Konsumerismi, potilaiden ja kuluttajien aktiivinen toiminta sekä erityisesti lääkäreiden kokemukset ja näkemykset potilaista kuluttajina

Consumerism emphasises the patient s position and freedom of choice. Consumerism is being promoted by a range of phenomena occurring in society and health care. Different actors hold different views on the patient as a consumer and on his or her participation. Consumer demand is created outside the patient physician relationship and the commercialisation of services generates new expectations with respect to physician s work. More and more patients may be interested in adopting a more equal position in the care relationship, and trying to negotiate with the physician or to even dictate how he or she should be cared for. In Finland, very little research has been conducted on patients and consumers organising themselves at national system level, patients as choosers, and physicians attitudes to various consumerist phenomena or the choice made by the patient. In the empirical data for this study, the term consumer-patient refers to active consumers and patients making choices related to their clinical care prior to a physician s diagnosis. Consumer-patients are also represented by consumer and patient organisations and movements. The main research question is: How do physicians regard the care choice made by the patient? This question is addressed from a perspective encompassing patients and consumers organised activities and individuals active behaviour in health care as well as physicians experiences and their views on patients as consumers making choices related to their care. The first part (Study I), examines the patient organisation field, information sources used including the websites of such organisations, files from Finland s Slot Machine Association, RAY, a survey conducted by a Finnish television news department and interviews of patient organisations. Based on observation and a physician survey, Study II examines physicians attitudes to the idea that patients could obtain information through consumer movements about physicians care practices before seeking medical care. Studies III−IV use a physician survey to examine physicians attitudes to direct-to-consumer-advertising of prescription drugs (DTCA) and their experiences and views of patient requests related to treatments and examinations. Study V uses comparative surveys to examine the attitudes of health care professionals and the population to the introduction of new technologies in health care, using genetic screenings and tests as an example. The number of patient organisations increased, with a particular escalation as of the 1990s. The characteristics and operating methods of the organisations varied greatly. Physicians organisations adopted a negative or neutral attitude towards the consumer movements idea of distributing information on care practices, whereas individual physicians attitudes were slightly more positive. Physicians regarded direct-to-consumer-advertising of prescription drugs as negative, but took a more permissive attitude towards indirect advertising. More than every third physician considered drug advertisements in general to be harmful or useless in the distribution of drug information to patients or consumers. More than half of physicians conducting patient work reported that they (very) often encountered patients who stated upon arrival for a consultation that they wanted specific treatments or examinations, and that the number of such situations had increased. Such situations were viewed as positive with regard to the care relationship by every fifth physician and as negative by two fifths. Physicians justified a reserved attitude to the patients consumer role by referring to their medical expertise and position as care decision-makers, the patient physician relationship and the public health care system. Reasons for a positive attitude included the patient s participation and co-operation, the patient physician relationship and the patient s knowledge. Professionals were more reserved than lay people about the introduction and extension of genetic technologies in health care. A significant minority of the physicians did not take a clear pro or con attitude to the patients consumer role or to the use of new technologies in health care. The physicians age, gender, place of work and specialisation influenced their attitudes to the patient s consumer role, and private physicians viewed it in a more positive light than those working in public health care. Active consumer-patients challenge the society to hold a discussion of the patient s choice, participation in care decision-making and participation in health care policy in general. Their transformation into customers and consumers implies not only a new division of individuals roles and powers, but also contributes to changing relationships between system level roles: between citizens and the state and between public and private health care. This phenomenon raises various issues related to health care policy. In conclusion, topics are presented for discussion, practical measures and further research. Keywords: health care, consumerism, distribution of technologies, commercialisation, physicians, patients, consumers, patient s choice, patient s role.

