Telemedicine as a tool fordeveloping healthcare

systems

Health Optimum 24th January 2006

• Established i 1992• Centre of expertice in telemedicine• Research & Development • WHO collaborating centre

Norwegian Centre for Telemedicine

Norway

University Hospital of TromsøDepartment of Telemedicine

5 Regional hospitals

70 Local hospitals2000 GP offices

• public funded • equal access to health care• lowest effective care level

4,6 mill inhabitants with 4,9 mill mobile subscribers

• Electronic communication• Telemedicine• Home care• Patient interactions

National IT-strategies2001-2004

• IT supported patient flow• New partners

- Pharmacies- Patients- Local communities

2004-2007

Rekvisisjon

Rekvisisjon

The Norwegian health net

NHN

MNH

VNH

SNH

ØNH

Digitalization of the paper flow

• Requests and reports

• Lab answers

• X-rays on the net

• Booking

• The ”E-on-duty”

Traffic UNN

and the Healthcarenetwork

e-messages

0

10 000

20 000

30 000

40 000

50 000

60 000

jan.0

2

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1 000

1 200

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2 000

e-Messages from UNN

e-Referals too UNN

Innovation diffuse S-pattern (Rogers 1995)

Characteristics/Personalities

of potential adopters

1. Innovators (2.5%)

2. Early Adopters (13.5%)

3. Early majority (34%)

4. Late majority (34%)

5. Laggards (16%)

Contextual and Managerial Factors

1. Environment that supports innovation

2. Leadership style

Cumulative adoption of technology

050

100150200250300

Diffusion Innovation Information from Donald M. Berwick “Disseminating Innovations in Health Care” JAMA

2003;289(15):1969-1975.

Sta

ge

of

dev

elo

pm

ent

Information

Buisiness value

Healthcare

Industry

Travel

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)

Transaction

Interaction

Service

Bank/Finance

GeneralPractitioner

CommunityCare

Patients

Buisinessvalue

Buisinessvalue

Stage of development

Stage of development

Hospitals

Information

Transaction

Service

Interaction

IT in hospitals

Organisation

IT

Patient administrationand logistic PAS)

Earlier

Organisation

IT

Patient flow and clinical desicion support (EPR)

Now

Cooperation and telemedicine

Future

Organisatoon

IKT

Health information systems

Past Present Future

Departmentsystems

Regional/nationalsystems

Hospitalsystems

Patients

Nurses

Physicians

Administrators

Public

Service delivery strategyService delivery strategy

ICT strategyICT strategy

Change managementChange management

TechnologyTechnology

Alpha-numeric

Images, signals

DNA, protein data

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 deliveryMore active and demanding patients

Teleradiology

TMSTMS

TromsøTromsø

VefsnVefsn

SandnessjøenSandnessjøen

RanaRana

HarstadHarstad

HammerfestHammerfest

NarvikNarvik

LofotenLofoten

BodøBodø

KirkenesKirkenes

Tele-Dialysis

TMSTMS

TromsøTromsø

VefsnVefsn

SandnessjøenSandnessjøen

RanaRana

HarstadHarstad

HammerfestHammerfest

NarvikNarvik

LofotenLofoten

BodøBodø

KirkenesKirkenes

AltaAlta

•Control and follow-up of

•Remote visit, guiding and education

One organization

Radiation therapy

Cooperating and supporting smaller hospitals in simulations and dose planning

Linear accelerator

Dose plan

UNN

St Olav

HaukelandDNR/Ullevål

NSS

GFS

VASSiR

Maternity care

TMSTMS

TromsøTromsø

VefsnVefsn

SandnessjøenSandnessjøen

RanaRana

HarstadHarstad

HammerfestHammerfest

NarvikNarvik

LofotenLofoten

BodøBodø

KirkenesKirkenes

AltaAlta

Copyright Medexa Monitoring Services Ltd, November 1999

Full Screen Surveillance with trend and scroll

Medical multimedia documents

• Text

• Images

• Sound

• Video

• Medical signals

• Acquisition• Display• Storage• Transmission• Conference

SYKEHISTORIE

PASIENT

DIAGNOSE

REFERANSER

BESKRIVELSE

Multimedia request and Report

Videobased emergency medical interaction

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

• Radiology• Pathology• Otorhinolaryngology• Dermatology• Cardiology• Psychiatry• Endoscopic surgery• Ophthalmology • Distant teaching

Telemedicine in routine operations

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

Chronic illness

Increase in Chronic Conditions

99105

112120

134

148158

167

0

20

40

60

80

100

120

140

160

180

1995 2000 2005 2010 2020 2030 2040 2050

in m

illion

s of

peo

ple

- 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

Wagner et al. identify 5 elements to improve patient outcomes for chronic illness:

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

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