1. Telemedicine as a tool for developing healthcare systems Health Optimum 24th January 2006

2. Established i 1992 Centre of expertice in telemedicine Research & Development WHO collaborating centre Norwegian Centre for Telemedicine

3. Norway University Hospital of Tromsø Department of Telemedicine 5 Regional hospitals 70 Local hospitals 2000 GP offices public funded equal access to health care lowest effective care level 4,6 mill inhabitants with 4,9 mill mobile subscribers

4. Electronic communication Telemedicine Home care Patient interactions National IT-strategies 2001-2004 IT supported patient flow New partners - Pharmacies - Patients - Local communities 2004-2007

5. Rekvisisjon The Norwegian health net NHN MNH VNH SNH ØNH

6. Digitalization of the paper flow Requests and reports Lab answers X-rays on the net Booking The ”E-on-duty”

7. Traffic UNN and the Healthcare network

8. Innovation diffuse S-pattern (Rogers 1995) Characteristics/Personalities of potential adopters 1.Innovators (2.5%) 2.Early Adopters (13.5%) 3.Early majority (34%) 4.Late majority (34%) 5.Laggards (16%) Contextual and Managerial Factors 1.Environment that supports innovation 2.Leadership style Diffusion Innovation Information from Donald M. Berwick “Disseminating Innovations in Health Care” JAMA 2003;289(15):1969-1975.

9. Stage of development Information Buisiness value Healthcare Industry Travel Stages og development Service delicery –Possible to deliver the actual product, (consultation, monitoring care) Interaction –Access to operational systems (Online booking) Transactions –Possible to send messages (referals descharge letters, lab reports) Information –Access to searchable relevant information (service meny, clinical guidelines) Transaction Interaction Service Bank/Finance

10. General Practitioner Community Care Patients Buisiness value Buisiness value Stage of development Hospitals Information Transaction Service Interaction

11. IT in hospitals Organisation IT Patient administration and logistic PAS) Earlier Organisation IT Patient flow and clinical desicion support (EPR) Now Cooperation and telemedicine Future Organisatoon IKT

12. Health information systems PastPresentFuture Department systems Regional/ national systems Hospital systems Patients Nurses Physicians Administrators Public Service delivery strategy ICT strategy Change management Technology Alpha-numeric Images, signals DNA, protein data

13. Structural changes In-patient – out-patient – general practitionar – home care Hospital beds – patient hotel – rural medical center – hospital at home Driving forces: No more money, reorganizing healthcare delivery More active and demanding patients

14. Teleradiology TMS Tromsø Vefsn Sandnessjøen Rana Harstad Hammerfest Narvik Lofoten Bodø Kirkenes

15. Tele-Dialysis TMS Tromsø Vefsn Sandnessjøen Rana Harstad Hammerfest Narvik Lofoten Bodø Kirkenes Alta Control and follow-up of Remote visit, guiding and education One organization

16. Radiation therapy Cooperating and supporting smaller hospitals in simulations and dose planning Linear accelerator Dose plan UNN St Olav Haukeland DNR/Ullevål NSS GFS VAS SiR

17. Maternity care TMS Tromsø Vefsn Sandnessjøen Rana HarstadHammerfestNarvik Lofoten Bodø Kirkenes Alta

18. Medical multimedia documents Text Images Sound Video Medical signals Acquisition Display Storage Transmission Conference SYKEHISTORIE PASIENT DIAGNOSE REFERANSER BESKRIVELSE

19. Multimedia request and Report

20. Videobased emergency medical interaction

25. Organizational readjustments Success for the project depends on development of new organizational solutions. Scheduling, agenda, reliability, responsibility, patient interaction, documentation, technical support, sound, image control The participants must develop these solutions

26. Radiology Pathology Otorhinolaryngology Dermatology Cardiology Psychiatry Endoscopic surgery Ophthalmology Distant teaching Telemedicine in routine operations

27. Barriers and responses Size & complexity: Professional resistance Risk aversion Heritage and legacy Public accountability and high profile Unclear outcomes/need for consultation Pace and scale of change – “innovation fatigue” (Lack of) capacity for organisational learning? Public/end-user resistance Absence of resources Technical barriers

28. www.helsekompetanse.no National portal Infrastructure for distant education and net based development of competence

29. Chronic illness Increase in Chronic Conditions - Evidence-based, planned care - Reorganization of practice to meet needs of patients who require more time, education, closer follow-up, etc. - Systematic attention to patient need for information and behavioral change - Ready access to clinical expertise - Supportive information systems Wagner et al. identify 5 elements to improve patient outcomes for chronic illness:

30. The benefits of eHealth enabled chronic care have been established by leading health care institutions including the Department of Veterans Affairs, which recently published results from over two years of demonstration projects showing 63% reduction in hospital admissions and a significant improvement in the quality of life

31. Healthcare@Home Video clips and text based information material Videoconferencing Medical sensor data Consultations and personalized follow-up Group based training and discussions Repetitions and exercises Services: –COPD –Diabetes 2 Acquisition and presentation on TV at home Personalized follow-up from health care professionals based on the information