Planning for the Future – Electronic Interaction Supporting Integrated Care

1. Planning for the Future – Electronic Interaction Supporting Integrated Care Tromsø Telemedicine and eHealth Conference 2006 Line Melby, researcher Guri Snøfugl, advisor

2. 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

3. 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

4. The patient at centre Specialist health sevice Nursing home GP/emergency ward Home/home nursing The health sector as interaction arena

5. Service- and support (lab., transport) Emergency care (ambulances, emergency call centres) Medical interaction (referrals, examinations, treatment) Integrated care interaction (discharge, rehabilitation, return to home) Specialist-supervised interaction Five interaction arenas Municipal health service Specialist health service

6. 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

7. Nursing home Death 2% 8% Death Home Home nursing 840 000 stays Integrated care Discharge – rehabilitation – return to home

8. ‘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

9. 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

10. 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

11. 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

12. 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.

13. 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

14. 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

15. 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?

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