Planning for the Future – Electronic Interaction Supporting Integrated Care

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Planning for the Future – Electronic Interaction Supporting Integrated Care, TTeC 2006

Planning for the Future – Electronic Interaction Supporting Integrated Care

Tromsø Telemedicine and eHealth Conference 2006

Line Melby, researcher

Guri Snøfugl, advisor

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Outline of presentation

• Background: Work for Nasjonal IKT (National ICT) on electronic interaction between the Regional Health Authorities (RHA’s) and municipalities

• Recommendations for priority areas and solutions to support the development of electronic interaction

• Empirical example: Fyrtårnsprosjektet (‘Beacon project’) in Stavanger• Evaluating the Stavanger-project: a taste of an ongoing project

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National ICT’s electronic collaboration measures 19 (tiltak 19)

NSEP’s mandate:

• Investigate steering documents

• Collect and analyse earlier and ongoing projects

• Identify and systematise areas/arenas for interaction between RHA’s and municipalities

• Prioritise between areas and suggest actions in order to improve and strengthen electronic interaction between RHA’s and municipalities

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The health sector as interaction arena

The patient at centre

Specialist health sevice Nursing home

GP/emergency ward Home/home nursing

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Five interaction arenas

Service- and support (lab., transport)

Emergency care (ambulances, emergency call centres)

Medical interaction (referrals, examinations, treatment)

Specialist-supervised interaction

Integrated care interaction (discharge, rehabilitation, return to home)

Specialist health service

Municipal health service

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Criteria for prioritising between actions/projects supporting el. collaboration

• The project must have documented effect on health care

• ICT must be able to support the actions

• The RHA’s must have responsibility for the area where the project is to be implemented, and the area should be of importance

• The gains should be higher than the effort

• The action should be based on/pursue ongoing ICT-projects

• Information about the project’s feasibility and risk should be available

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Integrated care

Nursing home

Home nursingHome

840 000stays

Death

2%8%

Death

Discharge – rehabilitation – return to home

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‘Fyrtårn Stavanger’ – implementing electronic messages

• Project: “Patient related communication between municipal care services and collaborating partners through using standardised electronic messages”

• Aim: improving communication and information exchange between municipal care services (Stavanger municipality) and hospital (SUS) and GP’s – and thereby improving quality of health care services and increase efficiency

• In other words… strengthening integrated care• Means: Implementing a number of standardised electronic messages

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The discharge process when patients need municipal care services

• Patient responsible doctor at hospital decides that medical treatment is finished. Patient is ready for discharge

• Nurse and doctors assesses the patient’s condition: is there a need for municipal services ?

• When yes: nurse contacts municipality and informs about the patient• Personnel from municipal care services assesses patient’s needs• Municipal care services presents a service to the patient (home

nursing, nursing home etc.)• Patient transferred e.g. to nursing home. Municipality take over

responsibility

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Challenges in communication

• Several actors are involved in the discharge process• The actors come from different parts of the health sector

– Communication across and within organisations

• Needs for information vs. information provided– Different org. goals, cultures

– Knowledge about what information others need

• Formal vs. informal ways of communicating– Ad-hoc ways of communicating

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Evaluating the implementation of e-messages

Aim:

• To obtain knowledge about how information is mediated between actors across and within sectors in the discharge process

• To identify and describe both intended and unintended consequences from the introduction of e-messages

– To obtain knowledge about the content of information

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Studying communication/info.exchange in the discharge process - methods

• 1st phase: interviews with a limited number of health personnel and clerical staff – In Stavanger Municipality:

• booking office (bestillerkontor), • nursing homes, • nursing home doctor (tilsynslege)

– At Stavanger University Hospital (SUS)• At one clinic where e-messages has been implemented• At one clinic where e-messages has NOT been implemented

• 2nd phase: questionnaire to all employees in clinic without e-messages. Follow up same procedure after impl. of e-messages.

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Communication/information exchange in the discharge process

• A challenging task!• Actors in municipal care services

are more dissatisfied with information exchange/content than hospital workers

• Telephone, fax, paper most used• Electronic communication within

hospitals and within municipality is working OK

• Electronic communication across these borders exists to a minimum – at present

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Studying changes in message content

• Focus on changes in content– How does the transition from

paper based to electronic prel. discharge reports affect message content?

• Textual analyses of paper based and e-messages

– Does the introduction of electronic prel. discharge reports affect discharge summaries (epikriser), e.g. in terms of re-use of text?

• Textual analyses, interviews with senders

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Conclusion

• Integrated care is an important area to support electronically…– Better collaboration between specialist health services and municipal

health services has effects on patients (healthier patients decrease in re-admittances, less need for home care/nursing homes stays etc.)

• But there are many challenges:– Communication between RHA’s and municipalities (different systems etc.)

– What processes may be supported?

– What are health personnel's needs?

– What kind of technological solutions are most effective?

– And what kinds of organisational changes must follow the implementation of those technologies?

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More information:http://www.nsep.no/index.php/no/publikasjoner http://www.shdir.no/samspill/kommuneprogram/fyrtaarnsportalen/

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Planning for the Future – Electronic Interaction Supporting Integrated Care