Mobile and Wireless Social and Healthcare Services with the Mallu (Mobile Clinic)
The South Karelia District of Social and Health Services, Finland
The Mallu: taking advantage of ICT solutions for preventive care in rural areas
In South Karelia a large number of aging people are living in less-populated areas from where it is often difficult to have transportation to centers where the social and health services are located. Eksote launched a Mobile Clinic in November 2010 to address to these difficulties. The first duty of the Mobile Clinic (Mallu in Finnish) was to deliver influenza vaccination campaign to less-populated areas. Beginning in 2011 the Mobile Clinic began stopping at different appointed villages in South Karelia providing nurse’s consultations and social services for the older people living in less-populated or rural areas. Through the Mobile Clinic, nurses give health guidance, conduct small operations such as removing stitches and clearing ears, give vaccinations, and take blood work for analysis. The ability of the Mobile Clinic to serve citizens in the less-populated areas will increase dramatically as the nurses’ roles are expanded to prescribe some medications, renew prescriptions as well as conduct small examinations or procedures currently only carried out by doctors.
The technology fuelling the Mobile Clinic
The personnel working in the wireless Mobile Clinic uses laptop computers and antennas attached to the vehicle that can be directed on site to the best direction ensuring sufficient connections in the entire operating region. The Mobile Clinic utilizes @450/3G-network for real-time connection to IT-department’s Citrix-server. ICT enables professionals working in the Mobile Clinic to have a secured access to Eksote’s common Electronic Patient Record, Web Lab and the Internet. The built in wireless network can also be accessed outside the vehicle when needed (for consultations in nearby buildings). The nurse writes entries into the system during the consultation in the mobile unit the same way the entries are written in any other health care unit within Eksote. Additionally, a common system for making appointments is being used. Some challenges concerning the telecommunication connections have emerged during the testing period in the rural areas.
Eksote’s Electronic Patient Health Record (EPR) solution is provided by a national company and contains the whole medical record of a patient. All information concerning primary or secondary care as well as dental health record can be found from the same place. A health care professional working anywhere in Eksote’s region, including the Mobile Clinic, can utilize information on the patient’s whole care process when needed (e.g. the reasons for using health care services, any operations made and the time of being discharged from the hospital). A health care professional can also make use of the system for printing prescriptions and other useful forms. In addition, the system allows for the collection of useful statistical information. Access to the EPR allows the professionals to assess the patient’s situation in a broader perspective and health issues that might not otherwise be detected may now be noticed with the help of the information available on EPR.
Mallu and the European-wide RENEWING HEALTH initiative
RENEWING HEALTH, (Regions of Europe Working together for HEALTH), is a European project, which aims at implementing large-scale real-life test beds for the validation and subsequent evaluation of innovative telemedicine services using a patient-centered approach and a common rigorous assessment methodology.
Eksote, which is the official Finnish partner in the RENEWING HEALTH project, has been undergoing trial remote patient monitoring (RPM) and combining it with health coaching. Recent studies show that RPM should be accompanied by human support, such as Health coaching, in order to be effective.
The trial is targeted at self-management of type 2 diabetes (200 participating patients + 75 controls) and heart disease (200 participating patients + 75 controls) patients in the Eksote region. The research patients involved in the project are provided with measuring device for home use to support managing their self-care, along with the support from their personal health coach. The patients are able to record the values that they have measured at home (e.g. weight, blood pressure), in the data base by using a mobile phone. They can also see their measuring results in the data base and their health coach is able to utilize the results in health coaching.
The Mobile Clinic concept can benefit from the experiences gained from the RENEWING HEALTH project. There is discussion of incorporating health couching as one of the Mobile Clinic’s services in the future. Patients living in less-populated areas could meet health coaches regularly in connection to Mobile Clinic’s visit. The health related information the patients have measured at home could then be accessed in the Mobile Clinic by the health care professionals. These solutions would provide an excellent possibility to support citizens living in rural areas to manage their self-care as a part of an integrated healthcare service.
Follow-up with patients showed that delivery service of prescription medication and the services of a physiotherapist were the most hoped for services that could possibly be offered in connection of Mobile Clinic’s visit in the future. The role of ICT solutions in developing and providing new add-on services is substantial, as these solutions can optimize collaboration between different actors.
The new model supported by the Mobile Clinic increases the equality of citizens in terms of access to health care, as well as benefits for efficient allocation of time and resources. The nurses can make a preliminary assessment and recommend only those patients to a doctor’s appointment who really need such a consultation. This enables the doctors to concentrate better on their own tasks and therefore has a significant effect on the development of health centers and on the doctors’ interest in working in public sector health centers which have suffered from lack of available doctors.
The economics of the Mobile Clinic project
The municipalities are paying a fixed share of the social and health care costs to Eksote. As a result, the municipal borders are therefore no longer a hindrance to the routing of the Mobile Clinic. The clients can use the services of the Mobile Clinic also outside their own municipality. The Mobile Clinic has its role also in providing health care to summer residents. The RENEWING Health project is partially funded under the ICT Policy Support Program by the European Community.