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IKTPLUSS-IKT og digital innovasjon

TELMA - Felles telemedisinsk løsning Agder (Videreføring av prosjektnr. 227131)

Alternative title: Joint Telemedical Solution Agder - an extension of United4Health and Verdikt Project Collaborative Point-of-Care Services Agder

Awarded: NOK 15.8 mill.

The Joint Telemedicine Solution Agder (TELMA) project is based on the experience made in the EU study United4Health (U4H) and the NFR Verdikt project Collaborative Point-of-Care Services Agder. TELMA was a collaborative project between the municipalities Kristiansand, Farsund and Arendal, Sørlandet Hospital, University of Agder (UiA), Karde and Siemens Healthineers with support from the Research Council of Norway. The project's ambition was to establish a joint telemedicine solution for all 30 municipalities at Agder and Sørlandet hospitals. The project was anchored in the Regional Coordination Group for eHealth and Welfare Technology Agder. At the end of the project, more than 20 municipalities in Agder were affiliated with TELMA. Kongvinger municipality joined TELMA in 2018. The solution follows up residents with chronic illness/functional impairment and multimorbidity (several different diseases simultaneously in the same person). Patients are followed up with combinations of medical condition measurement, e.g. oxygen saturation and heart rate, questions via tablets and video or telephone consultation with a nurse at a telemedicine centre. Important goals were to promote coping with the health situation, prevent, detect and treat the worsening of the disease. Other goals were to create a better life situation and provide increased security for the patient, reduce the need for personnel-intensive health services in municipalities and hospitals, as well as reduce re-hospitalizations. TELMA should enable good interaction between patients, specialist health service, GPs and municipal health and care services. Own service modules for COPD, heart failure, diabetes and multimorbidity were developed. Sørlandet hospital led the work on developing algorithms and follow-up courses for COPD, heart failure and diabetes. A self-treatment plan for COPD was prepared, and work on heart failure and diabetes has started and will continue after the end of the project. To ensure privacy, 2-factor authentication for health professionals was implemented. It enables, among other things, follow-up of patients in the municipal services. The project was provided with funds from the County Governor of Agder. This enabled the follow-up of mental disorders. Mental illness is the most common cause of disability insurance (NAV). TELMA included people with anxiety and depression, as well as people in a rehabilitation course - preferably after substance abuse treatment. The patient course was developed in the fall of 2018 and the first patients were included at the beginning of 2019. Telemedicine centres were established and put into operation in Arendal, Farsund and Kristiansand. Service descriptions and inclusion criteria that include both prevention and necessary health care were prepared. Municipal procedures for the inclusion, follow-up and termination of telemedicine treatment were defined and implemented. Follow-up tools for staff at the telemedicine centres for COPD, diabetes and heart failure were developed and used as a guide in the conversation with the patients. Routines for equipment logistics and ensuring that patients have equipment that works at all times have been prepared and implemented. Furthermore, a cooperation agreement was drawn up for municipalities in Agder that were associated with TELMA. Affiliation was made free of charge for partner municipalities. UiA led the research in the project. An experience report from the precursor project U4H was used as a starting point for the activities in TELMA. Machine learning was included in the project related to analysis of patient data. This enables more precise assessments of the condition of the individual patient, and serve as additional decision support in the follow-up of the patient. The results of the machine learning activity were positive but have not been put into operation. UiA has prepared a socio-economic analysis in the first place based on COPD patients, and contributed to the work on benefits realisation through action research in the project. TELMA has used Open Tele Health (OTH) software from Denmark to collect user data and transfer it to the telemedicine centres. Siemens Healthineers is the representative of OTH in Norway and has contributed to the solutions meeting Norm for information security in health and care services (Normen) and Norwegian regulations. Benefits of the TELMA project: ? Cost-effective use of health care services (hospital, emergency room, general practitioner and home care services) ? Safety and coping so that the patient experiences better quality of life ? Increased interaction between the actors in the follow-up of patients with chronic health failure ? Cost-effective utilization of the technical solution ? Experiences and models in the form of best practices that have great transfer value nationally and internationally ? Increased competence in the region by following up patients with chronic health failure

Resultater: - Oppfølging av pasienter på Telemedisinsk sentral - Egenbehandlingsplaner for KOLS, diabetes og hjertesvikt - Tjenestemodell for kommuner - Algoritmer og pasientforløp for kronisk syke pasienter med kols, hjertesvikt, diabetes og psykiske lidelser - Maskinlæring for beslutningsstøtte - Utprøving av digital løsning og utstyrslogistikk - Gevinstrealisering og samfunnsøkonomisk analyse - Regional nettverksorganisering Virkninger og effekter - Erfaringer på hvordan kommuner, sykehus, fastleger og spesialisthelsetjenesten kan samarbeide - Erfaringer på hvordan avstandsoppfølging kan breddes ut til en ganske stor region med ca. 300.000 innbyggere - Prosedyrer for kommuner, sykehus og fastleger som sørger for sømløs samhandling mellom aktørene - Avtaleverk mellom aktørene - Algoritmer for oppfølging av kols, hjertesvikt, diabetes, psykiske lidelser og multimorbiditet - Overføringsverdi til andre som skal innføre avstandsoppfølging nasjonalt og internasjonalt

Innovasjonsprosjektet Felles Telemedisinsk løsning Agder (Telma) vil bygge videre på erfaringene som er gjort i EU-studien United4Health og NFR Verdiktprosjektet Collaborative Point-of-Care Services Agder (prosjektnummer 227131). Disse ble avsluttet i 2015. Prosjektet skal videreutvikle ambisjonen om en fremtidig modell for telemedisinsk samhandling for alle 30 kommuner på Agder og Sørlandet sykehus HF for innbyggere med kroniske sykdommer og komorbiditet (flere ulike sykdommer samtidig hos samme person) eller grupper av pasienter som representerer kost/nytte for kommunene. Partnerne i Verdikt (Sørlandet sykehus HF, Kristiansand kommune som pilotkommune og UiA) har gjennom opparbeidet kunnskap i U4H/Verdikt sett behovet for videre forskning og utvikling, både når det gjelder teknologiske løsninger og organisatoriske forhold. Det er blant annet nødvendig med økt kunnskap om de helseøkonomiske effektene av tjenesten og betydningen telemedisinsk hjemmemonitorering kan ha for livskvalitet og egenmestring for kronisk syke. Den overordnede idéen for verdiskapning er å undersøke om en telemedisinsk løsning kan bidra til å løse de forestående utfordringene helsetjenesten står overfor med store demografiske endringer og en forventet knapphet på helsepersonell. Vår erfaring så langt tilsier at oppfølging og behandling av pasienter med kroniske lidelser ved bruk av telemedisinsk hjemmemonitorering er krevende. Løsninger bør prøves ut over lengre tid og for flere pasientgrupper med somatiske og/eller psykiske helseutfordringer. Dette for å få mer erfaring med på hvilken måte slike løsninger kan bidra til å fremme mestring og autonomi for pasienter og pårørende, og samtidig ivareta behovet for profesjonell helsehjelp på en mindre personellkrevende måte. Utfordringene knyttet til utbredelse av telemedisinsk hjemmemonitorering i stor skala er imidlertid mange og det er behov for videre forskningsbasert innovasjon for å finne hensiktsmessige svar på disse utfordringene.

Funding scheme:

IKTPLUSS-IKT og digital innovasjon

Thematic Areas and Topics