Turning up the Heat on Admissions: A Study of the Impacts of Extreme Heat Events on Tasmanian Hospital Admissions 2003-2010

Introduction: Extreme heat events (both heat waves and extremely hot days) are increasing in frequency and duration globally and cause more deaths in Australia than any other extreme weather event. Numerous studies have demonstrated a link between extreme heat events and an increased risk of morbidity and death. In this study, the researchers sought to identify if extreme heat events in the Tasmanian population were associated with any changes in emergency department admissions to the Royal Hobart Hospital (RHH) for the period 2003-2010. Methods: Non-identifiable RHH emergency department data and climate data from the Australian Bureau of Meteorology were obtained for the period 2003-2010. Statistical analyses were conducted using the computer statistical computer software ‘R’ with a distributed lag non-linear model (DLNM) package used to fit a quassi-Poisson generalised linear regression model. Results: This study showed that RR of admission to RHH during 2003-2010 was significant over temperatures of 24 C with a lag effect lasting 12 days and main effect noted one day after the extreme heat event. Discussion: This study demonstrated that extreme heat events have a significant impact on public hospital admissions. Two limitations were identified: admissions data rather than presentations data were used and further analysis could be done to compare types of admissions and presentations between heat and non-heat events. Conclusion: With the impacts of climate change already being felt in Australia, public health organisations in Tasmania and the rest of Australia need to implement adaptation strategies to enhance resilience to protect the public from the adverse health effects of heat events and climate change.

Suomen talviukkoset 2003-2007

Tutkimuksen tarkoitus on kartoittaa Suomen talviukkosten ominaisuuksia ja klimatologiaa. Tiedot Suomen talviukkosten klimatologista tutkimusta varten kerättiin mm. salamanpaikantimilta ja ihmisten IL:lle tiedottamista havainnoista, SYNOP-kartoilta, rintama-analyyseistä, luotauksista ja luotaustietojen pohjalta piirretyistä salamakartoista sekä sadetutkan kuvista. Tutkimuksessa määriteltiin talviukkoseksi yksi tai useampi salamahavainto säätilanteessa, jossa salamahavaintopaikkaan ja -aikaan nähden lähimmistä synop-havainnoista ainakin yhdessä on havaittu joko ≤ 0 °C lämpötila tai lumi- tai räntäsadetta. Näin rajattuna vuosina 2003-2007 talviukkostapauksia oli 19 kpl. Tapaukset jakaantuivat melko tasaisesti loka-marraskuun vaihteen ja huhtikuun välille, pienet maksimit olivat marras- ja helmikuussa. Tapausten esiintymisajankohtia rajoitti siis vain talviukkosten määritelmän mukaisten sääolosuhteiden esiintyminen. Vuorokaudenajalla ei ollut merkittävää vaikutusta talvisalamoiden esiintymiselle. Alueellisesti talviukkoset painottuivat maan lounaisosaan mutta niitä havaittiin koko maassa Käsivarren Lappia myöten. 16 tapauksessa 19:sta talviukkoset havaittiin okluusiorintamaksi analysoidun rintaman yhteydessä. Yhdessä tapauksessa rintama oli analysoitu kylmäksi ja kahdessa rintama-analyysi oli epäselvä. Matalapaineen keskus sijaitsi iskuhavaintopaikkoihin nähden yleensä lännen puolella. Lännen puolen yleisyyden aiheutti okluusiorintamien kiertosuunta myötäpäivään matalapaineen keskukseen nähden. Pintalämpötila oli lähes kaikissa talviukkostapauksissa lähellä nollaa ja havaintopaikan lähellä olevissa SYNOP-havainnoissa havaittiin useissa tapauksissa sadetta sekä vetenä että kiinteässä olomuodossa. CAPE:n arvot olivat joko nollassa tai hyvin lähellä sitä iskuhavaintoihin nähden lähimmissä luotauksissa. Lämmintä advektiota havaittiin lähes kaikissa tutkituissa luotauksissa, myös sulan meren vaikutus näkyi tuloksissa talviukkosia edistävänä tekijänä. Maasalamoita havaittiin talviukkosten yhteydessä useimmin 1 tai 2 ja iskuja salamaa kohden 1 tai 2. Havaituista maasalamoista positiivisia oli 46 % ja negatiivisia 54 %. Tapaustutkimukset tehtiin kahdesta vuosien 2003-2007 talviukkosia hyvin edustavasta tapauksesta sekä yhdestä salamamäärältään poikkeuksellisen runsaasta tapauksesta.

