MC-S209 December 2006

The Funen telemedicine initiative 2004-2006

Telemedicine inpracticalapplication

2 Contents

Telemedicine – in brief

Telemedicine can be defined as a remote healthcare service using information and com-munication technology.

Two parties, for example a patient and one ormore healthcare professionals, are brought into close contact despite a greater or lesserphysical distance separating them.

Funen telemedicine initiative

The Telemedicine Project – Digital Funen –comprises both Funen telemedicine at the Danish Centre for Health Telematics and pro-ject preparation for international projects. The practical content of the initiative is shownby the many project descriptions in this bro-chure.

Foreword: A successful initiative! . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3

Needs and opportunities:Telemedicine – that’s why! . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4Telemedicine – that’s how! . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5How did it go? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6Cooperation and success . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31

The 17 telemedicine projects . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7

Potential and outlook. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32Outlook for the individual projects . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35

Other telemedicine activities:Passing on knowledge. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36Partners in cooperation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37

Danish Centre for Health Telematics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38

A successful initiative!

It is not an aim in itself for it to be possible for healthcare services to be provided over longdistances. This is an option and a way of responding to a number of the challenges andtasks which the healthcare system faces.

Knowledge is being centralised, while there continues to be a great need for the decentralisedfunctions of the health services, such as general practitioners and smaller hospitals, to be able toaccomplish as many healthcare tasks as possible. Part of the answer is to make specialised know-ledge available across distances, and that is precisely what telemedicine can do. The capabilityexists, as technology makes it possible to communicate image, sound and text over long distancesat high quality and consequently at relatively low cost.

In relation to needs and opportunities telemedicine is a simple and elegant answer, but technicalstandard solutions do not do it by themselves. Each individual situation demands careful adap-tation of the technical solution. At the same time, it is just as important that the human factor istaken into account. What consequences does telemedicine have for the distribution of tasks andthe organisation as a whole? Is there a need for continuing professional development? How dopatients respond to this new form of contact with the healthcare system? In other words there isa need for development work with a view to creating practical solutions, putting them to use andextending them.

With this aim in mind, the County of Funen and the Danish Centre for Health Telematics in2004 launched a three-year initiative in cooperation with a large number of parties in the health-care sector, primarily on Funen and in the rest of the Region of Southern Denmark, alongside aset of international projects focused on telemedicine. Three years on, the knowledge and experi-ence gained through the project work have been analysed, and the results are described in this brochure.

An underlying principle in the practical solution has been to take existing technological solutionsas a basis, including videoconferencing equipment, healthcare data networks, image communica-tion and the MedCom communication standards. But there are exceptions to every rule. Twoprojects have resulted in the development of new prototypes through cooperation with Funen ITcompanies: a smart exercise mat and an on-line communication solution for patients in theirown homes.

Some of the projects are still under way, while other telemedicine solutions have already becomea part of everyday life. Here and now, however, there is no doubt about the main conclusion:The initiative was a success, the capabilities and potential of telemedicine have been proven. There is a solid basis on which to continue working on development and dissemination.

Lars Hulbæk Chief consultant Danish Centre for Health Telematics

3 Foreword

Telemedicine – that’s why!

It is possible. There is a need for it

It is not a coincidence that a great deal ofattention has been focused on telemedicine inrecent years. There are two fundamental reasons: technology can be used to conveyhealthcare services over long distances, andthere is a need for it.

It is possible, because information technologyis making advances, gradually extending thecapability to pass on text, images and sound ina flexible way. At the same time there is a di-stinct trend towards the technology becomingcheaper.

There is a need for telemedicine, partly be-cause development in the healthcare sector isclearly pointing in the direction of specialisa-tion and therefore also centralisation. Specia-list functions are being combined into fewerunits, and this is happening at the same timeas there is a need to maintain a high level ofservice and efficiency in the decentralisedparts of the healthcare sector.

As large a proportion of the services as possi-ble are to be provided close to the patient’sown home, in some cases in the home, inothers at the patient’s GP practice, at the smalllocal hospital or at a similar location. If it canbe done, the healthcare service, the necessaryexpertise, must and can be decentralised in avirtual form in the local area.

In some cases it means that the patient’s pro-blem can be solved there and then. If this isnot possible, telemedicine can raise the qualityof the effort, before the patient physicallycomes face to face with healthcare expertise,

for example in the shape of the spe-cialist or the specialised hospital

function.

4 Needs and opportunities

Telemedicine and the patient

For the patient, the advantages of telemedicinelie primarily in easy access to the best exper-tise. Typically this may involve the patient go-ing to see his or her own doctor and the latterobtaining a second opinion from a specialist.In some situations patients would like to stayin their own homes and also deal with someof the check-ups and treatment themselves.

Telemedicine means that in many cases pati-ents will be able to receive treatment withoutneeding to travel far. A group of patients whowill benefit particularly are those who live onislands or in other places far away from specia-list functions. Other groups of patients arepeople for whom the journey would causestrain for health-related reasons and chronical-ly sick patients who have to travel frequentlyto obtain the necessary expert assistance.

Telemedicine offers great potential – also byvirtue of the fact that the number of chroni-cally sick patients is rising sharply as the proportion of the elderly in the populationincreases.

Telemedicine and the healthcare sector

For healthcare professionals in decentralisedfunctions, the benefits of telemedicine are pri-marily to be found in the fact that necessaryinformation can be obtained at any time andanywhere. The potential for communication isliterally boundless.

Decentralised functions in particular are underpressure, because under normal circumstancesthey will find it difficult to provide all the services the patients demand. They lack theexpertise. Often there is a shortage of resour-ces, either because the function has limitedcapacity or because it is not possible to fillvacancies in these functions. Here telemedici-ne can have a positive effect, firstly by makingnew resources available remotely and secondlyby making the function more appealing tohealthcare professionals. The decentralisedfunctions quite simply become more attractivein purely professional terms due to close con-tact with specialist functions.

Telemedicine – that’s how!

5 Needs and opportunities

Planned online consultationThe patient gains access to a consultationusing telemedicine for example as outpatientchecks during a course of treatment.

Planned offline consultationEnquiry, for example on assessment of a caseon the basis of a picture or a similar item, isanswered by specialist within an agreed periodof time.

Urgent consultationOnline specialist assessment of an illness inconnection with an urgent consultation.

Remote functionThe clinical procedure is performed locally,while assessment is made by an expert remote-ly.

Preparation for surgeryPreparation of surgical intervention by video-conferencing.

Discharge/transfer Moving of patients between two organisationalunits in the healthcare system supported byvisualised information on continued treatment.

Follow-up of admissionThe admission is followed up with treatmentin the patient’s own home.

Second opinionA healthcare specialist is asked for advice on an investigation or treatment.

ConferenceVideoconferencing, for example in hospitaldepartment with geographically dispersedunits.

Training/exchange of experienceOnline lectures and taped recordings of proce-dures and/or lectures as an element of trainingand exchange of experience.

ExamplesFor example the Health Optimum project described on page 26, the County of Funen telealcohol abuse therapy project on page 10 and telepsychiatry on page 30.

ExampleFor example teledermatology, described on page 8.

ExampleFor example teleradiology cooperation betweenSouth West Jutland Hospital Esbjerg/Varde andOdense University Hospital, page 12.

ExamplesExamples of teleradiology cooperation are CAGcooperation between Haderslev Hospital andOdense University Hospital, page 14, HealthOptimum, page 26 and Baltic eHealth, page 28.

ExampleFor example Department of Orthopaedic Sur-gery, Odense University Hospital, page 22.

ExampleFor example Videoconferencing in the TherapyDepartment of Funen Hospital, pages 18–19.

ExamplesExamples of continued treatment of COPD patients, page 25, and IT in paediatric homecare, page 16.

ExamplesFor example tele-echocardiography, described onpage 17, tele-wound assessment, page 15 andvideoconferencing in medical practice on endo-crinology patients, page 24.

ExamplesFor example Department of Orthopaedic Sur-gery, Odense University Hospital, described onpage 22, and the Therapy Department of FunenHospital, page 18.

ExampleFor example Videoconferencing in the TherapyDepartment of Funen Hospital, page 18.

How did it go?

Aim:To ensure a leading position in telemedicinesolutions for the County of Funen/the Regionof Southern Denmark before 2007.

Aim: To demonstrate the Danish Centre for HealthTelematics as a national centre of excellence intelemedicine.

Aim: To implement practical use of telemedicine inthe Funen healthcare system.

Aim: To support telemedicine initiatives in theRegion of Southern Denmark.

Aim: To make the County of Funen and the Regionof Southern Denmark a known and key region in international contexts.

6 Needs and opportunities

Result:Assessed on the basis of awareness of telemedi-cine activities in other parts of the country, itis evident that the County of Funen holds aleading position in practical application oftelemedicine today.

Result:There are several telemedicine centres of excel-lence in Denmark. The Danish Board ofTechnology report “Healthcare Services withIT”, May 2006, emphasises Ålborg University,the Centre for Pervasive Healthcare in Århusand the Danish Centre for Health Telematics.The latter in particular has marked itself outas a centre of excellence for the practicalapplication of telemedicine. The Centre iswidely acknowledged internationally as a national centre of excellence.

Result: Telemedicine solutions have been put to usein the Funen healthcare system and provide a good basis for a targeted dissemination effort in selected areas, both regionally andnationally.

Result: The Danish Centre for Health Telematics hassupported telemedicine activities in the Regi-on of Southern Denmark by joining regionalworking groups in the area and extending tele-medicine solutions to cover healthcare provi-ders in all counties in the Region of SouthernDenmark.

Result: Today the County of Funen is one of the leading players in European projects, boththrough existing international projects andwith the approval of four new ones. TheCounty of Funen has built up networks andpractical cooperation both with other regionsand with significant industrial parties in healthcare IT.

The principal conclusion after a three-year project period is that the initiative was success-ful. Objectives and results are as follows:

The 17 telemedicine projects

7 The 17 telemedicine projects

Teledermatology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8X-ray consultation from specialist practice . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9Tele-alcohol abuse therapy. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10

Interview: Alcohol abuse therapy for Funen and the islands. . . . . . . . . . . . . . . . . . . . . . . 11Teleradiology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12

Interview: Quicker assessment of scans . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13Tele-wound assessment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14CAG cooperation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15IT in paediatric home care. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16Tele-echocardiography . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17Telemedicine in the therapy department . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18

Interview: At the forefront . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19Cooperation between residential institution and hospital . . . . . . . . . . . . . . . . . . . . . . . . . . . 20Cooperation between general practice and hospital . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21Videoconferencing in the Department of Orthopaedic Surgery . . . . . . . . . . . . . . . . . . . . . . . 22

Interview: Useful management instrument . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23Videoconferencing in general practice . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24COPD-Funen . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25Health Optimum . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26

Interview: Better quality for the patients . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27Baltic eHealth – teleradiology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28

Interview: Outsourcing of tasks . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29Telepsychiatry . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30

Teledermatology

In 2004 a pilot project wascarried out with teledermato-logy between general practiceand specialists in private prac-tices and a hospital depart-ment. The trial was evaluatedat the beginning of 2005.

The idea was to make itpossible for patients to obtaina specialist assessment of theirskin problem when they visit-ed their own doctor. Thedoctor took pictures of theskin problem and sent them

ExperiencesThe general practitioners’ assess-ment is that the teledermatologi-cal service has helped them tomake diagnoses and has contri-buted to better quality of treat-ment for the patient.

Finally, general practitionersevaluate that teledermatologyhas had a positive impact in theform of improved cooperationbetween general practice anddermatologists, and that theyhave gained from the project interms of training.

For the patients, it meant fewer visits to the GP and a shor-ter period of illness. Most of thepatients whose skin ailmentswere assessed by means of tele-dermatology have been able tocontinue with check-ups and treatment at their own doctors.

