planning for the future – electronic interaction supporting integrated care
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Planning for the Future – Electronic Interaction Supporting Integrated Care. Tromsø Telemedicine and eHealth Conference 2006 Line Melby, researcher Guri Snøfugl, advisor. Outline of presentation. - PowerPoint PPT PresentationTRANSCRIPT
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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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Planning for the Future – Electronic Interaction Supporting Integrated Care, TTeC 2006
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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Planning for the Future – Electronic Interaction Supporting Integrated Care, TTeC 2006
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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Planning for the Future – Electronic Interaction Supporting Integrated Care, TTeC 2006
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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Planning for the Future – Electronic Interaction Supporting Integrated Care, TTeC 2006
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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Planning for the Future – Electronic Interaction Supporting Integrated Care, TTeC 2006
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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Planning for the Future – Electronic Interaction Supporting Integrated Care, TTeC 2006
Integrated care
Nursing home
Home nursingHome
840 000stays
Death
2%8%
Death
Discharge – rehabilitation – return to home
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Planning for the Future – Electronic Interaction Supporting Integrated Care, TTeC 2006
‘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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Planning for the Future – Electronic Interaction Supporting Integrated Care, TTeC 2006
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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Planning for the Future – Electronic Interaction Supporting Integrated Care, TTeC 2006
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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Planning for the Future – Electronic Interaction Supporting Integrated Care, TTeC 2006
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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Planning for the Future – Electronic Interaction Supporting Integrated Care, TTeC 2006
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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Planning for the Future – Electronic Interaction Supporting Integrated Care, TTeC 2006
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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Planning for the Future – Electronic Interaction Supporting Integrated Care, TTeC 2006
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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Planning for the Future – Electronic Interaction Supporting Integrated Care, TTeC 2006
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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Planning for the Future – Electronic Interaction Supporting Integrated Care, TTeC 2006
More information:http://www.nsep.no/index.php/no/publikasjoner http://www.shdir.no/samspill/kommuneprogram/fyrtaarnsportalen/
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