A Critical Assesment of Occluded Fronts

The aim of this work was the assessment about the structure and use of the conceptual model of occlusion in operational weather forecasting. In the beginning a survey has been made about the conceptual model of occlusion as introduced to operational forecasters in the Finnish Meteorological Institute (FMI). In the same context an overview has been performed about the use of the conceptual model in modern operational weather forecasting, especially in connection with the widespread use of numerical forecasts. In order to evaluate the features of the occlusions in operational weather forecasting, all the occlusion processes occurring during year 2003 over Europe and Northern Atlantic area have been investigated using the conceptual model of occlusion and the methods suggested in the FMI. The investigation has yielded a classification of the occluded cyclones on the basis of the extent the conceptual model has fitted the description of the observed thermal structure. The seasonal and geographical distribution of the classes has been inspected. Some relevant cases belonging to different classes have been collected and analyzed in detail: in this deeper investigation tools and techniques, which are not routinely used in operational weather forecasting, have been adopted. Both the statistical investigation of the occluded cyclones during year 2003 and the case studies have revealed that the traditional classification of the types of the occlusion on the basis of the thermal structure doesn t take into account the bigger variety of occlusion structures which can be observed. Moreover the conceptual model of occlusion has turned out to be often inadequate in describing well developed cyclones. A deep and constructive revision of the conceptual model of occlusion is therefore suggested in light of the result obtained in this work. The revision should take into account both the progresses which are being made in building a theoretical footing for the occlusion process and the recent tools and meteorological quantities which are nowadays available.

Naomi Block Manners Stern collection of Eleanor Roosevelt correspondence undated, 1941-1962, 1972, 1974, 1976, 1984, 2003

This collection is mainly composed of correspondence between Ms. Stern and Mrs. Roosevelt, spanning the years from their first acquaintance in 1941 to Mrs. Roosevelt's decease in 1962. Letters that hold particular interest concern Ms. Stern's experience at the Summer Student Leadership Institute, and the White House. Additional material in the collection encompasses articles, newsclippings, programs, press releases, and photographs. The articles and newsclippings folder contains information pertaining to Ms. Stern's college career, the first Summer Student Leadership Institute, Mrs. Roosevelt's talk at Community Day, National Youth Association, and a donation of an ambulance to the war effort by Hunter college students. Naomi Block Manners Stern personal folder contains an article Naomi Block wrote in her college magazine, "Echo," describing her perceptions of President Roosevelt and Prime Minister Winston Churchill during her first visit at the White House. Also included is her graduation program, listing Mrs. Roosevelt as the main speaker, a commemoration of President Roosevelt in 1972 in which Ms. Stern took part, an article and press release describing Ms. Stern's career at Revlon, and a 2003 written summary of Ms. Stern's relationship with Mrs. Roosevelt. Photographs were taken by Naomi Block and others at the Summer Leadership Institute in 1941 portray identified fellow students, Mrs. Roosevelt, James Roosevelt, the Roosevelt home in Campobello, and Felix Frankfurter.