In other cases teledermatologyhas led to a substantial improve-

electronically to a dermatolo-gist, who returned a casesummary. The patient, thus,in most cases avoided beingreferred to a specialist.

Another aim of the project was to give general practitio-ners continuing professionaleducation through their con-tacts with skin specialists.

8 Teledermatology

ment in referrals to specialists.The pilot project and its assess-

ment have led to the formulationof permanent Section 2 and Sec-tion 3 agreements in connectionwith payments for the consulta-tions of general practitioners andspecialists in private practices inconnection with teledermatology.

OutlookExperience from the trial periodshows that it will be advanta-geous if image management isintegrated into the patient re-cord using the MedBin standard.The doctors felt that it was time-consuming and laborious to sendphotographs via e-mail and makereferrals via Edifact.

The project also showed thatthe participants needed trainingin photography. The Danish Cen-tre for Health Telematics there-fore arranged photographic

Project description

From the CD “How totake a good skinphotograph in twominutes”.

courses, and in cooperation withthe dermatology specialist NielsVeien from Ålborg issued the CD“How to take a good skin photo-graph in two minutes”.

The outlook for teledermato-logy is that this option may beextended to the entire Region ofSouthern Denmark and all theother regions.

A future option may be forpatients to send images directlyfrom home by e-mail or mobilephone.

Technical solutionAn ordinary digital camera with 4megapixel resolution and a PCwith reasonable memory for image processing are used forphotography. There is also a needfor record systems at generalpractitioners and specialists thatcan handle the message formatsMEDREF/MedBin and MEDDIS.

FinanceThe basic costs for the generalpractice are around DKK 2,500for a digital camera plus any costsassociated with the addition ofan image database and supportfor the MedBin standard in medi-cal record systems. The costs ofthis vary and depend on the sup-plier.

X-ray consultation from specialist practice

Radiological examinations inthe form of X-rays and CTand MRI scans are of greatsignificance in diagnosis byspecialists and for the safetyin treatment and the sub-sequent check-up. The aim ofthe project has been to givehealthcare professionals directaccess to radiological exami-nations and descriptionsusing web consultation onthe Health Data Network.This type of X-ray consulta-

ExperiencesThe greatest advantage in webconsultations is the time saving inprivate clinics, as specialists haveaccess to the image materialimmediately after the examina-tion. Diagnostics and treatmentcan therefore be initiated farquicker than in the past. The cli-nic also saves time by not havingto gather examination resultsmanually.

Another advantage is that thespecialist can use the images directly in dialogue with the pa-tient. At the same time there is abenefit in that the images areavailable when they are needed.In the manual procedure it maybe difficult and time-consumingto get hold of the images again.

Web consultation additionallycontributes to increased coopera-tion between specialist practiceand the imaging diagnostics de-partment, as practice occasionallyprovides feedback on examina-tion data.

OutlookSpecialist private practice judgesweb consultation to be a substan-tial improvement in the serviceprovided by the Imaging Diagno-stics Department at Odense Uni-versity Hospital (OUH). When thewhole of Funen in the future ison PACS (Picture Archiving and

tion is particularly useful inpatient pathways that involvehospitals and private specia-list clinics.

In practice the web con-sultations give specialistsaccess to material from theImaging Diagnostics Depart-ment of Odense UniversityHospital and X-rays fromFunen Hospital Aeroe.

The general procedure isthat examination data is re-quested by fax. Radiologicalimages are supplied on filmand descriptions are sent asEdifact. The manual proce-

dure means that two to threeweeks normally pass beforethe specialist receives thematerial.

9 X-ray consultation

nical equipment in the form of astandard PC with an Internetbrowser and connection via theHealth Data Network to a web-based server in the PACS/RISsystem.

FinanceA specialist private practice usu-ally has a PC with the softwareneeded to take part. Initially there is a minor cost associatedwith establishing access to theHealth Data Network.

Project description

Communication System), the timesaving in hospitals and clinics willbe even greater.

It is envisaged that in the future it will be possible to set upa national radiology index con-taining all radiological examina-tions. The index can be used byrelevant healthcare professionalsand by the healthcare system inother countries where Danishpatients receive treatment.

Technical solutionThe radiological examinationsand descriptions are stored in RIS(Radiology Information System)or PACS (Picture Archiving andCommunication System). Webconsultation necessitates tech-

Troels Laulund, orthopaedic sur-geon, performs web consultationof X-ray images and scans fromhis private clinic in Odense.

Tele-alcohol abuse therapy

The aim of the project, which began in 2004, is toexamine whether an alcoholabuse therapy facility usingtelemedicine might attractmore patients who live faraway from the treatmentinstitution, and whether itwill induce more people tocomplete their treatment.

The project is based at theAlcohol Rehabilitation Cen-tre in the County of Funen,and tele-therapy is offered to patients on the islands of Aeroe and Langeland.

Alcohol abuse therapy inthe County of Funen takesplace in the form of indivi-dual therapy sessions, and inprinciple it is of little signifi-

Experiences30 patients have received or arereceiving tele-therapy. This num-ber is too small for it to be possi-ble to draw any conclusions onwhether the quality of the thera-py is as good as in traditionaltherapy. Results to date suggest,however, that the patients rema-in in treatment longer, and thatmore patients commence therapyas this facility becomes known.

For patients, this option meansthat they save time and inconve-nience when they can attend their local hospital instead oftravelling to Svendborg. At thesame time, therapy can be atten-ded more discreetly.

At the rehabilitation centre,this facility has increased flexibili-ty in the use of therapist andmedical resources. The medicalteam spend less time travellingand more time with the patients.This facility has not had any orga-nisational consequences, as itmakes no difference whether thesessions take place remotely orface to face.

10 Tele-alcohol abuse therapy

OutlookIt is planned that this provisionwill be extended, so that peoplewho live in Faaborg can alsoobtain professional alcohol abusetherapy at their local hospital.Teleconferencing facilities arealso to be set up in the MedicalDepartment of Funen HospitalSvendborg, so that the patientscan be offered alcohol abuse the-rapy while they are hospitalised.The rehabilitation centres inOdense, Middelfart and Nyborgare now also purchasing video-conferencing equipment.

Provided tele-therapy is aseffective as conventional out-patient therapy and other patient groups are brought into therapy, the outlook for the future is bright. It will be possibleto combine discretion and proxi-mity to citizens with professionalalcohol abuse therapy, greatcapacity and a high degree ofspecialisation.

It is possible to imagine equip-ment set up at GPs’ surgeries, insocial services, departments at

Project description

large workplaces etc. The tele-therapy may even be offered inthe patient’s own home. To attract young people in parti-cular, it must be possible to setup chat-rooms on the Internet,where young people can receiveadvice anonymously on alcoholrehabilitation.

Furthermore the rehabilitationcentres have plans for the serviceto be extended to family mem-bers.

Technical solutionStandard videoconferencing equipment is used, and the ses-sions take place via the County ofFunen network. The therapist canuse a portable monitor. However,most tele-therapy sessions takeplace from a room set up for thepurpose.

FinanceThe purchase price for videocon-ferencing equipment is DKK35,000–50,000, and operatingexpenses are low.

Anne Mette Nielsen, nurse, in front of the videoconferencing equip-ment. (Photograph shows a model).

cance whether the therapistand the patient sit face toface or whether they see each

other via a television screenand camera.

Alcohol abuse therapy for Funen and the islands

In 2004 the Alcohol Rehabilitation Centre ofthe County of Funen entered a new era. Pati-ents from Aeroe and Langeland now choosefor themselves whether they want to travel fora therapy session in Svendborg or prefer avideoconference session in the PreventionCentre in Rudkoebing or the Hospital in Aeroeskoebing. The patients will continuemaking appointments in Svendborg, andwhen they arrive in Rudkoebing or Aeroes-koebing they will be assisted by a secretary.

“It’s turned out that neither patients northerapists feel that it makes a great differencewhen the therapy sessions are carried outusing videoconferencing equipment,” saysAnette Søgaard Nielsen, the head of theCounty of Funen Alcohol Rehabilitation Centre.

“In fact, this option helps to ensure thatmore patients actually get alcohol abuse thera-py, and that they remain in therapy longerthan they would if they had to travel toSvendborg every time.”

Greater anonymity“Many patients find it difficult to walk intoan alcohol rehabilitation centre, because theyare ashamed and do not want other people to

Anette Søgaard Nielsen, head of the County of Funen Alcohol Rehabilita-tion Centre.

Anne Marie Berntsen, head of de-partment at the Alcohol Rehabilita-tion Centre in Svendborg.

11 Tele-alcohol abuse therapy

Interview see that they have a problem with alcohol,”says Anne Marie Berntsen. She is head ofdepartment at the Alcohol RehabilitationCentre in Svendborg and together with thefive therapists at the centre she has already gained considerable experience with tele-alco-hol abuse therapy.

“It’s more anonymous for patients to go tothe Prevention Centre in Rudkoebing or theHospital in Aeroeskoebing, and that makes iteasier for them to turn up.

At the same time, the short travelling timemeans that this option can be utilised by abroader target group, including those who arein employment and are unable to get toSvendborg during the centre’s opening hours.”

Technology working wellAfter a running-in period during which tech-nical problems were solved, there is little difference between face to face therapy andtele-therapy.

“The image quality is excellent, but youhave to talk a little slower than normally,” saysAnette Søgaard Nielsen.

“And you mustn’t talk at the same time,which is actually an advantage. In essence, it’sjust an extension of telephone contact, andtherefore the patients do not think that it’scomplicated either.”

Tele-alcohol abuse therapy can be combi-ned with sessions at the centre in Svendborg,depending on what the patient wants and howthe therapist assesses the situation.

More facilities on the way“Tele-alcohol abuse therapy can be usedadvantageously in other contexts in order toreach more target groups,” says Anne MarieBerntsen.

“For instance, we’ve initiated cooperationwith the Medical Department at Funen Hos-pital Svendborg to offer a clarification sessionto patients who are admitted for detoxifica-tion. Patients are more receptive to the offerwhile they are hospitalised, so we can see quiteclearly that more patients get started on acourse of therapy.”

In the future the videoconferencing equip-ment can also be used for example to treat prison inmates or young people in their ownhomes, using a webcam.

The County ofFunen AlcoholRehabilitationCentre has suc-cessfully startedusing videocon-ferencing equip-ment for alcoholabuse therapy forpatients on theislands of Aeroeand Langeland.

Teleradiology

The Department of Neuro-surgery at Odense University

ExperiencesThe project was launched at thebeginning of 2005,and since thatteleradiology has become stan-dard procedure.

Over a three-month period inthe trial project in 1999, Esbjergsent 44 examinations of acutepatients to OUH. Of these, 18patients either completely avoi-ded being transferred to OUH ortheir transfer was deferred untilthe following day. In 2005 imageswere sent from Esbjerg to OUHalmost daily.

The consequence is substan-tially better treatment. Above all,this scheme ensures that patientswho need specialist treatment goto OUH and that they are onlytransferred as urgent cases ifnecessary. Other patients can stayat the South West Jutland Hospi-tal Esbjerg/Varde and avoidstressful transport. At the sametime both hospitals save moneyas well as resources.

OutlookThe cooperation on teleradiologywill benefit from the fact thatOUH will soon have a fully ex-panded PACS. With regards tosystems, it will also be desirableto bring the patients into OUH’sRIS/PACS. This depends on a ten-dering process for RIS/PACS forFunen and South Jutland which is

Hospital (OUH) provides aregional service for Funenand South Jutland and recei-ves both acute and electivepatients as well as outpatientsfrom the whole of this area.

The idea behind the pro-ject is to make possible anoptimum assessment of whe-ther neurosurgical patientsfrom South West JutlandHospital Esberg/Varde shouldbe transferred to the Depart-ment of Neurosurgery atOUH for treatment.

