Telemedicine as a tool for developing healthcare systems

1. Telemedicine as a tool fordeveloping healthcare systems Health Optimum 24th January 2006

2. Norwegian Centre for Telemedicine • Established i 1992 • Centre of expertice in telemedicine • Research & Development • WHO collaborating centre

3. 5 Regional hospitals 70 Local hospitals 2000 GP offices University Hospital of Tromsø Department of Telemedicine Norway 4,6 mill inhabitants with 4,9 mill mobile subscribers • public funded • equal access to health care • lowest effective care level

4. 2004-2007 • IT supported patient flow • New partners • - Pharmacies • - Patients • - Local communities National IT-strategies 2001-2004 • Electronic communication • Telemedicine • Home care • Patient interactions

5. NHN MNH Rekvisisjon Rekvisisjon ØNH VNH SNH The Norwegian health net

6. Digitalization of the paper flow • Requests and reports • Lab answers • X-rays on the net • Booking • The ”E-on-duty”

7. 60 000 2 000 e-messages 1 800 50 000 1 600 e-Messages from UNN e-Referals too UNN 1 400 40 000 1 200 30 000 1 000 800 20 000 600 400 10 000 200 0 0 jul.02 jul.03 jul.04 jan.02 jan.03 jan.04 jan.05 mai.02 sep.02 mai.03 sep.03 mai.04 sep.04 nov.02 nov.03 nov.04 mar.02 mar.03 mar.04 mar.05 Traffic UNN and the Healthcarenetwork

8. Innovation diffuse S-pattern (Rogers 1995) Characteristics/Personalities of potential adopters • Innovators (2.5%) • Early Adopters (13.5%) • Early majority (34%) • Late majority (34%) • Laggards (16%) Contextual and Managerial Factors • Environment that supports innovation • Leadership style Diffusion Innovation Information from Donald M. Berwick “Disseminating Innovations in Health Care” JAMA 2003;289(15):1969-1975.

9. Stages og development • Service delicery • Possible to deliver the actual product, (consultation, monitoring care) • Interaction • Access to operational systems (Online booking) • Transactions • Possible to send messages (referals descharge letters, lab reports) • Information • Access to searchable relevant information (service meny, clinical guidelines) Service Interaction Stage of development Bank/Finance Travel Transaction Industry Information Healthcare Buisiness value

10. Information Transaction Interaction Service Stage of development General Practitioner Patients Buisiness value Buisiness value Community Care Hospitals Stage of development

11. IT in hospitals Future Earlier Now Organisation Organisatoon Organisation IKT IT IT Patient administration and logistic PAS) Patient flow and clinical desicion support (EPR) Cooperation and telemedicine

12. DNA, protein data Regional/ national systems Public Images, signals Service delivery strategy Hospital systems Patients ICT strategy Nurses Alpha-numeric Change management Physicians Department systems Technology Administrators Health information systems Past Present Future

13. Structural changes • In-patient – out-patient – general practitionar – home care • Hospital beds – patient hotel – rural medical center – hospital at home • Driving forces: • No more money, reorganizing healthcare delivery • More active and demanding patients

14. Teleradiology Hammerfest Kirkenes Tromsø Harstad TMS Lofoten Narvik Bodø Rana Vefsn Sandnessjøen

15. One organization Tele-Dialysis Hammerfest Kirkenes Tromsø Alta Harstad TMS Lofoten Narvik Bodø Rana Vefsn Sandnessjøen • Control and follow-up of • Remote visit, guiding and education

16. UNN Dose plan Linear accelerator NSS St Olav GFS Haukeland DNR/Ullevål SiR VAS Radiation therapy Cooperating and supporting smaller hospitals in simulations and dose planning

17. Hammerfest Kirkenes Tromsø Alta Harstad TMS Lofoten Narvik Bodø Rana Vefsn Sandnessjøen Maternity care

18. PASIENT SYKEHISTORIE DIAGNOSE REFERANSER BESKRIVELSE Medical multimedia documents • Text • Images • Sound • Video • Medical signals • Acquisition • Display • Storage • Transmission • Conference

19. Multimedia request and Report

20. Videobased emergency medical interaction

25. Organizational readjustments • Success for the project depends on development of new organizational solutions. • Scheduling, agenda, reliability, responsibility, patient interaction, documentation, technical support, sound, image control • The participants must develop these solutions

26. Telemedicine in routine operations • Radiology • Pathology • Otorhinolaryngology • Dermatology • Cardiology • Psychiatry • Endoscopic surgery • Ophthalmology • Distant teaching

27. Barriers and responses • Size & complexity: • Professional resistance • Risk aversion • Heritage and legacy • Public accountability and high profile • Unclear outcomes/need for consultation • Pace and scale of change – “innovation fatigue” • (Lack of) capacity for organisational learning? • Public/end-user resistance • Absence of resources • Technical barriers

28. Chronic illness Wagner et al. identify 5 elements to improve patient outcomes for chronic illness: Increase in Chronic Conditions • - Evidence-based, planned care • Reorganization of practice to meet • needs of patients who require more • time, education, closer follow-up, etc. • Systematic attention to patient need • for information and behavioral change • - Ready access to clinical expertise • - Supportive information systems

29. The benefits of eHealth enabled chronic care have been established by leading health care institutions including the Department of Veterans Affairs, which recently published results from over two years of demonstration projects showing 63% reduction in hospital admissions and a significant improvement in the quality of life

30. Healthcare@Home • Video clips and text based information material • Videoconferencing • Medical sensor data • Consultations and personalized follow-up • Group based training and discussions • Repetitions and exercises • Services: • COPD • Diabetes 2 • Acquisition and presentation on TV at home • Personalized follow-up from health care professionals based on the information