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Introduction Timely, complete and accurate patient data is needed in care decisions along the continuum of care. To access patient data from other organizations, there are three types of regional health information exchange systems (RHIS) in use In Finland. Some regions use multiple RHISs while others do not have a RHIS available. The recently introduced National Patient Data Repository (Kanta) is increasingly used for health information exchange (HIE). Objectives The purpose of this study was to assess usage of paper, RHISs and Kanta by context in 2017; evolution of paper use over the years; and predictors of paper use in 2017 among Finnish physicians for HIE system development. Methods Data from national electronic health record (EHR) usage and user experience surveys were taken from 2010 (prior to ePrescription system implementation), 2014 (prior to implementation of Kanta) and 2017 (Kanta was in full use in the public sector and in large private organizations). The web-based surveys were targeted to all physicians engaged in clinical work in Finland. Results Kanta was the most frequently used means of HIE in 2017. Paper use had reduced significantly from 2010 to 2014. The trend continued in 2017. Still, up to half of the physicians reported using paper daily or weekly in 2017. There were great variations in paper use by healthcare sector, available RHIS type and EHR system used. In multivariable analysis (with all other variables constant), predictors of more frequent use of paper than electronic means for HIE were: private sector or hospital, access to Master Patient Index RHIS (type 1), multiple RHIS (type 4) or no RHIS (type 5), two particular EHR systems, older age, less experience, operative, psychiatric or diagnostic specialties, and male gender. Conclusions Usability of HIE systems including EHRs as access points to HIE need to be improved to facilitate usage of electronic HIE. Usage ensures more timely and complete patient data for safe, coordinated care. Specialty-specific needs and requirements call for more user participation in HIE design. Especially older professionals need training to better exploit HIS for HIE.

This report is a synthesis of the technical assistance (TA) and recommendations, carried out by the World Bank water and sanitation program (WSP) since September 2014. To achieve the target of 100 percent improved sanitation, there is a national drive to improve fecal sludge management (FSM). This TA recognizes that to achieve the goals it is necessary to support the development of national FSM policies, regulations, and guidelines, while also improving capacity at the local level by supporting the implementation of improved FSM models in target cities. The objective of the TA was to provide government with tested advice on how to scale up improved septage management nationwide through: (i) improvement of septage management in three cities through the application of new management models (local level); and (ii) assistance to national government in training and capacity building and the formulation of policies and regulations to improve septage management at scale (national level). This report is structured as follows: chapter one is the executive summary; chapter two gives the background to sanitation in Indonesia and to fecal sludge management in particular; chapter three provides an overview of the TA approach; chapter four gives details of the implementation of the TA; chapter five summarizes the lessons learned; and chapter six outlines the recommendations and next steps.

Pulp and paper companies all over the world certify their environmental management systems assuming public commitments for the continuous improvement of their relationship with the environment. Once certified, they consider themselves having done their part. But is this enough? This work has been carried out with the clear intention of provoking the professionals who can give the much needed answers for the construction of environmental sustainability in the pulp and paper sector.