StellarQ-platform (user interface for professionals)

The StellarQ platform is a treatment monitoring system for patients with neurological and other chronic conditions. The system features two user interfaces: one for professionals, and one for patients. The StellarQ platform is integrated into the electronic patient records (ERPs) and offers an overall view of the patient’s medical history. The StellarQ platform stores information related to the patient’s neurological or other long-term illnesses. Information relating to neurological diseases is part of a national quality register – a neuroregister – whose information is unidentifiable. The treatment monitoring system of the StellarQ platform aims at medical benefit: more effective treatment of long-term illnesses, better monitoring of the effectiveness of treatment, and comparison of treatment outcomes between wellbeing services counties. [1]  

This Digi-HTA assessment includes only the StellarQ platform used by healthcare professionals. 

Research evidence related to the assessed product 

The neuroregister of the neurological chronic disease treatment monitoring system has been in use since 2014 and is widely used in Finland [1]. The advantages of register data are reliability, wide coverage, and regional comparability [2]. The register has been found useful  

• in evaluating the effectiveness of medication [3]  
• as support for clinical decision-making and the introduction of new multiple sclerosis (MS) drugs [4,5] 
• in looking for patients suitable for clinical trials [4,5]  
• in identifying various risk factors in patients, which helps to identify MS patients at increased risk of developing, e.g. infectious diseases [6]. 

The current care recommendation advises use of the neuroregister [7]. 

Literature reviews 

Digital care monitoring systems support co-operation between the organisations treating the patient: they facilitate the transfer of patient data and avoid double entry [4].  

Another benefit of the StellarQ platform is that the entries entered into the StellarQ My service by the patient are also visible to a health care professional before the appointment. This can make the planning of the patient’s treatment and appointments easier.    

The StellarQ platform facilitates the medical care of neurological patients by bringing all information relevant to the patient’s neurological illness together.

Risks have been comprehensively mapped and documented during the development phase of the product as part of the CE conformity assessment process. The risks are assessed regularly in conjunction with software updates and the company has a risk management plan in place. Any reports related to customer safety will follow the CAPA (corrective and preventive actions) process and, if necessary, an incident report will be made to the Finnish Medicines Agency (FIMEA) in accordance with the company’s procedures. [1] 

The company has a designated data protection officer responsible for handling adverse events and, if necessary, submitting incident reports. No reports related to the safety of patients or clients are known. [1] 

The StellarQ system requires an Internet connection to function.  If an Internet connection is not available, the system notifies the user of the problem. [1] 

The costs related to the use of the service consist of the organisation’s annual fee, the amount of which varies slightly between hospitals. The fee includes use, necessary updates, and the use of the StellarQ My service by patients. [1]  

Integration with other systems is invoiced separately on a one-off basis. Training in the use of the system is included in the fees. [1] 

Based on the information provided by the service provider, it appears that the costs of using the Service are reasonable.

The assessment was carried out using the list of data security and data protection requirements for social welfare and health care procurement and the response material provided by StellaQ [8]. 

Crisis preparedness and prevention 

Real-time backups are taken from the StellarQ system. StellarQ has a recovery plan and a vulnerability management process to maintain the security of the system. The technical logs of the system are monitored using the Azure Monitor service. StellarQ uses the SIEM solution provided by Microsoft. 

Access to computing environments always requires strong identification. The data is transferred encrypted and stored encrypted in the database. [1] 

User management 

The service supports strong authentication through a certificate card and the suomi.fi service. You can also use a single-use password provided by a professional to sign in, in which case it is the professional’s responsibility to do so. Otherwise, the Service does not utilize passwords. [1] 

The service supports role-based access control and restriction. For the management of user data, StellarQ uses up-to-date practices and technologies. [1] 

Equipment 

StellarQ is a software as Service (SaaS) service. The system relies on cloud computing services provided by Microsoft Azure [1]. 

Data protection 

StellarQ acts as the data processor and the client organisation acts as the registrar. StellarQ has conducted a data protection impact assessment (DPIA). [1] 

Patient data is stored within Europe on Microsoft Azure servers [1]. 

Other considerations 

StellarQ has no plan for regular penetration testing. 

General guidance on procurement

During the purchase phase it is always important to contact the IT management, data security specialist and data protection specialist of the organisation. Please discuss with them whether the product in question fulfils your requirements. In addition, we recommend that wellbeing services counties utilise the European Union Agency for Cybersecurity’s (ENISA) data security procurement guidelines [9]. 

In this usability and accessibility section, only the web-based user interface (UI) of the StellarQ platform for professionals is assessed [1].  

A usability analysis of the web-based UI used by StellarQ professionals was carried out in 2020 on the basis of heuristics, which revealed shortcomings in usability and offered development proposals. Professionals have actively participated in the development of the StellarQ system. The usability of the system has been assessed both internally and with health care professionals. 

The product has been on the market for 10 years and its development is guided by feedback from professional users. In addition, the company co-operates with national expert groups and patient associations. [1] 

According to the company’s self-assessment of accessibility, the professional UI does not fully meet the A and AA level requirements of WCAG 2.1, but deficiencies will be identified and remedied in future software versions [10]. Feedback on the accessibility of the professional UI can be provided through an electronic feedback channel. Regarding accessibility, the company’s customer support will process the customer feedback within 14 days. The company has taken into account abnormal colour vision and visual impairments in the professional interface [1]. 