This is done by sendingCT and MRI scans electroni-cally to specialists at OUH

asking them to judge whethera patient should be trans-ferred urgently, electively ortreated locally, and whetherthere is a need for urgent treatment prior to transfer.

The procedure is that thehospital in Esbjerg examinesa patient and sends the ima-ges via PACS, a system forthe storage and distributionof digital X-ray images, toOUH. At the Department ofNeurosurgery specialistsassess the images using aPACS/Web viewer.

12 Teleradiology

(Radiology Information System)and PACS (Picture Archiving andCommunicating System), whileOUH has SECTRA RIS and a SEC-TRA MiniPACS system, which isprimarily used for image storage.The PACS systems are linked viathe Health Data Network.

FinanceThe project has not required purchasing or investments, asexisting equipment and networksare used. A setup of systems andnetworks, as well as testing, havemeant limited use of resources.

Project description

currently in progress.In terms of development

opportunities, it can be imaginedthat the same solution will beused by all hospitals in the Region of Southern Denmark andby the hospitals of other regions,particularly in those areas whereOUH has national or regionalspecialties. When OUH acquires afully expanded PACS, it will alsobe natural to transfer all imagesof elective patients and out-patients electronically.

Technical solutionSouth West Jutland HospitalEsberg/Varde has SECTRA RIS

Quicker assessment of scans

Overall, no major difficulties were encounte-red in implementing the teleradiology solu-tion, which is based on the link between thePACS systems in the Radiodiagnostics Depart-ment of OUH and in Esbjerg.

“It was an advantage, for example, thatOUH and Esbjerg use PACS from the samesupplier, so in everyday language the systemsare able to talk to each other,” says JørgenNepper-Rasmussen, a consultant doctor in theDepartment of Radiodiagnostics, Neuroradio-logy Section, OUH.

“The link to the Health Data Networkadditionally offers the advantage that we re-ceive scan images 24 hours a day. To make useof this improvement, some of the internal procedures of the Health Data Network werechanged, so that the system is monitored around the clock.”

Expanded electronic cooperation betweenOUH and South West Jutland HospitalEsbjerg/Varde has been planned for manyyears. In 1998–99 the parties adopted a low-technology solution, in which the depart-ments’ laser film printers were linked together.This made it possible for the radiology depart-ment at OUH to print films from CT andMTI scans performed in Esberg.

“That solution was already a step forward,because we were able to make a quicker assess-ment of patients. At the same time it was clearthat there was a need for a more advancedsolution,” says Nepper-Rasmussen.

Fewer journeys, better planningWhen the radiology department at OUH re-ceives CT and MRI scan images from Esbjerg,the images are automatically stored in thedepartments Mini-PACS system, where theneurosurgeons can view them and decide ondiagnosis and treatment. The neurosurgeonsinvolve the neuroradiologists in their assess-ments when necessary, and in some cases theimages are also discussed at case conferences.

“The main purpose is to ensure that pa-tients who are admitted in Esberg and Vardewith a head injury or cerebral haemorrhageare quickly assessed by a specialist in order toplan the treatment. The advantage for the

Jørgen Nepper-Rasmussen, consultant doctor in theDepartment of Radiodiagnostics, NeuroradiologySection, OUH.

13 Teleradiology

Interview

patients is that in some cases they avoid beingtransferred to Odense, because the treatmentcan take place at the local hospital,” Nepper-Rasmussen explains.

“On other occasions the journey can bepostponed to the next day. This gives us a better opportunity to plan and coordinate in-ternally in the department. At the same time itmeans that the patient is received as well aspossible. Furthermore there are fewer costsassociated with transporting patients duringthe day rather than in the evening or duringthe night.”

Earlier treatment of blood clots in the brain“Our vision is to use teleradiology in connec-tion with thrombolytic treatment of patientsaffected by a blood clot in the brain,” saysNepper-Rasmussen.

“Scans will enable the specialists at OUH to assess the prospects for thrombolytic treat-ment, without having the patient transferred toOUH. The time factor is crucial in thrombo-lytic treatment, and therefore the treatment has to be performed locally following guidancefrom OUH.

The idea is that the specialists should beable to follow the progress both from OUHand from home via a link to the Health DataNetwork, so that qualified staff monitor thepatient permanently. In order to realise theproject a common system in the whole of the Region of Southern Denmark for transmissionof the images is needed. If everything goesaccording to the plan, this will be in placewithin six months to a year”.

The cooperationbetween SouthWest JutlandHospital Esbjerg/Varde and OUHon teleradiologymeans quickerassessment of CTand MRI scans, tothe satisfaction ofboth patients andstaff.

14 Tele-wound assessment

Tele-wound assessment

Treatment of wounds ischaracterised by an interdisci-plinary approach and fewnational expert centres. It isessential to support clinicalcooperation between specia-list units and other functionsin the healthcare system withtelemedicine tools.

The aim is to make theinitial assessment more infor-med and the diagnosis morereliable. This is achieved bysupplementing referrals withimage material. The treat-ment can in this way be initi-ated quicker. This results inquality improvements in thecourse of treatment and in

ExperiencesTo date the pilot project has onlycovered a few referrals. The pro-ject has nevertheless had severalpositive effects. Among otherthings, nurses who work in thehomes of particularly debilitatedpatients can take images of pres-sure sores and obtain specialistassessments via telemedicine. Inthis way, some of these patientscan avoid going to the hospital.

OutlookReferrals are sent as edifact com-munication from general prac-

tice, and in this context gettingthe MedBin standard into use inthe patient record systems ofgeneral practitioners poses a great challenge.

The University Centre forWound Healing is working todevelop a wound database as anaddition to the department’s EPR.This means that tele-assessmentof wounds can be handled withthe same tools as the depart-ment’s other tasks.

In addition, work is under wayon the idea of instructional videos, which can be used in re-lation to general practitioners,home care and patients.

An interesting perspective is tobroaden the area to also coverthe other hospitals in the Regionof Southern Denmark. Coopera-tion has already been establishedwith Ribe County on a number ofpatients. In addition, cooperationcould advantageously be establi-shed with home-care nurses, whohave great experience in asses-sing and treating wounds.

Technical solutionGeneral practice sends referralsand image material as edifact

Project description

The telemedicinewound images areassessed on a port-able PC.

communication. The record systems at both

general practitioners and specia-lists must be able to handle theMedBin standard.

The County of Funen receivesthe messages in the Cloverleafsystem, which routes the referralto FPAS, the county’s patientadministration system and EPR.

A standard digital camera withhigh resolution is used for photo-graphic recordings. This solutionadditionally necessitates a PCwith reasonable memory for image processing.

FinanceA digital camera typically costsaround DKK 2,500. The costs ofadding an image database andsupport for the MedBin standardin the medical record systemsvaries from DKK 0–25,000 depen-ding on supplier.

At OUH there have been costsassociated with developmentwork to support requests in EPRand MedBin in the image data-base. In addition there is the de-velopment of interfaces betweenthe systems.

some cases it is even possibleto avoid amputations.Furthermore the solution canfacilitate out-patient treat-ment of patients who requireparticular care and who aredifficult to transport.

This specific project sup-ports cooperation between theUniversity Centre for WoundHealing at the Department ofPlastic Surgery at OdenseUniversity Hospital and theDepartment of Orthopaedic

Surgery and the Medical De-partment at Funen HospitalSvendborg, as well as selectedGP practices.

The project cooperation ismeant to contribute to theestablishment of a telemedi-cine wound consultation inthe County of Funen. At thesame time the project will sup-port and supplement alreadyexisting patterns of initialassessment and cooperation forwound patients in the county.

CAG cooperation

The aim of this project is toassess whether videoconferen-cing is suitable for conduc-ting consultations betweencardiologists, in this case atHaderslev Hospital, and spe-

OutlookThe primary challenge is to intro-duce and carry out the pilot pro-ject and reach so far that the pro-ject can become operationalwhen the necessary confidence inthe solution has been built up.

In the long term, it will also be

cialists – medical specialistsand surgeons – at theDepartment of Cardiology atOdense University Hospital.

The vision is that all patients should have equalaccess to treatment by thesame group of specialists.

The videoconferences willproceed in such a way thatthe cardiologists in Haderslevand the specialists in Odenselook at the same coronaryangiography images at thesame time. Together they willdecide whether it is possibleto perform balloon dilatationor by-pass surgery or whetherthe patient will be treatedwith medication.

The project started at theend of 2006 and will lead to

increased use of specialistresources and expanded co-operation between hospitals.It is anticipated that coopera-tion by videoconferencingwill raise the quality of confe-rences and thus lead to bettertreatment of patients.Furthermore it is anticipatedthat time and travel expensesin connection with meetingscan be saved.

relevant to involve South WestJutland Hospital Esbjerg/Varde inthe solution. Cardiologists fromOUH travel to Esbjerg for a con-ference every 14 days. This canpossibly be avoided and coopera-tion otherwise expanded withmore frequent conferences.

Technical solutionGeneral videoconferencing equip-ment will be used at OUH and atHaderslev Hospital, together withthe necessary hardware and soft-ware. The network connectionwill be made via the regionaldata network.

FinanceCosts of the order of DKK335,000 are estimated for theproject. Of this sum, around DKK260,000 will be used for a clinicalworkstation, while the remainingDKK 75,000 is spent on acquiringvideoconferencing equipment.

Project description

15 CAG cooperation

Per Thayssen, consultant in theDepartment of Cardiology ofOUH, assesses electronic coronaryangiography images.

IT in paediatric home care

The aim of the project hasbeen to examine and try outvarious telemedicine solutionsthat can contribute to enhan-cing the efforts in PaediatricHome Care. Among otherthings it entails reducing thenumber of hospital admis-sions, generally improving theefficiency of the work in Paediatric Home Care andmaking it possible to involvethe sick child and its parentsto an even greater degree.

Paediatric Home Care isorganisationally part of thePaediatric Clinic DepartmentH, Odense University Hospi-tal, and the tasks consist ofnursing and instruction ofchildren and their families inthe home.

The overall aim of theeffort is to ensure as goodconditions as possible for sickchildren and their families,among other things by avoi-ding or shortening of thelength of hospital admissions.Ten members of staff areattached to Paediatric HomeCare, and make around fivehome visits a day.

In practice, Paediatric

Home Care staff have madeuse of GPS navigation to findtheir way better. Furthermorethey have used various aidsfor examination, investiga-tion and instruction. Theseare a portable PC and mobileconnection to various hospi-tal systems, digital videocamera, digital stethoscopeand spirometer and a colourprinter.

16 Paediatric Home Care

Project description

clear advantage when it becomespossible to connect more quicklyto the systems via the mobilenetwork.

A prospect for the future is touse image documentation forexample for video photographyof the home and on this basis topropose changes in furnishing tothe municipality. When the tech-nological opportunities are inplace, video conferences fromhome to treating functions atOUH will also be relevant.

Technical solutionGPS navigation, digital videocamera, digital stethoscope andspirometer have been tested asindividual devices and not linkedto a network. The portable PCcan be connected to all the hospi-tal systems via a local network atOUH or via the mobile phonenetwork G3/GSM.

Finance Acquisition and initial costs havebeen approximately DKK 70,000.

Paediatric Home Caredeals with nursingand instructs sick children and theirparents in the home.

ExperiencesInitial experience from the pro-ject indicates that the total ITsolution can support the work ofpaediatric home care and indoing so contribute towards avoi-ding to hospitalise the child, ortowards reducing the length ofthe hospitalisation. This improvesthe quality of life for the childand its parents.

For staff, it is a positive experi-ence to be able to complete tasksat the patient’s home and thusprovide a more professional ser-vice.

The use of GSM navigation hasbeen a success. The digital videocamera for the time being is usedprimarily for instruction purposes,because the mobile network doesnot yet provide an opportunity touse the technology for imagedocumentation. The mobile con-nection to hospital systems hasprimarily been used for storagein the booking system and foraccess to records. Experience withthe digital stethoscope is notgood, as it is highly sensitive tonoise. A spirometer for lungfunction analysis and colour prin-ter have not yet been put to use.