Kansankirkko, uskonnonvapaus ja valtio : Suomen evankelis-luterilaisen kirkon kirkolliskokouksen tulkinta uskonnonvapaudesta 1963-2003

A national church, freedom of religion, and the state The interpretation of freedom of religion formulated by the Synod of the Evangelical Lutheran Church of Finland in reference to the relationship between the Church and the state from 1963 to 2003 This paper discusses the interpretation of freedom of religion formulated by the Synod of the Evangelical Lutheran Church of Finland during the years 1963-2003. The effect of these formulations and decisions made by the Synod on the relationship between the Church and the state is also discussed as the relationship has been a central issue in the debate about freedom of religion in Finland. Active co-operation with the state caused a dispute in the Church during this period. Another cause for concern for the Synod, a strong defender of the national church, was the weakening position of the Church in a society undergoing many changes. As the Synod of 1963 discussed the status of the Church, the Church began to reflect upon its identity as a national church, and to evaluate freedom of religion in the country, as well as the relationship between the Church and the state. Some of the radicals of the 1960s and 1970s presented the Church as an obstacle to freedom of religion. The Synod was keen to emphasize that, in accordance with international agreements on human rights, freedom of religion means the freedom to have and follow a religion, and also that freedom of religion was a right of the majority in Finnish society. As an active guardian of the rights of its members, the Synod defended such issues as the teaching of religion in schools. Throughout the dispute, the Church focused on its right to act freely and, according to its identity, to express spirituality in the society. At the end of the 1960s, several efforts to reform the law on the freedom of religion and the relationship between the Church and the state gained favour in the Synod. These formulations of the Church were the basis for the work of a parliamentary committee in the 1970s, but no significant changes resulted. Instead, freedom of religion in Finland was judged to be fairly good. The committee paper did, however, lead to preparations for greater independence of the Church. The Synod at the time chose to react to the changes presented to it, but it was not before the 1990s that the Synod became an active force of reform in these matters. Though the Synod, particularly from the 1970s onwards, began clearly to favour the improvement of the position of other religious communities in Finland, it felt it had reason to be cautious as each church and religious community had the freedom to decide individually its relationship with the state. Any changes that would have weakened the position of the Church in Finnish society were met with disapproval in the Synod. Even though some theological concerns regarding the national identity of the Church were raised, the Synod emphasized issues of church policy. Keen to preserve and protect its legal status in society, the Synod judged that this status supported the freedom of action enjoyed by the Church as well as the freedom of religion.

Lower limb amputation in Northern Netherlands: Unchanged incidence from 1991-1992 to 2003-2004

Background Investigating population changes gives insight into effectiveness and need for prevention and rehabilitation services. Incidence rates of amputation are highly varied, making it difficult to meaningfully compare rates between studies and regions or to compare changes over time. Study Design Historical cohort study of transtibial amputation, knee disarticulation, and transfemoral amputations resulting from vascular disease or infection, with/without diabetes, in 2003-2004, in the three Northern provinces of the Netherlands. Objectives To report the incidence of first transtibial amputation, knee disarticulation, or transfemoral amputation in 2003-2004 and the characteristics of this population, and to compare these outcomes to an earlier reported cohort from 1991 to 1992. Methods Population-based incidence rates were calculated per 100,000 person-years and compared across the two cohorts. Results Incidence of amputation was 8.8 (all age groups) and 23.6 (≥45 years) per 100,000 person-years. This was unchanged from the earlier study of 1991-1992. The relative risk of amputation was 12 times greater for people with diabetes than for people without diabetes. Conclusions Investigation is needed into reasons for the unchanged incidence with respect to the provision of services from a range of disciplines, including vascular surgery, diabetes care, and multidisciplinary foot clinics. Clinical relevance This study shows an unchanged incidence of amputation over time and a high risk of amputation related to diabetes. Given the increased prevalence of diabetes and population aging, both of which present an increase in the population at risk of amputation, finding methods for reducing the rate of amputation is of importance.

