Innovative telehealth clinical work models Dr Christina Igasto a Dr Virginia Zazo b a Director Digital Transformation and Innovation Customer Crunch Pty Ltd, Australia, UX Community of Practice at HISA – Leadership team, Australia, former Chief eHealth Officer, Region Västerbotten, Sweden b Senior Consultant and Head, Department of Dermatology, Region Västerbotten, Sweden Visiting Academic at Translational Research Institute, Australia. @dr_igasto @VZazo
Northern Health Region Sweden • The Northern Health Region - Half of the size of the land area of Swedish • University Hospital in the Region Västerbotten has the responsibility of the high specialised care for the inhabitant in the whole Northern Region. The County of Västerbotten • The Region Västerbotten is as large as Denmark to the surface and extends from the mountains in the north to coastline towns in the south. • There are three hospitals in the county. Challenges Goals • • Diverse population Create proximity to and equal care regardless of • Long distances place of residence * Sweden is as large as UK, Estonia, Ireland, Denmark and Netherlands combined
Profession Growth in expenditure Dispersed & Diverse Ageing Population ICT & Medical Technology Increased demand lead to YoY growth in Provision of equitable and accessible care, Larger population living with chronic Staff and clinicians are under great Increased use of information communication disease and disability, which are healthcare expenditure advice and services across all pressure and the health workforce technology (ICT) and an integrations with medical leading to increased health and care Opportunity to re-design economical areas/regions. shortage has become an challenge technology (convergence) demand Opportunity to leverage solutions models, increase engagement, innovate Opportunity to support clinical teams and Opportunity leverage the potential at the clinical models to achieve improved utilise technology to improve or change to provide different services and Opportunity to transform the intersection of ICT and medical technologies services and outcomes healthcare services care in remote or home locations. delivery of care Evidence based medicine Data Analytics & AI IOT (Internet of Things) Future Patients are here Consumer/Provider/Partner Interactions Speed to learn and the ability to act on Political and societal pressures to use research Wearables and medical tracking apps, Access & communicate information between, Patient/consumer/family are demanding to evidence in decision making continue to rise. understanding products and devices disrupting the specialists, hospitals, primary care, laboratories, be in the center and part of the care team health & care industry. Opportunity to transform data to get insurance, pharmacies, etc. Opportunity to improve the evidence informed Opportunity to engage and involve insights - consumer, decision making and Opportunity to gain real-time information decision making and knowledge translation of Opportunity to improve interoperability and empowered consumers and patients, etc. health service outcomes, cost of care, of customer needs and condition and evidence based prevention and inventions in interactions in the ecosystem. increase consumer and provider satisfaction. provide selfcare and treatment healthcare @dr_igasto @VZazo
Healthcare Transformation HOW DO WE OVERCOME THESE EMERGING CHALLENGES? Competing Pressures Consumers External Partners Workforce Decision Environment Makers ? ? ? ? ? Needs STRATEGY? CULTURE? PROCESSES? TECHNOLOGY? EVALUATION? + + + + = What is the impact How are we going What technique do How do we know Is this the right DELIVER THE BEST to culture? How do to implement new we need, have? that decisions we direction to meet we manage tools, models, and What support is make are given our needs? CARE change? processes? required? the best care? @dr_igasto @VZazo
New governance arrangements for eHealth To encourage and support the transformation of healthcare, the Region Västerbotten decided new governance arrangements for eHealth and a Chief eHealth Officer was appointed to establish the Department of eHealth with the commission to lead and strengthen eHealth transformation and to develop and implement strategies, in close in collaboration with clinicians, for eHealth and ICT necessary to deliver the very best rapidly changing need for the best care. This commission and responsibility comprised six objectives: 1. Strengthening governance, decision making, operational management and performance evaluation 2. Provide and enhance efficient consumer/patient-safe services and telehealth-/medicine applications and solutions 3. Innovate and renew, develop and invest in clinical care and business support systems 4. Improve interoperability - information structure, integrations and architecture 5. Enhancing the support and delivery, maintenance and robustness of ICT and Medical Technology 6. Achieve the national and the regional objectives of eHealth @dr_igasto @VZazo