OutlookThe plan is for the project tobecome operational and for con-tinued development to take place in the direction of makinguse of more telemedicine tools.There are also expectations inthis context of putting spirometryand image documentation in thehome to practical use.

In this connection it will be a

Tele-echocardiography

Every year around 500 chil-dren are born with heart de-fects, aroundhalf of whomneed surgical intervention orballoon dilatation. In Den-

mark around 300heart operations areperformed on chil-dren each year. År-

hus Hospital, Skejbyand CopenhagenUniversity Hospital

are alone in performingheart surgery on children inDenmark.

The project, which is plan-ned to begin at the end of2006, is intended to improvethe treatment of children withcongenital heart defects byusing telemedicine to supportconferences and preparations

ExpectationsIt is anticipated that the projectwill lead to improved treatmentfor children, partly due to thepossibility of quickly setting upurgent case conferences and part-ly due to improved communica-tion options in general. In somesituations it is desirable to avoidmoving the sick child.

At the same time, it is antici-pated that it will be possible to achieve savings in the form of a reduction in travel time andtravel expenses to attend thecase conferences.

Challenges and plansThe project is expected to be-come operational at the end of2006, when the last organisa-tional and technical solutions arein place.

Technical solutionThe Paediatric Department ofOUH has an ultrasound scanner,which is able to send images tocardiologists at Århus Hospital,

for surgical procedures in co-operation between OdenseUniversity Hospital, ÅrhusHospital, Skejby and Copen-hagen University Hospital.

The project is based in thePaediatric Heart Centre, Pae-diatric Cardiology Ward inthe Paediatric Department ofOUH. The Paediatric HeartCentre examines, treats andchecks children with congeni-tal heart diseases. The wardalso takes urgent cases. Thereare 8–12 patient visits to theoutpatient unit daily.

In outpatient visits, theunit carries out general medi-cal examinations, and in mostcases performs ultrasoundscans of the heart. This exa-mination may be supplemen-ted by ECG and/or a fitnesstest on a treadmill. The unitalso performs foetal echo-

cardiography for pregnantwomen, where there is suspi-cion or increased risk that thechild has congenital heartdefects.

Today the procedure isthat ultrasound scans are kepton CD-ROM, and aboutonce a month a team travelsto Århus Hospital, Skejby tohold a case conference andplan treatment. And up totwice a month a need arisesfor an urgent case conference,and immediate transfer toÅrhus is often chosen.

The telemedicine solutionenables the PaediatricDepartment at OUH to holdcase conferences with ÅrhusHospital, Skejby and Copen-hagen University Hospitalaccording to need and with-out long journey times forboth patients and staff.

17 Tele-echocardiography

Skejby or Copenhagen UniversityHospital while the scan is still inprogress. The parties can usevideoconferencing equipment tocomment on, influence on anddiscuss the examination and takedecisions on further treatment.

Communication takes place viathe Health Data Network.

FinanceNo investment has yet beenmade in new equipment underthe project.

Project description

Gunner Nielsen, consultant, Paediatric Department, OUH, tests anewborn baby for heart defects using echocardiography.

Telemedicine in the therapydepartment

The Therapy Department atFunen Hospital provides thesetting for two telemedicineprojects. The department hastried out videoconferencingacross the hospital’s sites andis taking part in the develop-ment of a smart exercise mat.

The need for videoconfe-rencing arose as a consequen-ce of the merger of differentsites of the Funen Hospitalinto one therapy department.The project is intended tostrengthen cooperation acrossgeographical distances andsupport quality in the servi-ces provided. The project isan important tool in thedepartment’s professional andorganisational development.

The videoconferencingsystems were implemented inApril 2005 to support com-

ExperiencesThe use of videoconferencing formeetings is working as intendedand contributing to passing onknowledge and inspiration in thedepartment. Staff save on traveltime and resources.

OutlookThe idea is to extend the use of

18 Therapy Department

videoconferencing in the Regionof Southern Denmark. Anotherclear prospect is to use the solution in closer cooperation between hospitals and municipa-lities in the transfer of patientsfor rehabilitation.

Technical solutionThe equipment is standard equip-

ment linked to the County ofFunen Network.

FinanceThe videoconferencing equipmentin Svendborg, Nyborg and Faa-borg has cost around DKK 200,000to purchase, including installationand instruction. In Aeroeskoebingexisting equipment is used.

ExperiencesThe effect of rehabilitation onthe mats is highly positive. Thepatients are enthusiastic aboutthe tool and often forget abouttheir functional limitations. Anincidental gain is many valuablecontacts with other organisationsat both national and internatio-nal level.

OutlookIt is a challenge for the depart-ment to be involved in the devel-opment of the smart exercise

mat. The project costs resources,but in turn provides energy andmotivation. The developmentwork is continuing, and the prototypes will be improved con-tinually.

Technical solutionThe task of the Therapy Depart-ment is to test the exercise matand take part in its development.For the time being four exerciseprogrammes have been develop-ed for heart patients.

FinanceThe County of Funen directlycovers DKK 0.5m of the develop-ment expenses for the exercisemat, while Funen Hospital coversDKK 0.2m and the Danish Centrefor Health Telematics DKK 0.2m.The parties have entered into acooperation agreement whichgoverns the development effortand rights. Funen Hospital is assured of royalties from futuresales to customers.

Project description

Videoconferencing

Smart exercise mats

munication between the chieftherapist/heads of specialtiesand the hospital units. Theintention in practical termswas to use the equipment inmorning conferences, devel-opment of quality and skills,professional discussions andinstruction.

Later in 2005 the ideaarose of cooperation with theMærsk McKinney Møller In-stitute for Production Tech-nology at the University ofSouthern Denmark and

Entertainment Robotics todevelop “smart physiotherapytraining equipment”. TheMærsk McKinney MøllerInstitute and KOMPAN hadjointly developed a smartplayground mat, and the ideawas to further develop thetechnology for the healthcaresector. The mat was success-fully tested on knee patientsand heart patients and wasthen brought into the depart-ment’s telemedicine project.

At the forefront

Heart patients in rehabilitation play an impor-tant role when the Therapy Department ofFunen Hospital takes part in the testing anddevelopment of a smart exercise mat. Thepatients move around following lights fittedinto the mats. A computer program controlswhere and when lights are on.

“So far 20–25 patients have tried out themats, and they are all enthusiastic about thisform of rehabilitation. The patients work ontheir stamina and fitness, which we assess byintensity and pulse measurements. We recordtheir coordination and balance on video,” saysdevelopmental physiotherapist and project leader Tonny Jæger.

“The mat is designed so that it can be fit-ted both on the floor and on a wall, enablingpatients to exercise their whole body. It’s veryexciting to take part in generating ideas fordevelopment of the prototype. One thing wewould like to be able to do is to model themat for different purposes, for example a longwalkway. In the longer term we would alsolike to be able to program the light, so thatpatients can practise particular movementsthey previously used for example in playinggolf or tennis.

In the test phase we naturally identify somethings that do not work, but the opportunitiesfor development are so great that it’s worth it.It’s also logical to use the mats for the re-habilitation of other groups of patients, forexample hip patients.”

Jæger presented the mat at the Nordic Tele-medicine Conference in Tromsø in June 2006and there was keen interest in the smart exer-cise tool, leading to many international con-tacts. He anticipates that the mat will becomea permanent feature in the department’s reha-bilitation equipment during the course of2007.

Meetings and instruction via camera and monitor Videoconferencing is another telemedicinetool used by the Therapy Department. Staffwere quickly able to see the benefit of commu-nicating by monitor and camera rather thantravelling between sites to meet face to face.

Developmental physiotherapist Tonny Jæger, fromthe Therapy Department of Funen Hospital.

19 Therapy Department

Interview

“Today we typically hold three or fourorganisational meetings a week by videoconfe-rencing. As a result we cope with planningand coordination quickly and effectively,” saysJæger.

“We also use the equipment for instructionacross sites and even across national borders.On the other hand, we are not yet so good atusing the equipment for professional develop-ment. To some extent it’s a matter of gettingused to the medium. Some people find com-municating through a monitor cold. At thesame time, many therapists would rather be indirect contact with patients themselves thanassess a rehabilitation situation by teleconfe-rencing,” Jæger feels.

Another reason for limited use is that thegeographical spread of the therapists is not asgreat as expected.

“I can see some clear opportunities in broadening the use of videoconferencing whenthe municipalities take over a number of reha-bilitation tasks. For example, home care staffcan film the patient’s home, so that the hospi-tal therapist can offer advice on rehabilitationand furnishing. We could also monitor rehabi-litation situations in municipal healthcare centres through videoconferencing equipment.That makes it possible for the therapist whohas trained the patient at the hospital to con-tribute his or her experience. Finally I see anumber of opportunities to use videoconfe-rencing in connection with cooperation in theregion.”

The TherapyDepartment ofFunen Hospital isat the forefrontwhen it comes totelemedicine. Itsstaff use video-conferencing andare also takingpart in the devel-opment of asmart mat forrehabilitation.

Cooperation between residential institution and hospital

The aim of the “Social IT”project is to support coopera-tion between the Lindebergresidential home and relevantparts of the healthcare system.The home has around 70adult residents.

Half of them suffer fromepilepsy, while the others need psychiatric treatment.The home therefore oftencooperates with specialists. In this connection there is aneed for an effective exchange

ExperiencesThe exchange of correspondencemessages and outpatient noteswith OUH has worked smoothlysince May 2006. The same appliesto access from OUH to the Homesystem. The video recording solu-tion has been tested and enteredservice.

Waiting time for specialistassessments is reduced to one dayrather than the previous one totwo weeks. The information reaches the right person quicklyand reliably, so that optimum treatment can be commenced

of information.In practical terms the pro-

ject is concerned with elec-tronic exchange of correspon-dence messages between thehome and the residents’ gene-ral practitioner, an epilepsyspecialist from NeurologyDepartment U of OUH anda psychiatrist from PsychiatryDepartment P of OUH.

In addition, epilepsy spe-cialists at OUH have anopportunity to devise webconsultation in the Homesystem, so that they can viewthe residents’ records, inclu-

ding video recordings of epi-leptic seizures, with a view to assessment and advice to thestaff of the home.

Other than simplificationsand time savings, the intro-duction of IT solutions doesnot have any impact on theorganisation, as it involvesautomation of relatively sim-ple functions.

20 Residential institution

immediately.One result of the shorter wait-

ing time is that it is easier andquicker to change medication.Relevant social educational activities can be started at shortnotice.

OutlookLindebjerg wishes to follow upthe project by developing an elec-tronic form, which the instructorswill use to describe seizures suf-fered by residents with epilepsy.The form will give the neurologistat OUH a uniform and relevant

description of the seizures. Inaddition, Lindbjerg would like toinstall a videoconferencingsystem for training purposes, forexample in cooperation with theOdense Social Education Seminar.

Technical solutionFacilities have been set up fordigital video recording and edi-ting in the Lindebjerg Homesystem and functions have beendeveloped to handle electroniccorrespondence messages be-tween Lindebjerg and OUH andthe residents’ general practitio-ners. In addition, access has beenprovided from OUH to the Homesystem via the Health Data Net-work.

FinanceThe project expenses have beenshared so that the Danish Centrefor Health Telematics has paidthe costs of the Health DataNetwork in the project periodtotalling DKK 30,000. The otherdevelopment expenses are paidby the other suppliers.

Project description

Deputy manager Michael Henrik-sen and assistant Ellen Foss, Lin-debjerg Home, assessing videorecordings from the home. Onthe left is one of the Lindebjergresidents.

Cooperation between generalpractice and hospital

The aim of this project hasbeen to try out new technicaloptions in cooperation be-tween general practice andthe hospital sector. In prac-tice it entails creating elec-tronic access to patient dataacross the sectors as a supple-ment to the sending of patient data, which alreadytakes place.

