Doctors spend half of their time doing something other than working with patients (YLE, https://yle.fi/a/3-11119252). They spend a significant portion of this with the patient information system. However, these systems are notorious for being clunky or even outright user-hostile. Reduce the clunkiness, and the whole medical system works better. 

To create a better patient information system, Esko Systems has a new approach. They have brought the users to the centre of the development. This means that their system is designed with and tested by healthcare professionals: experienced nurses and doctors. With this direct feedback, they have developed the most user-friendly client and patient information system available.

Esko Systems is a modern and truly agile organisation. Their product owners organise the work with a prioritised backlog and keep user-friendliness at the core of every decision. The main force of Esko’s development team are their own software developers and product owners, but they also use some consultants to strengthen their team. This is where Buutti comes in.

Buuttians have been a part of Esko’s team since 2019. Our consultants Teemu, Arttu, Johannes, Joonas and Heli have contributed to the software. Additionally, Esko has hired four developers through the CodeMatch-program. 

”Esko is a modern and agile software development organisation”, states Joonas, a frontend developer in the team. ”Esko’s Product Owner had a clear vision, but she also listened to other opinions and respected our expertise”, continues Johannes, a backend developer from Buutti.

A better flow

As a recent significant development, the Esko team has created a better version of a core feature: the patient medical record feed. This feed combines the patient’s whole health history into one place, and doctors and nurses use it dozens of times daily. 

The development process started with a design workshop. This meant a discussion between software developers, healthcare professionals, UX designers and product owners. This way, the user viewpoint was included right from the start. Together they created a specification for the feed, and the developer team got to work.

The goal was to make the feed quick, clear and easy to use. This was not exactly easy, as a single patient might have thousands of entries from Esko’s own system and the national Kanta database. How do you make sure there is adequate information, and it is delivered quickly enough?

Introducing Elasticsearch

To increase speed and user-friendliness, the team added Elasticsearch. Before, the feed was only available in chronological order. The user would have to scroll through all of the patient’s medical history to find what they need. That might mean decades of unorganised information.

Now, the user can search and filter information: if they need to access the patient’s history with diabetes, Esko returns all records with the word. Other filtering options include diagnosis codes, assigned doctors or a specific time. Especially useful is the ability to see all records related to a case, for example, a certain knee injury.

The software team spent plenty of time making sure the search worked properly. The quickness is based on an indexed cache on a separate server: Esko doesn’t have to look through every word in the whole database. Buutti’s Johannes worked with Esko to ensure the cache has adequate information, it is updated often enough, and there is nothing in excess.

Other Buuttians know Johannes to have a comprehensive understanding of web services and applications. With this knowledge, he worked to make Elasticsearch and its cache fast and reliable. Together, the team achieved their goals: the time looking for information is reduced from minutes to seconds.

Smooth user interface

A fast and reliable backend needs a smooth frontend. Buutti’s Joonas worked with the record feed’s user interface. Esko’s UX designers and frontend developers provided high-quality design guidelines, but Joonas also had the chance to voice his opinions.

The team’s most important frontend technical decision was to switch from JavaScript to TypeScript. This technology was chosen to reduce the number of annoying bugs. Using TypeScript has made developing and maintaining the feed significantly easier.

Other Buuttians know Joonas to have an excellent eye for design. Adding to that, he understands the technical implementation of frontend design. The collaboration has proved fruitful: the new UI has received very favourable user feedback. It has been praised for its simplicity and appealing looks. 

Publishing the feed

The feed was tested in Oulu University Hospital for two months in the Spring of 2023. During this time, the new feed was used 100 to 200 times a day. The development team got some very valuable feedback from the end-users of Esko.

Currently, the feed is being refined and finished. By the end of 2023, it will replace the old patient record feed for all Esko users. Before that, there are some bugs to be fixed.

”Working with Buutti’s consultants has been delightful. Buuttians have proved cooperative with Esko’s devs and other consultants. They have listened to our views carefully and provided excellent technical solutions,” states Jaana Jämsä, Esko’s Chief Operating Officer. ”We are going to keep Buutti as a part of the team.”

You can learn more about the feed here ( in Finnish): https://eskosystems.fi/esko-kertomusvirta-kayttoon-oys-paivystyksessa/