Healthcare Transformation DEVELOP A TRANSFORMATION GOVERNANCE FRAMEWORK Competing Pressures Consumers External Partners Workforce Decision Environment Makers STRATEGY CULTURE PROCESSES Needs TECHNOLOGY EVALUATION + + + + = STAFFS PROCESSES & TECHNOLIGY EVALUATE BUSINESS MISSION DELIVER THE BEST PARTNERS INNOVATION TOOLS TARGET STRATEGY LEADERSHIP POLICIES MAINTENANCE INSIGHTS GOALS ENGAGEMENT FINANCE MODEL SUPPORT LEARNED CARE ROADMAP @dr_igasto @VZazo
+40 clinical telehealth work models BENEFITS • Provision of equitable and accessible care, advice and services across all areas/regions • Speech Therapy Real time wireless Stethoscope Rheumatology on a distance Convenience for patient – reduced travel time • Increase patient engagement • Need to reduce service costs IMPROVEMENT AREAS Self Served Blood pressure TELEDERMATOSCOPY Remote Cleft assessment • Generation and dissemination of evidence • Establishment and spreading of routines and economical models • Education • Technology and facilities • Attitudes and values Multidisciplinary rounds Emergency support for birth Ultra sound robot arm complications @dr_igasto @VZazo
Teledermatology in Västerbotten Insights from a Specialty care setting • Expanding access to care • Delivering the highest level of clinical care • Providing a good experience for the patient • Dermatology is uniquely suited for telemedicine because of the largely visual component involved in the diagnosis. @dr_igasto @VZazo
Healthcare Transformation • Online consultations- Videoconference 2000 • Store and forward-Digital images – Electronic medical record (EHR) 2005 • Teledermoscopy-Skin cancer screening 2014 • Leadership and supervision at a distance 2017 + + + + = STRATEGY CULTURE PROCESSES TECHNOLOGY EVALUATION Needs EMPLOYEEES PROCESSES & TECHNOLIGY EVALUATE BUSINESS MISSION PARTNERS INNOVATION TOOLS TARGET DELIVER THE BEST STRATEGY LEADERSHIP POLICIES MAINTENANCE INSIGHTS GOALS ENGAGEMENT FINANCE MODEL SUPPORT LEARNED ROADMAP CARE @dr_igasto @VZazo
Healthcare Transformation Online consultations 40-50/ month 2000 Specialist shortage – Avoiding long distance travel- Waiting times 2002 + + + + = STRATEGY CULTURE PROCESSES TECHNOLOGY EVALUATION Needs EMPLOYEEES PROCESSES & TECHNOLIGY EVALUATE BUSINESS MISSION PARTNERS INNOVATION TOOLS TARGET DELIVER THE BEST STRATEGY LEADERSHIP POLICIES MAINTENANCE INSIGHTS GOALS ENGAGEMENT FINANCE MODEL SUPPORT LEARNED ROADMAP CARE @dr_igasto @VZazo
Healthcare Transformation 2005 Store and forward-Digital images EMR 713 referrals 550 Digital image 337 FTF (53%) + + + + = STRATEGY CULTURE PROCESSES TECHNOLOGY EVALUATION Needs EMPLOYEEES PROCESSES & TECHNOLIGY EVALUATE BUSINESS MISSION PARTNERS INNOVATION TOOLS TARGET DELIVER THE BEST STRATEGY LEADERSHIP POLICIES MAINTENANCE INSIGHTS GOALS ENGAGEMENT FINANCE MODEL SUPPORT LEARNED ROADMAP CARE @dr_igasto @VZazo
Healthcare Transformation Equal skin cancer screening model -Teledermoscopy 2014 Reducing surgical procedures/costs TD Referrals /year + + + + = STRATEGY CULTURE PROCESSES TECHNOLOGY EVALUATION Needs EMPLOYEEES PROCESSES & TECHNOLIGY EVALUATE BUSINESS MISSION PARTNERS INNOVATION TOOLS TARGET DELIVER THE BEST STRATEGY LEADERSHIP POLICIES MAINTENANCE INSIGHTS GOALS ENGAGEMENT FINANCE MODEL SUPPORT LEARNED ROADMAP CARE @dr_igasto @VZazo
Healthcare Transformation Leadership and supervision at a distance Brisbane-Sweden (Västerbotten) 2017 + + + + = STRATEGY CULTURE PROCESSES TECHNOLOGY EVALUATION Needs EMPLOYEEES PROCESSES & TECHNOLIGY EVALUATE BUSINESS MISSION PARTNERS INNOVATION TOOLS TARGET DELIVER THE BEST STRATEGY LEADERSHIP POLICIES MAINTENANCE INSIGHTS GOALS ENGAGEMENT FINANCE MODEL SUPPORT LEARNED ROADMAP CARE @dr_igasto @VZazo
Conclusion • Technology as a tool not a goal • Digital health is not about understanding technology , it’s about understanding people • Building trust • To strengthening the governance of transformation of healthcare is essential in reaching the sustainability and well excepted clinical work models • Telemedicine is an important contribution to a sustainable health system in Västerbotten @dr_igasto @VZazo
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