The project is based onAeroe in support of the National Health Insurance

ExperiencesThe project has led to increasedelectronic communication acrossthe sector boundary betweengeneral practice and hospital. It isa great benefit that the on-callGP can consult the record systemsof other general practices andview notes, medication and laboratory data for patients whoare not his/her own. This providesgreater certainty of correct treat-ment for the patient,

For the time being the GPs willonly be using X-ray consultationsto a limited extent, as the systemis too time-consuming in shortconsultations. Furthermore theyonly use access to SUP data fromFunen Hospital in a few cases,because the solution at presentdoes not contain admission datafrom Funen Hospital. This need ismet in practice by phone calls tothe hospital.

OutlookIt is a challenge for a general practice to become familiar withthe telemedicine solutions andintegrate them into daily rou-tines. The general practitionersoften find that they do not haveenough time to use these toolsduring an appointment.

Digital image communicationcan be utilised better in the future. One idea is for the gene-

effort to preserve and streng-then primary healthcare ser-vices on the island, on whichthe proportion of people overthe age of 70 is twice as highas in the entire County ofFunen. The National HealthInsurance and the four medi-cal practices on the island arecooperating in the project.

The telemedicine solutionmeans that general practitio-ners on Aeroe have access toX-ray images from FunenHospital Aeroeskoebing viathe Health Data Networkand to patient data from the

Funen hospital service via theHealth Data Network andSundhed.dk (The DanisheHealth Portal). The general practitioners can also consulttheir colleagues’ recordingsusing P-EPJ, which extractsrecord data at personal iden-tity number level from themedical record systems. Thisis useful when the GP is onduty and is consulted by acolleague’s patient. The GPsadditionally take part in theCounty of Funen telederma-tology service.

21 Cooperation between general practice and hospital

ral practitioner to go on homevisits with a digital camera whenthe patient returns home fromthe hospital. Photographs candemonstrate where there is aneed for improvements of theequipment of the home.

Technical solutionUse of existing systems and linkto the Health Data Network. TheP-EPJ system, which extractsrecord data at personal identitynumber level from medical recordsystems, has been developed forthe project.

Project description

FinanceThere has been limited financialinvestments in the form of pur-chases of digital cameras andimage modules for recordsystems. In addition resources arespent in setting-up and defini-tions of access conditions insystems and networks. Develop-ment of the extracting system P-EPJ is funded by the suppliers ofGPs’ systems and the Danish Cen-tre for Health Telematics. Thereare no expenses associated withthe operation of the extractingsystem in the project period.

Videoconferencing in the Depart-ment of Orthopaedic Surgery

The aim of this project hasbeen to support an organisa-tional merger of the twodepartments of orthopaedicsurgery. The departments,located in Middelfart andOdense, have a total of 427employees. In practice theproject is concerned withpromoting interdisciplinaryinformation and planningbetween the department’stwo sites using videoconfe-rencing. In addition, the de-partment’s doctors will haveaccess to X-ray consultation.

The overall aim of thevideoconferences is to pro-mote the process of integra-tion by creating a visual com-munication environment.The employees should experi-ence that they are a singleforum, despite being in diffe-rent places. The conferences

are intended to ensure thedaily organisation of workand the coordination of func-tions and at the same timeassist in clarifying difficultpatient cases.

The solution also makesprovision for remote instruc-tion using a double monitor,so that the participants gainthe perception of a common

forum and on the secondmonitor can, for example,follow a PowerPoint slideshow or other digitised infor-mation. External communi-cation to accomplish nationaland regional functions canalso take place via videocon-ferencing.

The project was launchedin May 2006.

22 Orthopaedic surgery

solution serves as a managementtool for more effective planningand better distribution of tasksand application of resources. Thedepartment additionally savestime and resources in travelbetween the sites.

The department has investedin a number of interactive CDinstruction programmes to sup-plement internal training.

OutlookMotivation and time are requiredto familiarise all staff groups withthe technology.

The solution can usefully beextended, not just to orthopaedic

surgery but to all functions thatare separated physically and thatare to fulfil one function withinterdisciplinary planning. Aboveall it is appropriate to have pro-fessional meetings for specialistsin the region.

Technical solutionConference rooms have been setup in Odense and Middelfart,both equipped with two largeflat-screen monitors. In Odense aprojector has additionally beenconnected to the equipment. Theother equipment is standardvideoconferencing equipment linked together via the County ofFunen network.

FinanceThe investment in the combinedequipment, including installation,implementation and support,amounts to around DKK 250,000.

Project description

ExperiencesThe department holds morningconferences daily and heads ofdepartment meetings weeklyusing videoconferencing. In addi-tion, meetings between consul-tant doctors, staff group meet-ings and specialist meetings areheld by videoconferencing. The

Using two flat-screen monitorsand a web camera, staff in theDepartment of Orthopaedic Surgery in Middelfart can holdvirtual meetings with their collea-gues in Odense.

Useful management instrument

The Department of Orthopaedic Surgery ofOdense University Hospital has good experi-ences using videoconferences. The departmentis physically divided with a third of the staff inMiddelfart and the remainder in Odense.

“With the establishment of one depart-ment covering two sites, the need for aninstrument for internal coordination and plan-ning arose. Videoconferencing equipment wasan appropriate tool to use, and it could alsohelp to support the formation of a new com-mon culture,” Hans Ri Jørgensen, a consul-tant in the Department of Orthopaedic Surge-ry in Middelfart, explains.

Two large flat screens and a video camerawere installed in special conference rooms atthe two hospitals. In Odense a projector hasadditionally been connected to the equipment.Every morning the monitors and cameras areswitched on in Middelfart and Odense whenthe department has a joint conference. InOdense 40 staff members typically take partand in Middelfart 16.

“The conferences follow a fixed structure,in which the department management provides guidance on all conditions and onplanning. We also exchange information forexample on excess occupancy and transfer of patients, so that we make the best possible useof capacity,” says Jørgensen.

“We’re still experiencing some technicalproblems, with the sound coming in bursts.The participants in the meeting need to becareful not to interrupt one another.”

There is a meeting between heads ofdepartment every Tuesday. Here, too, the formof meeting is firmly structured with discus-sions of such things as coordination and workarrangement. Every other Wednesday it is theconsultant doctors who gather in the video-conference room.

“In fact all staff groups can book the confe-rence room for staff meetings. The secretariesin particular are very adept at using the digitalmeeting forum,” says Jørgensen. “A great ad-vantage is that we save time and resources intravelling between Odense and Middelfart.We can spend that time on other tasks and inso doing gain more quality in our work.”

Digital specialised meetings and instruction While it has been relatively simple to imple-ment the electronic form of communicationin connection with organisational meetings,the challenges are slightly greater with regardto specialist meetings and instruction.

“Every Wednesday we have an opportunityfor an instructional conference by video, butwe could make even better use of the electro-nic form of communication in specialist con-texts,” Jørgensen feels.

“For instance, doctors could view recor-dings of operations for use in discussion andexchange of experience to an even greaterextent.”

Some groups of healthcare professionals arestill hesitant to use videoconferencing. Thismay possibly be due to the fact that these groups have never been affected by the pro-blem of having to travel between the two sites.

“To a large extent it’s a matter of cultureand getting used to the idea,” says Jørgensen.

“The best way of motivating staff is simplyto use the technology during the regular orga-nisational meetings, so that everyone graduallybecomes familiar with the medium.

All in all, I consider that the time is rightfor extending the use of videoconferencing.Many hospitals have departments dividedbetween two sites. This will also be a practicalmeeting policy in many contexts in the newregions.”

Hans Ri Jørgensen, consultant doctor in the Depart-ment of Orthopaedic Surgery, Middelfart.

23 Orthopaedic surgery

Interview

Videoconferen-cing is a brilliantmanagement toolwhen two hospi-tal departmentsat different sitesmerge into one.

Videoconferencing in general practice

This project is a furtherdevelopment of the HealthOptimum project (see page26) with the aim of optimis-ing the treatment of endo-crinology patients.

In connection with theproject teleconsultations areinitially conducted between ageneral practitioner and theMedical Department onFunen Hospital. The consul-tations take place once amonth and may relate to alltypes of endocrinology patients, for example patientswith diabetes, hirsutism (in-creased hair growth), osteo-

OutlookThe project has not yet been putinto operation due to technicaldifficulties in establishing video-conferencing at GP practices.

No special agreements havebeen made on fees in connectionwith the arrangement, but theproject is carried out on the basisof interest and goodwill on thepart of those involved.

It is a requirement that GPpractices that join the arrange-ment in the future will have tosend data to FDDB (Funen Dia-betes Data Base).

Technical solutionStandard videoconferencing set-up at the GP practice and use ofexisting equipment at FunenHospital Svendborg. A reliable

network connection has beenestablished via the Health DataNetwork.

FinanceVideo equipment in GP practiceshas been purchased for aroundDKK 30,000. In addition there isthe connection to the HealthData Network.

porosis (brittle-bone disease)and thyroid disease (a meta-bolic disease). One of theaims may be to obtain asecond opinion and to conferon transfer of type 2 diabetespatients from hospital to continued checks by generalpractitioners.

The project does not haveany organisational consequ-ences. There may, however,be a need for a nurse at thegeneral practice, to assist withthe arrangement.

It is anticipated that thearrangement will optimisepatient treatment, for exam-ple because more patients canbe treated exclusively in theprimary healthcare sector,

and because outpatientchecks and travel to FunenHospital Svendborg are avoided.

24 Videoconferencing in general practice

Project description

Brigitte Lund, GP in Vindeby, Tåsinge, has the telemedicine equipment ready for videoconferences with theMedical Department of Funen Hospital.

COPD-Funen

The aim of the project is tocarry out a scientific compa-rison of two different modelsfor early discharge of patientswho are suffering fromCOPD, Chronic ObstructivePulmonary Disease. Onemodel is known as a “followme home-scheme”, where alung disease nurse accompa-nies the patient to his or herhome after discharge andmonitors the patient closelyfor around 14 days.

In the other model, the patient is given a “briefcase”to take home, containing acomputer, measuring equip-ment and communication

OutlookPilot trials of the two models willtake place in the spring of 2007,and, following from that, theactual project will be launched.

It is planned that the projectwill cover 100–150 patients. Thepatients take part in the projectfor two weeks, followed by athree-month follow-up after discharge. It is anticipated that around 25% of COPD patients inthe Medical Department will besuitable to take part.

It is important that the patientfeels secure with the arrange-ment so that re-admission is avoi-

connection to the hospital.The idea is that patients willperform measurements them-selves and communicate withthe hospital using the tele-medicine equipment.

The primary aim of theproject is to improve qualityfrom the patient’s point ofview. The comparison is therefore going to provide abasis for evaluating how satis-fied the patients are with thetwo arrangements. The pro-ject is also intended to showwhether there is a differencebetween the two models inthe number of re-admissions,and how frequently the patients are in contact withthe hospital department orgeneral practitioner.

The project is based at theMedical Department ofFunen Hospital, where a full-time project nurse has beenappointed to manage theproject. The project will bethe local Danish part of anEU project, “Better Breath-ing”, which is supported byeTEN.

25 COPD-Funen

ded as far as possible, and moni-toring of the patient is an essen-tial element of both models. Thehospital is setting up a hotline onwhich patients in both arrange-ments can obtain expert help.

It is estimated that there are250–300,000 patients with COPDin Denmark, and around 20% ofall admissions to medical depart-ments are COPD patients. Thenumber of patients is expected torise considerably over the nextfew years. The expectation forthe project is that COPD patientswho are admitted in their ownhomes will save up to 15–20 daysof admissions to hospital eachyear.