Kansankirkko, uskonnonvapaus ja valtio : Suomen evankelis-luterilaisen kirkon kirkolliskokouksen tulkinta uskonnonvapaudesta 1963-2003

A national church, freedom of religion, and the state The interpretation of freedom of religion formulated by the Synod of the Evangelical Lutheran Church of Finland in reference to the relationship between the Church and the state from 1963 to 2003 This paper discusses the interpretation of freedom of religion formulated by the Synod of the Evangelical Lutheran Church of Finland during the years 1963-2003. The effect of these formulations and decisions made by the Synod on the relationship between the Church and the state is also discussed as the relationship has been a central issue in the debate about freedom of religion in Finland. Active co-operation with the state caused a dispute in the Church during this period. Another cause for concern for the Synod, a strong defender of the national church, was the weakening position of the Church in a society undergoing many changes. As the Synod of 1963 discussed the status of the Church, the Church began to reflect upon its identity as a national church, and to evaluate freedom of religion in the country, as well as the relationship between the Church and the state. Some of the radicals of the 1960s and 1970s presented the Church as an obstacle to freedom of religion. The Synod was keen to emphasize that, in accordance with international agreements on human rights, freedom of religion means the freedom to have and follow a religion, and also that freedom of religion was a right of the majority in Finnish society. As an active guardian of the rights of its members, the Synod defended such issues as the teaching of religion in schools. Throughout the dispute, the Church focused on its right to act freely and, according to its identity, to express spirituality in the society. At the end of the 1960s, several efforts to reform the law on the freedom of religion and the relationship between the Church and the state gained favour in the Synod. These formulations of the Church were the basis for the work of a parliamentary committee in the 1970s, but no significant changes resulted. Instead, freedom of religion in Finland was judged to be fairly good. The committee paper did, however, lead to preparations for greater independence of the Church. The Synod at the time chose to react to the changes presented to it, but it was not before the 1990s that the Synod became an active force of reform in these matters. Though the Synod, particularly from the 1970s onwards, began clearly to favour the improvement of the position of other religious communities in Finland, it felt it had reason to be cautious as each church and religious community had the freedom to decide individually its relationship with the state. Any changes that would have weakened the position of the Church in Finnish society were met with disapproval in the Synod. Even though some theological concerns regarding the national identity of the Church were raised, the Synod emphasized issues of church policy. Keen to preserve and protect its legal status in society, the Synod judged that this status supported the freedom of action enjoyed by the Church as well as the freedom of religion.

A Soul for Europe? : Contributions of European Churches to the Forum of the Convention on the Future of Europe

The aim of this research was to study how European churches contributed to the shaping of the Constitutional Treaty during the work of the Convention on the future of Europe through the public discussion forum, established by the Convention for this specific purpose in the years 2002 2003. In particular, this study sought to uncover the areas of interest brought up by the churches in their contributions, the objectives they pursued, and the approaches and arguments they employed to reach those objectives. The data for this study comprised all official submissions by European churches and church alliances to the Forum, totalling 21 contributions. A central criterion for inclusion of the data was that the organization can reasonably be assumed to represent the official position of one or more Christian churches within the European Union before the 2004 expansion. The contributing churches and organizations represent the vast majority of Christians in Europe. The data was analyzed using primarily qualitative content analysis. The research approach was a combination of abductive and inductive inference. Based on the analysis a two-fold theoretical framework was adopted, focusing on theories of public religion, secularization and deprivatization of religion, and of legitimation and collective identity. The main areas of interest found in the contributions of the churches were the value foundation of the European Union, which is demanded to coherently permeate all policies and actions of the EU, and the social dimension of Europe, which must be given equal status to the political and economic dimensions. In both areas the churches claim significant experience and expertise, which they want to see recognized in the Constituional Treaty through a formally guaranteed status for churches and religious communities in the EU. In their contributions the churches show a strong determination to secure a significant role for both religion and religious communities in the public life of Europe. As for the role of religion, they point out to its potential as a motivating and cohesive force in society and as a building block for a collective European identity, which is still missing. Churches also pursue a substantial public role for themselves beyond the spiritual dimension, permeating the secular areas of the social, political and economic dimensions. The arguments in suppport of such role are embedded in their interest and expertise in spiritual and other fundamental values and their broad involvement in providing social services. In this context churches use expressions inclusive of all religions and convictions, albeit clearly advocating the primacy of Europe's Christian heritage. Based on their historical role, their social involvement and their spiritual mission they use the public debate on the Constitutional Treaty to gain formal legitimacy for the public status of religion and religious communities, both nationally and on a European level, through appropriate provisions in the constitutional text. In return they offer the European Union ways of improving its own legitimacy by reducing the democratic and ideological deficit of the EU and advancing the development a collective European identity.

