Momentum telemedicine service descriptions
Objectives, expected outcomes, main beneficiaries
The full name of this service is “Decentralised psychiatrist on-call service collaboration using videoconferencing”. It is a service through which specialists (psychiatrists) are available via video conference around the clock. The service allows patients and health personnel in the municipalities to communicate easily and directly with a psychiatrist. It includes patients treated by their local general practitioner and both in-patients and out-patients at the local centre for mental health (SPH), which is also called a district psychiatric centre (DPS).
Due to the use of video conferencing, specialists can be employed and located at different places in the region. In this case, the service can be offered as far away as 300 kilometres from where the patient is located.
The purpose of this service is to ensure that patients and health personnel have around the clock access to psychiatric specialist reviews as close to a patient’s home as possible in order to assess the patient’s condition when needed. Hence, health personnel can find out which initiatives should be taken especially in emergency situations or when the patient’s state worsens.
The overall aims of the service are to:
• Run a new model for emergency assistance in the South Division area of Troms County. It takes place in cooperation between primary care and specialist care. The service includes an ambulatory team from the specialist health care. It involves primary care personnel, emergency beds in residential units in the local institution in combination with videoconferences with psychiatrist situated in other areas.
• Reduce unnecessary patient travel to Tromsø from remote areas.
• Avoid unnecessary hospitalisation in Tromsø when patients can be treated locally based on advice given by a psychiatrist via videoconference.
• Refine the service based on experience gathered.
• Disseminate this service (once refined) to other areas with the same characteristics.
• Evaluate the service systematically after some time.
The main beneficiaries of the service are the patients.
Targeted population, number of patients
Broadly, the service falls into the category of acute/emergency intervention.
The service is aimed at people with mental disorders. The people involved include mentally ill patients in emergency situations, and patients who need a new evaluation of their condition. These patients are offered access to psychiatric specialist reviews and communication as close to their home as possible. In the videoconference, the patient can be seen by representatives from the acute ambulatory team, personnel from the local residential unit, their general practitioner and/or employees in the primary health care sector.
Between ten and twenty people receive the service each month.
Type of telemedicine service
The telemedicine service category is psychiatry. Key actors in the service are the patient, his or her general practitioner, or other personnel from the primary health care, members of the ambulatory acute team, and a psychiatrist from the specialist health care service.
Set-up that was being replaced
Maintaining a stable specialist psychiatry service in the District Psychiatric Centre(s) (DPS)/Centre for Mental Health (SPH), i.e., alternatively known as SPH/DPS or DPS/SPH, has been a challenge. This challenge has existed not only in centres that are now organised within the Southern Department’s area, but also for SPH/DPS in the whole service area of the University Hospital of North Norway (UNN). It will take many years before it is possible for the DPS/SPH to establish a viable on-site around the clock service.
Outcomes and results expected after introduction
There are large potential gains in the project, both in terms of raising the quality of services on offer and, economically, by ensuring a more efficient use of resources.
The service improves patient care and ensures safe emergency aid. The system can also support the establishment of acute beds at local in-patient units so that unfortunate and expensive transportation of patients to the hospital for evaluation/admission can be avoided.
An important ripple effect has resulted from the introduction of this duty scheme into regular routine: it is the gaining of experience with patient consultations via videoconference and the expansion of its range of use. This can make it easier to carry out regular checks via telematics and to obtain special expertise in different parts of the health system. Today, specialists are available on an ambulatory basis during the day in the regular in-patient units and out-patient clinics at the SPH/DPS. Part of this activity might to some extent in the future be easier to administer and make more efficient as a result of the use of information technology.
There is also a great potential for the transfer value of the project. Good solutions are easily transferable to other parts of UNN’s geographical area. This applies for example to the northern area of Norway (the Finnmark county and the northern areas of Troms county), and to other SPH/DPSs all over the country. More district psychiatric centres/local centres for mental health can enter into secure cooperation with the specialist health care in the best interest of their patients.
This service ensures that patients who are in emergency situations, or whose conditions worsen, have access to psychiatric specialist reviews as close to home as possible. Specialist reviews are made possible through the use of videoconferencing.
This service is operational and part of the mainstream health service.