Technical solutionThe equipment the patient willbe using at home has to be sim-ple to apply and must be possibleto operate following a briefinstruction and testing. Anotherrequirement for the equipment isthat it can be set up and operatewith 1–2 hours’ warning. It mustbe independent of cables, andhigh data security is required.The idea is that the equipment iscontained in a “briefcase” for

satellite-based communicationwith a monitor, camera andmicrophone for videoconferen-cing, a spirometer to test lungfunction and a pulse oximeter totest oxygen saturation.

The project will run as a closed system. Later on it is in-tended that the system will beintegrated with EPR, so that measured data are automaticallytransferred to the patient’srecord.

FinanceThe price of the equipment hasnot yet been fixed.

Project description

Health Optimum

The aim of the project is toensure the best possible quali-ty of treatment for the popu-lation of Aeroe by givingthem direct contact with spe-cialists from Funen HospitalSvendborg and thus savingthem a trip to Svendborg.The project has covered twoareas of medicine, cardiologyand diabetes.

Health Optimum is aneTEN project supported bythe European Commissionand is taking place in closecooperation between partnersfrom the Veneto region inItaly, the Aragon region inSpain and the County ofFunen in Denmark. The

ExperiencesAll the parties involved evaluatethe clinical effectiveness of thetelemedicine investigation andcheck-up to be just as good aswhen the patient travels to thehospital to consult the specialist.Both telemedicine solutions arenow in everyday use.

According to the general prac-titioners on the island of Aeroe,many of the patients would nothave been examined by a specia-list without the telemedicine facility. In other words, morepatients are being examined at a

Danish part of the project isbased at the Medical Depart-ment of Funen Hospital.

A specially trained cardiacnurse takes the ferry fromSvendborg to Aeroeskoebingonce a fortnight. She brings aportable ultrasound scanner,which is used for examiningpatients at Funen HospitalAeroeskoebing. The imagesare assessed by a heart specia-list, who is in Svendborg, andhe is in dialogue with the nurse and patient via video-conferencing equipment.

Similarly, a diabetes nursetravels to Aeroeskoebing oncea fortnight to measure pati-ents’ blood pressure, bloodsugar and BMI (Body MassIndex) and to assess circula-tion and sensitivity in the feet.

The diabetes specialist inSvendborg follows the exami-nation on-line and is able tomake a diagnosis, commencetreatment and prescribemedication. From his or heroffice, the doctor can evenzoom in on foot wounds,changes in the patient’s eyesetc.

26 Health Optimum

higher professional level. Theimprovements thus entail a signi-ficant rise in the quality of treat-ment.

OutlookThe greatest challenges in theproject have been the culturalchanges associated with the factthat healthcare personnel haveto get used to new working methods and ways of thinking.

Undoubtedly, the telemedicinetools can be used in other areasof medicine, and the MedicalDepartment of Funen Hospital

already has several projects readyfor trial in early 2007.

Technical solutionA portable GE ultrasound scanneris used for the telecardiologysolution. In addition there isvideoconferencing equipment atFunen Hospital Aeroeskoebingand Funen Hospital Svendborg.The heart specialist has twomonitors, so that he can assessthe examination images and atthe same time have a video image and audio communicationwith the patient and nurse.

Existing videoconferencingequipment at Funen HospitalAeroeskoebing and at the dia-betes specialist at Funen HospitalSvendborg are used in connectionwith the telediabetes solution.

Both solutions use the countynetwork.

FinanceFunen Hospital has purchased theultrasound equipment with pro-ject support from the EU. Thehospital already had the video-conferencing equipment.

Project description

Kenneth Egstrup, aconsultant doctor inthe Medical Depart-ment, Funen Hospi-tal, assesses ultra-sound scans from hisoffice in Svendborg,while the cardiac nurse carries out the examination on Aeroe.

27 Health Optimum

Better quality for the patients

“The reason why these particular telemedicineprojects were chosen was that we had to choose areas with just the right volume interms of the number of patients. That’s vitallyimportant if the staff are to become familiarwith the technology,” says senior consultantdoctor Michael Hansen-Nord from the Medi-cal Department, Funen Hospital.

Good results“Our experience with telemedicine has beenvery positive. Above all it has given a substan-tial improvement in the quality of treatment,because otherwise some patients would neverget to see a specialist. And from the point ofview of all the patients involved, they havesaved a lot of travel time.

The nurses have become considerably moreprominent and assist in ensuring better initialassessment of the patients. In the area of cardi-ology, for example, the nurses can examinepatients with suspected heart problems refer-red by their own GPs and in many cases makethe diagnosis.

“The nurse can sift out those patients whoare in good health and make sure that the restreceive treatment,” Hansen-Nord explains.

“The doctor becomes involved to the ex-tent that the nurse finds a need for a specialistassessment. In many cases the doctor’s assess-ment can be made using videoconferencingequipment. Only in a few cases the patientneeds to travel to Svendborg for a personalconsultation.”

Shift in tasks Telemedicine services have thus greatly expan-ded the set of tasks accomplished by nurses,while doctors are able to spend more time onthings for which they are particularly quali-fied. The outcome is better utilisation of re-sources.

“The greatest challenge was that staff andpatients had to get used to communicatingthrough the videoconferencing equipment.The change-over was quite painless, becauseboth parties were quickly able to see the bene-fits. Any scepticism patients might have tendsto disappear after the first consultation, and,

by far, the majority are in favour of continu-ing their treatment in this way,” says Hansen-Nord.

“It is also found that the diagnostics is justas good as in traditional examinations. Andpatients on the island of Aeroe have reachedthe national level with regard to the numberof heart scans.”

From project to operationToday both telecardiography and telediabetesare part of daily operation in the MedicalDepartment. And if it was up to Hansen-Nord, the solution would also be extended.

“We would like, for example, to be able tosend a specially trained nurse with a heartscanner to the new municipal healthcare cen-tres or large medical centres. We would alsolike to be able to extend videoconferencing toother medical areas such as lung diseases andmetabolic diseases.

The international dimension has been particularly significant for the project work,”Hansen-Nord emphasises.

“We’ve been pleased with the internationalcooperation with Italian and Spanish partnerswho have been working on equivalent tele-medicine projects. At conferences we’ve hadan opportunity to discuss solutions and talkabout the difficulties we’ve encountered alongthe way.”

Michael Hansen-Nord, senior consultant, Medical Department, Funen Hospital.

Interview

A handful of enthusiasts in theMedical Depart-ment of FunenHospital Svend-borg, a portableultrasound scan-ner and videocon-ferencing equip-ment are themain ingredientsin the two Danishsub-projects inHealth Optimum.

Denmark Lithuania

Estonia

Tallinn

VilniusSvendborg

Baltic eHealth – teleradiology

OutlookIf the project fulfils the expecta-tions, it will be possible to ex-pand and broaden internationalcooperation in this area. It will bepossible to outsource examina-tions across borders, for examplein the case of basic examinations,examinations for which there islimited expertise at one of theparties, or where one of the part-ners has special expertise. Theexpectation is that the projectcould, in particular, have favour-able consequences for hospitalsin fringe areas, which do nothave sufficient capacity in all areas, and which perhaps alsofind it difficult to attract thenecessary workforce.

From the patient’s point ofview, cooperation of this typewill help ensure that there isequal access to high-quality servi-ces wherever they live within theEU.

Technical solutionThe healthcare data networks inthe countries are linked, so thatit is possible to exchange infor-mation across borders.

level in order to raise qualityin areas for regional develop-ment. It will be possible tooutsource tasks to other hos-pitals, for example, becausethere is a need for specialexpertise, or because it isnecessary to have basic taskssolved elsewhere in order tofree one’s own specialists.

Baltic eHealth is a coope-rative project between Den-mark, Sweden and Norwayand two hospitals in Estoniaand Lithuania. As part of theproject, the Danish Centre for Health Telematics in Denmark, Carelink in Swedenand the Norwegian Centre for Informatics in Health andSocial Care (KITH) haveexpanded their cooperation

and created the basis for theIT infrastructure that linksthe healthcare networks ofthe three countries. A linkhas also been established withthe regional networks inEstonia and Lithuania.

Funen Hospital, represen-ted by the Department ofImaging Diagnostics, is theDanish participant. As partof the project X-ray imagesfrom Funen Hospital Svend-borg will be sent for routineassessment and description tohospitals in Tallinn (Estonia)and Vilnius (Lithuania).

A pilot project will be carried out at the end of2006 with around 50 radio-logical examinations.

28 Baltic eHealth

will instead be sent, for the timebeing, as attachments to DICOMStructured Reporting.

FinanceThe project is being carried outwith support from the Baltic SeaRegion Interreg IIIB programmein the EU.

Project description

Teleradiology can be used bothto obtain expert assessments andto outsource basic tasks.

The aim is to introduce anddevelop electronic healthcareservices at an international

Images are sent from Svend-borg using a mini PACS system. InTallinn the images are received ina national PACS system. In Vilniusthe university hospital uses a RIS/PACS system, which has been de-veloped at the hospital.

The intention was to send theimages using streaming techno-logy, where the image is not sentphysically, only the information.However, streaming has neverworked satisfactorily. The images

Outsourcing of tasks

“We have great expectations for the BalticeHealth-project,” says Leslie Christensen, consultant doctor in the Department of Imaging Diagnostics at Funen HospitalSvendborg.

“The idea is perfectly logical, because inessence it’s simply a matter of making certainservices available across geographical distances.We are accustomed to having doctors appoin-ted from many different countries: Iran, Iraq,Venezuela, Hungary, Poland. They work inthe department on an equal footing with therest of the staff. The situation in principle isthe same when we use teleradiology. It’s justthat the doctor is somewhere else.”

Special tasks and basic tasks “The original approach in the project was thatwe wanted to use teleradiology to obtain spe-cialist knowledge from experts abroad. Wewanted to be able to send images and get anexternal assessment from a specialist, regardlessof whether he or she is in Copenhagen,Malmö or Tallinn. That option is still relevant,but the focus now is on using the technique tooutsource tasks. It may be basic tasks that weoutsource, either because we lack resourcesourselves or because we would like to give ourown doctors better ways of ensuring their pro-fessional development in other more know-ledge-heavy areas,” says Christensen.

“I think it’s a good and correct way of looking at telemedicine, but at the same timewe’re aware that it’s a balancing act when wechoose to outsource tasks. If we outsource toomuch, it may be at the cost of our local exper-tise, and we obviously don’t want that.”

Mental adjustment “The greatest barrier in a project like this isprobably the need to get used to the idea thatdoctors in another country solve some of ourtasks. There are some cultural differences totake account of and perhaps some prejudicestoo. As part of the preparations for the projectwe’ve been visited by the doctors from Estoniaand Lithuania who are taking part in the pro-ject, and we’ve had a chance to compare thequality of our work. The result is quite clear,

there are no quality differences. Then there isthe cultural adjustment, but as I’ve mention-ed, we’re used to having doctors of many dif-ferent nationalities, so it should be possible todeal with that aspect too.

The only condition on our side is that co-operation in telemedicine must not entailcommunication problems, so it’s important inthis context that our cooperating partner has asecretary who speaks Danish and knows theappropriate terminology.

We believe in the project,” Christensenemphasises.

“Right now we’re waiting for the pilot test.When it’s been carried out with satisfactoryresults, I anticipate that we’ll be able to con-tinue with the cooperation, initially under atwo-year contact.”

Leslie Christensen, consultant, Department of Imaging Diagnostics, Funen Hospital Svendborg.

29 Baltic eHealth

Interview

The Departmentof Imaging Diag-nostics in Svend-borg actuallyviewed teleradio-logy primarily asa way of obtai-ning specialistknowledge, butnow the focus isjust as much onoutsourcing basictasks.