Concordia-lehti Lutherin ja luterilaisen ortodoksian teologian tulkitsijana 1994-2003

Concordia-lehti alkaessaan ilmestyä 1994 herätti ristiriitaisia reaktioita esimerkiksi SLEY:n henkilöstön keskuudessa. Alusta alkaen avainhenkilöitä ovat olleet Hannu Lehtonen, Hannu Halonen, Simo Kiviranta ja Sakari Korpinen. Ekumeniaan Concordia on suhtautunut kriittisesti arvioidessaan Porvoon sopimusta ja Yhteistä julistusta vanhurskauttamisesta. Keskeisiä teemoja tässä lehdessä ovat olleet tutkittavana aikana yleinen ja uskon kautta tapahtuva vanhurskauttaminen, Raamatun arvovallan korostaminen, sakramenttien merkityksen esillä pitäminen ja tietyt moraaliset ja eettiset periaatteet ja näkökulmat. Concordiassa on esiintynyt runsaasti sitaatteja Martti Lutherin teoksista, melko paljon myös luterilaisen ortodoksian edustajilta, kuten Martin Chemnitziltä ja Johann Gerhardilta. Ylivoimaisesti eniten artikkeleja kymmenen vuoden aikana on tehnyt päätoimittaja, pastori Hannu Lehtonen. Kirjoittajien joukossa maallikkojen osuus on ollut huomattava. Karismaattisia ilmiöitä arvioitaessa nähtiin osan armolahjoista kuuluneen ennen kaikkea alkukirkon aikaan, vaikka samalla todettiin ihmeitä voivan tapahtua nykyaikanakin. Concordian kirjoittajat eivät hyväksyneet läheskään kaikkia Suomen evankelis-luterilaisessa kirkossa tapahtuneita päätöksiä, asioita ja ilmiöitä. Voimakkaasti todettiin, että kirkossa ei tulisi samanaikaisesti sallia sekä totuutta että erilaisia harhaoppeja. Myös evankelisen liikkeen tai muiden herätysliikkeiden toimintaa ei aina pidetty tarpeeksi rohkeana, vaan katsottiin niiden mukautuneen liikaa yhteiskuntaan ja yleiseen ja valtaa pitävään kirkollisuuteen. Esimerkiksi Helsingin yliopistossa käytettyä historiallis-kriittistä metodia parempana metodina pidettiin historiallis-dogmaattista. Opetusta maailman syntymisestä pitkän evoluutio-prosessin seurauksena ei Concordiassa hyväksytty, vaan opetettiin Jumalan luoneen maailman kuudessa päivässä. Concordiassa kirjoittajina on esiintynyt myös useita tunnustuksellisen luterilaisuuden edustajia lähinnä Yhdysvalloista ja Pohjoismaista. Tutkitun lehden merkitys kirkollisessa kentässä ei ole tilaajamäärän pienuuden vuoksi kovin merkittävä, mutta eräänlaisena taustalla vaikuttajana ja keskustelun herättäjänä vaikutus on ollut suurempi. Concordian näkemyksen mukaan suuri enemmistö ei läheskään aina ole ollut oikeassa hengellisissä kysymyksissä. Evankeliseen liikkeeseen Concordian kirjoittajilla on ollut tietynlainen viha-rakkaussuhde, vaikka se on ollut monen kirjoittajan hengellinen koti. Lehdessä esiintynyttä pietismin arviointia tutkimus ei ole kovin paljon käsitellyt, koska se ei olisi kovin hyvin sopinut eri lukujen otsi- koiden alle. Helluntailaisuuden eri opinkäsityksiä Concordia on myös pyrkinyt kumoamaan. Lehti on halunnut koko ajan perustella opetuksensa selkeillä raamatunkohdilla ja edistää näin luterilaisen uskon ja opin tuntemusta. Tässä tutkimuksessa on ollut tietoinen valinta käyttää samoja raamatunkohtia lähteenä, joita Concordian kirjoittajat ovat itse käyttäneet. Kirkkohistoriaan kuuluvassa opinnäytteessä ei ole yleensä tyypillistä käyttää näin paljon viittauksia Raamattuun, mutta tällainen dogmatiikan mukaan ottaminen on perusteltua, koska se on niin olennainen osa Concordia-lehden teologiaa ja tapaa tuoda esille asioita. Tiivistetysti todeten ihmisten ainoa vapahtaja ja pelastaja on ollut tutkitun lehden mukaan ja on edelleen Jeesus Kristus.