General guidance on procurement

The purchasing organisation shall take into account the accessibility requirements set out in the legislation in force at the time. [11,12,13] 

Interoperability 

The product is integrated into the Apotti, Omni360, LifeCare and Esko EPRs. The product offers the opportunity to record all medications in the drug database of the Finnish Medicines Agency (FIMEA). The product supports the authentication and HL7 interfaces. [1] 

Technical stability 

Testing and product publications for the StellarQ system are conducted in accordance with the IEC 62304 standard. The company also continuously carries out manual testing, in particular in connection with product publications. StellarQ uses the JIRA Service Management tool to manage feedback. [1] 

The software updates are visible in the programme’s release notes, as well as being communicated to expert groups via email and meetings of expert groups. During office hours, software updates do not cause interruptions in the service, and they are mainly implemented on Friday evenings. [1] 

Training and product support 

StellarQ arranges training in the use of the software in Finnish for all client organisation users. The client organisation ensures that all users attend the operational training.  If necessary, you can find instructions on the StellarQ platform in the main menu of the program. [1] 

The platform also offers product support and an opportunity to provide feedback. Requests for support and feedback sent are logged directly into the StellarQ Customer Service system (JIRA Service Desk). [1] 

Distribution of the product 

The neuroregister and professional StellarQ platform are in use in 15 wellbeing services counties, all of the university hospitals, and in most central hospitals [1].

1. The Digi-HTA questionnaire filled out by the company, not public information. 
2. Luoto R. Kyselytutkimuksen suunnittelu. Lääketieteellinen Aikakauskirja Duodecim. 2009. 125(15):1647-53.  
3. Verkkoniemi-Ahola A, Hartikainen P, Hassi K, Kuusisto H, Lahdenperä S, Mehtälä J, Viitala M, Ylisaukko-Oja T, Soilu-Hänninen M. Real-world treatment outcomes and safety of natalizumab in Finnish multiple sclerosis patients. Mult Scler J Exp Transl Clin. 2023;9(4):20552173231204466. doi: 10.1177/20552173231204466   
4. Soilu-Hänninen M, Kaasinen V. MS-taudin ja liikehäiriöiden laaturekisterit. Erikoislääkäri 2022; 32(2):17-20.   
5. Laakso SM, Viitala M, Kuusisto H, Sarasoja T, Hartikainen P, Atula S, Tienari PJ, Soilu-Hänninen M. Multiple sclerosis in Finland 2018—Data from the national register. Acta Neurologica Skandinavica. 2019; 140(5):303-311. doi: 10.1111/ane.13145  
6. Pirttisalo A-L, Sipilä JOT, Viitala M, Soilu-Hänninen M. Trends and characteristics of infection-related hospital admissions in multiple sclerosis patients in Southwest Finland in 2009-2018. Mult Scler Relat Disord. 2020 Sep;44:102328. doi: 10.1016/j.msard.2020.102328   
7. Käypä hoito -suositus. MS-Tauti. Available at:  https://www.kaypahoito.fi/hoi36070  Accessed on 11.1.2024. 
8. National Cyber Security Centre: Information security and data protection requirements for social welfare and healthcare procurements. Available at: https://www.kyberturvallisuuskeskus.fi/en/ncsc-news/instructions-and-guides/information-security-and-data-protection-requirements-social Accessed on 11.1.2024. 
9. The European Union Agency for Cybersecurity Procurement Guidelines for Cybersecurity in Hospitals. Available at: https://www.enisa.europa.eu/publications/good-practices-for-the-security-of-healthcare-services Accessed on 11.1.2024. 
10. Neurosairaalan saavutettavuusseloste. Available at:  https://www.stellarq.fi/content/files/2023/11/saavutettavuusseloste-stellarq.pdf   Accessed on 11.1.2024. 
11. Act on the Provision of Digital Services 306/2019 (Available only in Finnish). Available at: https://www.finlex.fi/fi/laki/alkup/2019/20190306  Accessed on 11.1.2024. 
12. Regional State Administrative Agency of Southern Finland, Accessibility supervision unit. The requirements of the Act on Provision of Digital Services. Available at: https://www.webaccessibility.fi/requirements-of-the-act-on-the-provision-of-digital-services/ Accessed on 11.1.2024.. 
13. Act on public Procurement and concession contracts 1397/2016 (Available only in Finnish). Available at: https://www.finlex.fi/fi/laki/alkup/2016/20161397 Accessed on 11.1.2024. 

Petra Falkenbach, Head of Assessment, FinCCHTA 

Jari Haverinen, Senior Planning Officer, FinCCHTA 

Raija Järvinen, Senior Planning Officer, FinCCHTA 

Teemu Mustola, Senior Planning Officer, FinCCHTA 

Tommi Hanhela, Information Security Expert, University of Oulu 

Jere Kinnunen, Information Security Expert, University of Oulu 

Antti Koskela, Information Security Expert, University of Oulu