Telepsychiatry

The project will examinewhether it is appropriate touse telepsychiatric treatmentbased on videoconferencing.The idea is that the telemedi-cine solution will reduce theneed for psychiatrists totravel between different con-sultations and thus makemore time available for treat-ment. The solution is also in-tended to improve the treat-

ExperiencesThe project was launched at theend of October 2006, and the first telepsychiatry sessions havetaken place, with the expectedpositive results. Experiences fromelsewhere also indicate that thequality of the therapy sessions isjust as good as when the psychia-trist and patient are in the sameroom. The patients have no pro-blems accepting the technology,and the psychiatrists get used tothe new way of having therapysessions relatively quickly. In addi-tion, the psychiatrists save travel-ling time and expenses.

The diagnostic quality of sessions in foreign languages isjudged to be good, and morethan 90% of this group of pati-ents prefer therapy sessions intheir mother tongue. The advan-tages clearly exceeds the alterna-tive, where a Danish-speakingpsychiatrist uses an interpreter,because it is difficult for thepsychiatrist to diagnose and treatpatients with a substantially dif-ferent cultural background. Aswell as improved quality of treat-ment for refugees and immi-grants, the scheme also meanslower expenditure on interpre-ters and travelling.

OutlookThe head of Department P antici-pates a favourable outcome fromthe project and that telepsychia-try will quickly become routine

ment of refugees and immi-grants. Telemedicine willmake it easier for these patients to be treated by apsychiatrist who speaks theirmother tongue.

The project is based in theDepartment of Psychiatry ofFunen Hospital Svendborg,which attend to the psychia-tric patients admitted to Fu-nen Hospital Aeroeskoebingand to supervision underdistrict psychiatry in theMunicipality of Aeroe, with

premises at Funen HospitalAeroeskoebing.

A videoconferencing roomhas been set up in the Depart-ment of Psychiatry in Svend-borg and at Funen HospitalAeroeskoebing the staff usevideoconferencing equipmentthat already existed.

Patients with a differentethnic background can receivetele-therapy in their mothertongue from psychiatry spe-cialist Davor Mucic at Psychi-atric Centre Little Prince.

30 Telepsychiatry

Svendborg, Funen Hospital Aeroeskoebing via the County ofFunen data network. It is alsopossible to make calls to IPaddresses outside the County ofFunen data network in connec-tion with consultations and treat-ment in other languages with thespecialist Davor Mucic.

FinanceThe cost of acquiring videocon-ferencing equipment for the department at Funen HospitalSvendborg totals around DKK75,000. Funen Hospital Aeroes-koebing uses facilities that werealready installed.

Project description

Secretary Karen Bentzen demonstrates the videoconferencing equip-ment.

practice. It is also anticipated thatit will be possible for the techno-logy to be extended even furtherin the future. Consideration isgiven, for example, to installingvideoconferencing equipment indistrict psychiatry, initially in Faa-borg, Broby and Assens. It is alsothought that in special cases thepsychiatrists might be able to usethis solution to obtain a secondopinion, for example fromCopenhagen University Hospital.

Technical solutionStandard videoconferencing solu-tion between the Department ofPsychiatry at Funen Hospital

Cooperation and success

Funen success

Project results and experiences are described on the preceding pages. The projects offermany different prospects. Cooperation acrossthe sector boundaries is greatly increased, and better use can be made of specialists. Patientscan be treated earlier and can also gain accessto specialist assessments to a greater extent etc.In other words, the projects offer greateropportunities for positive effects, greater efficiency and savings.

An important lesson learnt from the projects isthat the use of telemedicine demands a willing-ness for change, particularly among the staff. It requires conscious and active management,for example in situations where telemedicineinvolves a transfer of tasks from one group ofstaff to another. Support from the managementis essential. The projects that have yielded thebest results have received both support andpressure from the management and, at thesame time, initiatives from the bottom of thehierarchy has been welcomed.

Good cooperation

There have been many close cooperative rela-tionships in connection with the projects –within the County of Funen, in the Region ofSouthern Denmark, national centres of excel-lence, clinical societies and international part-ners, including WHO, the Norwegian Centrefor Telemedicine in Tromsø, the InternationalSociety for Telemedicine and eHealth and theNordic Telemedicine Association. A number of IT companies have also taken part in thecooperation. And it has worked satisfactorily atall levels.

For most of the parties involved, the tele-medicine projects have been extra tasks in analready busy everyday situation. It is judged tobe very significant that responsibility for co-ordination has been placed in an independentproject organisation.

As a spin-off from two specific Funen projects,cooperation agreements have been made withexternal suppliers on joint product develop-ment and payment of royalties in connection

31 Needs and opportunities

with sale of the developed product to others.One project is “Telemedicine in the therapydepartment”, in which the Therapy Depart-ment of Funen Hospital has assisted in thedevelopment of a “smart exercise mat” together with the Danish Centre for HealthTelematics. The external partners are theMærsk McKinney Møller Institute at the Uni-versity of Southern Denmark and the compa-ny Entertainment Robotics. The other projectis COPD-Funen, in which the MedicalDepartment of Funen Hospital, the DanishCentre for Health Telematics and the compa-ny of GITS are developing and testing a “briefcase” containing communication andmedical equipment to be used by COPD patients who are discharged early.

International success

Ten international projects have been comple-ted, four are in progress, and applications forfour new projects have been approved. TheCounty of Funen, together with the DanishCentre for Health Telematics, is consequentlyone of the leading players in European tele-medicine projects. At the same time, the acti-vities mean that the Region of Southern Den-mark and the centre form part of a strength-ened network and practical cooperation withother regions in the area. In addition, strategiccooperation relationships are being developedwith the most significant industrial partners inhealthcare IT.

32 Potential and outlook

Potential and outlook

The use of telemedicine in the Danish health-care system is still in an introductory andtesting phase. Many of the obvious ways ofusing it that are emerging have therefore beenexploited for the first time in connection withthe projects described in this brochure.

It is nevertheless characteristic that some ofthe telemedicine solutions included in theprojects have already entered general opera-tion, or will be doing so very soon. The ad-vantages are so evident that there is not muchto be concerned about. The technique isneither complicated nor costly. It is oftenfound that it is mainly barriers in relation totraditions, organisation and culture that haveto be overcome.

In other areas, however, there are still techni-cal challenges to be faced before it will be possible to make full use of telemedicine. Thisapplies for example to integration with ITsystems and other information and communi-cation technology solutions in the organisa-tions that are due to take part in cooperation.Here too, however, favourable experience hasbeen gained during the projects.

Overall the projects provide a good picture ofthe potential and outlook for the use, develop-ment and expansion of telemedicine.

Telemedicine on a large scale

The projects demonstrate that it is possible toattain good effects, efficiency improvementsand savings. It is important that this becomeswidely known in the healthcare sector, andthat initiatives are taken for solutions on a large scale at local, regional and national level.This will mean that telemedicine becomes fully effective.

Increased cooperation across sector boundaries

Telemedicine can greatly assist in increasedcooperation across sector boundaries. Generalpractitioners can consult specialists and specialcentres. Specialists in private practice can con-sult specialists in hospitals. Hospitals whichprincipally fulfil basic tasks can consult hospi-tals with national or regional specialisms. Tele-medicine also provides opportunities for ex-panded cooperation between the healthcaresector and home care, all with a view to im-proving quality and optimising the treatmentof patients.

Decentralisation and centralisation

Most patients do not need highly specialisttreatment, or only need it to a limited extent.They therefore do not need to be transportedover long distances if they can attend thenecessary consultations near home or if theirlocal contact with the healthcare system canobtain advice at the right place. In otherwords, there is a need for a combination of adecentralised and centralised structure, in which telemedicine ensures that the decentra-

33 Potential and outlook

lised functions have access to consultation,advice, quality development etc.

New views of procedures and shift of skills

Optimum use of telemedicine very oftennecessitates adapting the distribution of tasksand arrangement of work. It is important todevelop a culture where there is a willingnessto embrace change, where it is not just theones who are given new tasks who are pre-pared for change. The ones who are to give uptasks must also be able to see the gain. Experi-ence from the projects shows clearly that it isamong healthcare personnel that attitudeshave to change – patients are ready for thenew situation.

Better use of specialists

There is great potential in telemedicine in anincreased proportion of the population recei-ving more advanced healthcare, as there iseasier access to specialists regardless of wherethe patient lives. At the same time it is possi-ble for the time of specialists to be focused onthe patients who really need it. One exampleis the situation where a specially trained nursein the outpatients department of the hospitalscans the patient and depending on needinvolves the specialist. Experience also shows

that in connection with telecardiology the car-diologist spends a maximum of 10 minutes ona consultation, while the time spent on anoutpatient consultation typically is around 30minutes. The assessment made on the basis ofthe project is that clinical effectiveness in tele-cardiology is just as good as when the patientconsults the specialist personally.

Distance is relative

There is often a tendency to view telemedicineas an aid used over long distances. In manycases healthcare professionals will, however, beable to use telemedicine internally betweendepartments in the hospital and within theindividual department to great advantage.

In the patient’s own home

Society is currently undergoing developmentin the direction of an ageing population thatdemands more treatment and towards therebeing fewer people of working age fromwhom to recruit healthcare professionals. Thisentails a great need for solutions under whichmore patients can help themselves and thatenable them to be diagnosed, treated andmonitored in their own homes. Telemedicinehas much to offer in this context.

Greater patient satisfaction

Telemedicine makes treatment more readilyavailable to patients. It can be said that thehealthcare system comes to the patient, ratherthan the other way round. This successfully

34 Potential and outlook

meets the political objective that all patientsmust have equal access to high-quality treat-ment and a specialist when and where theyneed one.

Early treatment, continued treatment

Decentralisation of particular treatment opti-ons in many situations makes it easier to bringpatients into treatment earlier and keep themin treatment. Tele-alcohol abuse therapy is agood example. Some patients start on the therapy while they are hospitalised for asomatic illness. Others say yes to the offeredtherapy because they can receive it withouthaving to make several long journeys.

Contact network and international projects

Being involved in telemedicine projects inmany cases entails that the individual functionis given a high profile in meetings, congressesand visits. This applies particularly in interna-tional projects. An important incidental gainin this context is many new contacts, inspira-tion and motivation to continue with thework of developing and improving tele-medicine solutions and thus the range of treat-ments offered by the function.

National index

In some contexts it is easy to imagine archivesbeing built up of test and examination resultsat regional, national or international level andthese archives being available on-line. Oneexample might be an index or archive of allradiological examinations in the form of ima-ges and descriptions, which can be accessedvia the public healthcare portal Sundhed.dk.

Outlook for the individual projects

● Experience is so good that the greatest challenge now is to ensure a general dissemination.

● This form of alcohol abuse therapy can alsobe used in general practice, in social servi-ces, at large workplaces, on ships, on dril-ling platforms, in prisons and in patients’ homes using a secure Internet solution anda web camera.

● Another area of use is Internet chat-rooms,where young people can receive advice anonymously.

● Extension of a similar solution to other areas – dietary advice from a dietician, treatment for abuse for example of narcoticsubstances, treatment of social phobias etc.

35 Potential and outlook

Tele-alcohol abuse therapy

Teleradiology

CAG cooperation

Tele-wound assessment

IT in paediatrichome care

Videoconferen-cing in hospitaldepartment

Telecardiologyand telediabetes

● The solution can be directly extended to allhospitals in the Region of Southern Den-mark.

● The solution can also be immediatelyextended to departments that need to out-source basic tasks to other departments in

Denmark and abroad, or which need a spe-cial opinion from particular specialists inthe specific area.

● In addition, the solution can be used totransfer images of elective patients and out-patients.

● The solution can be immediately extendedto all hospitals in the Region of SouthernDenmark.

● The solution can be directly extended toother hospitals in the region and can alsobe used by nurses who work in the homesof patients.

● In the slightly longer term, and with exten-ded technical capabilities, it will be possiblefor videoconferencing to be establishedfrom the homes of sick children to specia-lists at the hospital.

● The solution with videoconferencing between several wards in the same depart-ment can be directly extended to otherfunctions that are physically separated.

