1. 1 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

2. 2 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

3. 3 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

4. 4 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

5. 5 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

6. 6 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

7. 7 Planning for the Future – Electronic Interaction Supporting Integrated Care, TTeC 2006 Integrated care Nursing home Home nursing Home 840 000 stays Death 2% 8% Death Discharge – rehabilitation – return to home

8. 8 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

9. 9 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

10. 10 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

11. 11 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

12. 12 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.

13. 13 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

14. 14 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

15. 15 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?

16. 16 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/ Comments? Questions?