may be a signal that the fetus gets too little oxygen in the blood and tissues. Lack of oxygen can cause damage to the brain, central nervous system or other in- ternal organs. In severe cases lack of oxygen can cause the death of the fetus. Therefore, it is important to listen to fetal heart sounds. (Väyrynen 2009, 196.)
Fetal heart sounds are listened both in the maternity clinic and maternity wards. In the maternity clinic heart sounds are listened with a Doppler ultrasound from the 10th week of pregnancy. The normal range of fetal heart rate variation is 110-160 beats per minute and heart rate acceleration can be heard, for example, when the fetus is moving. Listening to fetal heart sounds is challenging if there are problems in fetal health and there is not a doctor in the maternity clinic (Blincoe 2005, 109). In this case the public health nurse must refer the mother to the hospital for further exam- inations. Cardiotocography (CTG) is performed in the hospital to determine the health of the fe- tus. (Klemetti & Hakulinen-Viitanen 2013, 16.) CTG registers fetal heart sounds and uterine con- tractions. In the interpretation of the CTG attention must be paid to the baseline and variation of the heart rate. CTG is used only in hospitals to monitor fetal health. (Sarvilinna, Isaksson, Kokljuschkin, Timonen & Halmesmäki 2016, 1336.)
The idea for the Health 4 Baby innovation was presented by the working life. In maternity clinics public health nurses work independently without the support of a doctor. The nurse is alone re- sponsible for diverse and sometimes difficult situations. If necessary, the nurse can consult a doc- tor by telephone but usually in unclear situations the nurse must refer the mother to the hospital for examinations, because the doctor wants to hear the fetal heart sounds personally. This is par- ticularly difficult in municipalities with long distances to the nearest hospital. Health 4 Baby im- proves consultation and reduces unnecessary referrals to hospital. In some cases, especially in risk pregnancies, the application can be given to the pregnant woman to be used at home from where she could send the fetal cardiac curve to either a nurse or a doctor. We think that this application for listening to and transmitting heart sounds is really a useful device for clinical work. The purpose of this innovation was to give tools for public health nurses and facilitate their work through digitalization. This innovation also makes public health care services more easily accessi- ble for clients living in remote areas far away from the nearest hospital and offers more flexibility in treatment processes.