● Possibility of adding mobile phone withcamera between first and second on-calldoctor and duty period reporting to morning conference via the videoconferen-cing system.

● The solution can be directly extended toother departments where there is a need tocarry out consultations and check-upsremotely.

● The solution can be extended to covergeneral practice and hospitals, hospitaldepartments across geographical distancesetc.

● The solution should be extended to alsosupport cooperation with municipal homecare.

Telemedicin

December 2005

- et vigtigt værktøj for fremtidens

sundhedssektor

Telemedicin

Center for Sundheds-telematik

Specialisering, effektivisering og kvalitetssikring er centrale nøgleord i en sundhedssektor under hastig forandring. Telemedicin rummer store muligheder for at understøtte denne udvikling.

Passing on knowledge

In addition to the specific telemedicine pro-jects, the Danish Centre for Health Telematicsconducts a whole series of activities to extendknowledge of technologies and opportunitiesin telemedicine. The activities comprise trai-ning, holding of and participation in confe-rences and the issuing of publications, brochu-res and articles. The Centre has additionallyestablished relations with the business com-munity and cooperates with national andinternational players.

Training activities

The Danish Centre for Health Telematicsoffers a photography course in teledermato-logy and tele-wound assessment to medical specialists and GPs. In this connection aninstruction CD-ROM has been prepared withdetailed instructions on how to take derma-tology photographs. In cooperation with theNorwegian Centre for Telemedicine, theDanish Centre for Health Telematics alsoholds videoconferencing courses.

Conferences

The Danish Centre for Health Telematicsregularly attends conferences on telemedicineto present projects and technologies andgather professional inspiration. The Centrehas, for example, taken part in or arranged thefollowing conferences:

Telemedicine themed day, February 2004Arranged by the Danish Centre for HealthTelematics as a launch-pad for the Funen tele-medicine initiative.

36 Other telemedicine activities

Årsmøde i Dansk Selskab for Klinisk Telemedicin

Telemedicin-globale mulighederog status iDanmarkFredag den 16. december 2005 kl. 8.30–15.30 på Radisson SAS H.C. Andersen Hotel, Claus Bergs Gade 7, 5000 Odense C

Dagens program:

08.30–09.00: Registrering og morgenkaffe

09.00–09.30: Kulturel morgenvækning med relation til H.C. Andersen

09.30–09.45: Velkomst og dagens program v/ Lars Hulbæk, projektleder, Centerfor Sundheds-telematik

09.45–10.15: Status på telemedicin i Danmark v/ Ole Winding, dr.med., formand forDansk Selskab for Klinisk Telemedicin

10.15–11.00: Telemedicin i det internationale kriseberedskab v/ Steffen Groth,WHO

11.00–11.45: Kaffepause i udstillingsområdet

11.45–12.15: Nordisk Råd satser på telemedicin v/ Kontorchef Arne Kverneland,Sundhedsstyrelsen

12.15–13.15: Det virtuelle Hospital: TeleKOL-projektet v/ speciallæge KlausPhanareth

13.15–14.00: Frokost

14.00–14.30: Giv de nye regioner telemedicin v/ Peder Jest, Cheflæge Sygehus Fyn

14.30–15.15: Connecting health v/ Kevin Dean,Cisco Systems

15.15–15.30: Afslutning v/ Ole Winding, dr.med.,formand for Dansk Selskab forKlinisk Telemedicin

Dansk Selskab for Klinisk Telemedicin og Center for Sundheds-telematik, Fyns Amt, inviterer til temadag om telemedicin. Temadagen vil berøre telemedicinens mange muligheder for at understøtte det kliniske arbejde på globalt, nordisk, nationalt og regionalt niveau – eller for den sags skyld hjemme fra patientens dagligstue.

DeltagergebyrKr. 200,- for medlemmer af Dansk Selskab for Klinisk Telemedicin (DSKT).Kr. 500,- for øvrige (inkl. medlemskab af DSKT i 2006, hvis ønsket).

TilmeldingVedlagte tilmeldingsblanket findes også på www.cfst.dk og www.dskt.dk, eller kontakt CFST@health-telematics.dk

Telemedicine – global opportunities and status in Denmark, December 2005Conference arranged in cooperation betweenthe Danish Society for Clinical Telemedicineand the Danish Centre for Health Telematics.

TTeC, Tromsø Telemedicine and eHealthConference, June 2006The Danish Centre for Health Telematics wasresponsible for the practical arrangements forparticipants from the County of Funen. Incooperation with the Norwegian Centre forTelemedicine, the centre also arranged aDanish-Norwegian workshop on public use of the Internet in connection with healthcareservices.

Telemedicine without frontiers, December 2006Conference arranged in cooperation betweenthe Danish Society for Clinical Telemedicineand the Danish Centre for Health Telematics.

Publications, brochures and articles

The Danish Centre for Health Telematics has issued a number of publications, articles andbrochures on telemedicine. For example:

Notes on general organisational conditions in the use of telemedicineDrawn up by Peder Jest, medical director,Funen Hospital, and Lars Hulbæk, DanishCentre for Health Telematics, in November2005.

Telemedicine – an important tool for the future healthcare sectorPublished December 2005.

Patient data migrate securely from hospitalto hospitalArticle on the Health Data Network and tele-medicine in Computerworld, CIO, no. 3April 2006.

Telemedicine and the Health Data Network Article in Medicinsk Teknologi no. 3, 2004.

How to take a good digital photograph in 2 minutesGuidance on CD-ROM.

The good teledermatology consultationPublished July 2003.

Partners in cooperation

Business relations

The Danish Centre for Health Telematics has taken various initiatives to involve IT companies in the development of telemedicine. The Centre has also entered into cooperation agreementswith a number of Funen IT suppliers on product and IT development in connection with theimplementation of the telemedicine projects. The IT companies are Team-Online, Digi-Eyes,Munk IT, Robotics Entertainment and Global IT Systems.

Partners in cooperation

The Danish Centre for Health Telematics cooperates with both national and internationalorganisations on the development and implementation of telemedicine. The principal organisa-tions concerned are:

Nordic Council – Nordic Telemedicine Cooperation Forum set up on the initiative of the Nordic Council of Ministers. The aim of the forum is to contribute to the development andincreased use of telemedicine in the Nordic countries. The Danish Centre for Health Telematicshas been designated by the Danish Board of Health as the Danish representative.

NTA – Nordic Telemedicine Association. This organisation focuses on Nordic exchange ofknowledge and experience and arranges a Nordic Telemedicine Congress once every two years.The Danish Centre for Health Telematics is represented on the board.

DSKT – Danish Society for Clinical Telemedicine. The Society’s task is to promote theoreticalknowledge and practical advances in the use of telemedicine tools. The Danish Centre for HealthTelematics is represented on the board and assists in the arranging of annual meetings.

ISFTeH – International Society for Telemedicine and eHealth. The organisation’s overall aimsare to facilitate international dissemination of knowledge and experience in telemedicine andeHealth and provide access to recognised experts in the field worldwide. The Danish Centre forHealth Telematics is represented on the board.

NST – Norwegian Centre for Temedicine, Tromsø is the national centre of excellence for tele-medicine in Norway. The centre is a world leader in research and development, instruction, guidance and advice on telemedicine. The Danish Centre for Health Telematics and the Nor-wegian Centre for Telemedicine cooperate on international projects and training facilities.

The Danish Technology Council has the task of promoting the technology debate, assessing thecapabilities and consequences of technology and advising the Danish Parliament and Govern-ment. The Danish Centre for Health Telematics cooperates with the council on Pervasive Health-care/telemedicine.

Sundhed.dk The joint public healthcare portal is intended to make electronic communicationpossible between doctor and patient. At the same time the patients will be able to keep track oftheir records from home. Sundhed.dk and the Danish Centre for Health Telematics cooperateboth generally and in connection with specific projects. The two organisations to a large extentsupplement and complement one another, and it is therefore natural for the cooperation to be-come ever closer.

37 Other telemedicine activities

Danish Centre for Health TelematicsThe Danish Centre for Health Telematics is concerned with electronic communication in thehealthcare sector, nationally and internationally. The centre’s principal tasks are the developmentof communication standards and the development and dissemination of electronic communica-tion solutions in general. The overall aim is to promote quality, service and cohesion between the various parties in the healthcare system to the benefit of effective and rational handling of tasks –and ultimately to the benefit of patients.

The Funen telemedicine initiative 2004–2006 is an example of a practical area of effort. In this context the centre appointed a special telemedicine team with the task of implementingtelemedicine solutions in the Funen healthcare system. The team has additionally contributed totelemedicine initiatives in cooperation with the four counties in the future Region of SouthernDenmark.

The Danish Centre for Health Telematics was set up in 1994 on the initiative of the County ofFunen, and up to the end of 2006 has had Funen, national and international sections. Followingthe structural reform the Centre has two departments, MedCom and International. In addition,a cooperation agreement has been entered into between MedCom and the Region of SouthernDenmark on the secondment of staff from the Region to the Centre.

The purpose of MedCom is to contribute to the development, testing, dissemination and qualityassurance of electronic communication and information in the healthcare sector at national level.The initiative is intended to support cohesive treatment, nursing and care in patient pathways.

MedCom is responsible for nationwide communication standards, which are to be used by allparties involved in the Danish healthcare system. Its activities also extend to the development ofthe Health Data Network and project management.

The Ministry of the Interior and Health, the Ministry of Social Affairs, the National Associationof Local Authorities, the Danish Board of Health and the Danish Pharmaceutical Associationsupport and finance MedCom.

International was set up in 1996 with the aim firstly of passing on the knowledge the DanishCentre for Health Telematics has obtained in connection with its regional and national projectsand secondly to learn from the experiences and knowledge of other countries with regard to elec-tronic healthcare communication.

The principal focus of the department is on developing the necessary infrastructure for the use oftelemedicine service, telemedicine across borders and sectors and standardisation of electroniccommunication.

International has attained considerable experience in managing and taking part in projects sup-ported by EU and other international bodies. The projects cover a broad range – from telemedi-cine in outlying areas of Europe to projects in which bio-informatics and healthcare informaticsare combined to achieve synergistic effects. International is an organisational part of MedComfrom 2007.

38 Danish Centre for Health Telematics

MedCom

International

Contact Danish Centre forHealth Telematics

International Society for Telemedicine and eHealth: www.ISFT.org

Nordic Telemedicine Association: www.Nordictelemedicine.org

Danish Society for Clinical Telemedicine: www.dskt.dk

Telemedicine information exchange: www.tie.telemed.org

MedCom – the Danish Health Data Network:www.medcom.dk

Danish Centre for Health Telematics: www.cfst.dk

39 Danish Centre for Health Telematics

Claus Duedal PedersenInternational Manager Tel. direct +45 6543 2029cdp@health-telematics.dk

Lars Hulbæk Chief consultant Tel. direct +45 6543 2031Lhf@health-telematics.dk

Lisbeth JørgensenConsultant Tel. direct +45 6543 2011lisbeth.joergensen@regionsyddanmark.dk

International telemedicine

National telemedicine

Regional telemedicine

Text: arkitekst kommunikation.Translation: Interpen Translation. Photographs: Niels Nyholm (pages 9, 10, 11 (right), 18, 20, 24, 27, 29, 30, 31, 34). Kent Bovin, Clinical Photography, OUH (pages 12, 13, 15, 17). Alex Tran (page 11, left). Christina Wanscher (page 33, bottom). Other photographs supplied by the individual departments.Graphic design: Christen Tofte Grafisk Tegnestue. Printed by: one2one. Print run: 500.ISBN 978-87-91600-02-9

Telemedicine links

The Funen telemedicine initiative 2004–2006

Rugårdsvej 15, 2nd floor DK-5000 Odense CTelephone +45 6543 2030 Fax +45 6543 2050www.cfst.dk