Tracking brand positioning for an emerging destination: 2003 to 2015

Few published studies have monitored destination brand image over time. This temporal aspect is an important gap in the literature, given consensus around the role perceptions play in consumers’ decision making, and the ensuing emphasis on imagery in destination branding collateral. Whereas most destination image studies have been a snapshot of perceptions at one point in time, this paper presents findings from a survey implemented four times between 2003 and 2015. Brand image is the core construct in modelling destination branding performance, which has emerged as a relatively new field of research in the past decade. Using the consumer-based brand equity (CBBE) hierarchy, the project has benchmarked and monitored destination brand salience, image and resonance for an emerging regional destination, relative to key competitors, in the domestic Australian market; and the survey instrument has been demonstrated to be reliable in the context of short break holidays by car. What is particularly interesting to date is there has been relatively little change in the market positions of the five destinations, in spite of over a decade of marketing communications by the regional tourism organisations and their stakeholders, and more recently the mass of user-generated travel content on social media. The project didn’t analyse the actual marketing communications for each of the DMOs. Therefore an important implication is that irrespective of the level of marketing undertaken the DMOs seem to have had little control over the perceptions held in their largest market during this time period. Therefore it must be recognised any improvement in perceptions will likely take a long period of time, and so branding needs to be underpinned by a philosophy of a long term financial investment as well as commitment to a consistency of message over time; which given the politics of DMO decision making represents a considerable challenge.

Use of Document Management Systems - a Case Study of the Finnish Construction Industry

Triggered by the very quick proliferation of Internet connectivity, electronic document management (EDM) systems are now rapidly being adopted for managing the documentation that is produced and exchanged in construction projects. Nevertheless there are still substantial barriers to the efficient use of such systems, mainly of a psychological nature and related to insufficient training. This paper presents the results of empirical studies carried out during 2002 concerning the current usage of EDM systems in the Finnish construction industry. The studies employed three different methods in order to provide a multifaceted view of the problem area, both on the industry and individual project level. In order to provide an accurate measurement of overall usage volume in the industry as a whole telephone interviews with key personnel from 100 randomly chosen construction projects were conducted. The interviews showed that while around 1/3 of big projects already have adopted the use of EDM, very few small projects have adopted this technology. The barriers to introduction were investigated through interviews with representatives for half a dozen of providers of systems and ASP-services. These interviews shed a lot of light on the dynamics of the market for this type of services and illustrated the diversity of business strategies adopted by vendors. In the final study log files from a project which had used an EDM system were analysed in order to determine usage patterns. The results illustrated that use is yet incomplete in coverage and that only a part of the individuals involved in the project used the system efficiently, either as information producers or consumers. The study also provided feedback on the usefulness of the log files.