2011-10-21 asip santé conférence télémédecine "présentation du système norvégien de...
TRANSCRIPT
Teledialysis
from project to routine service
Eli Arild Project manager
• Limited use of
telemedicine in Europe
• Telemedicine in chronic disease management
• Partnership of nine European regions
• Project period: 2010-2012
The Regional Telemedicine Forum aims to:
•Create new knowledge and skills for all involved stakeholders
•Improve regional policies and strategies
•Successfully transfer telemedicine services between regions http://regional-telemedicine.eu/
Agenda
• Background
• The teledialysis project
• Project evaluation results
• Experiences after the project period
TRANSPLANTATION
Kidney replacement therapy
HAEMODIALYSIS PERITONEALDIALYSIS
Hospital dialysis
Satellite dialysis
Home dialysis
Home dialysis
ONE UNIT!
Aim of the project
• Improve communication between
remote dialysis units in the neighboring
county of Finnmark (Alta and
Hammerfest) and the University
Hospital (UNN), where nephrologists
are located
Teledialysis on YouTube
• http://www.youtube.com/user/telemedisi
n?blend=2&ob=5#p/a/u/1/hmfJCqwzzc
Q
Patient follow up before TM
• Tromsø
– unlimited access to
nephrologist
– regular rounds
– specialists in every
field available
– professional milieu
• Satellites
– limited access to an
ambulatory nephrologist
every 4th week
– limited access to the
patients chart (spread
information)
– in case of emergency limited
diagnostic tools and
treatment options
– professionally isolated
health staff
New technology
• Videoconferencing
• Electronic patient record
• Dialysis machine program
• Ultrasound
• Electronic Stethoscope
New service delivery
routines
Results
Videoconference
• Used for daily two-way audio-visual
communication between UNN and
satellite units:
– For consultations
– For administrative purposes
– For distance education
– For tele-visits with the patients (twice a
month)
• Both patients and personnel were satisfied with services
• 4 of 7 patients were active
• Utility consideration: – 1. Videoconference
– 2. Electronic patient record
– 3. Dialysis machine program
– 4. Ultrasound
– 5. Stethoscope
Avoided hospitalizations
• Venous thrombosis – Cardioasular surgeon/nephrologist.Ultrasound employed
– Pseudoaneurysm disclosed
• Skin rash.Infection? – Eczema disclosed
• Chest pain,Myocardial infarction – Videoconference
• Hematoma at the fistula – Ultrasound guided puncture of the fistula
• Technical problem – Videoconferencing with technologist solved problem
Cost and cost savings
• Investment costs
• Time costs for health staff
• Technical staff
• Travel costs
• Costs of overnight stays
• Emergency admissions
• Specialists travels
Results are published
• Markus Rumpsfeld, Eli Arild, Jan
Norum, and Elin Breivik: Telemedicine
in haemodialysis: a university
department and two remote satellites
linked together as one common
workplace
• J Telemed Telecare July 2005 11:251—
255; doi:10.1258/1357633054471885
Recommendations
• Plans and routines
• Simple as possible
• Laws and security
• Technical support
• Training
Conclusion
Project was immediately implemented
into a routine service,and has been
extended to all satellites
Telemedicine home to
dialysis patients • Survey of the need for new telemedicine
solutions for use at home by patients
with kidney failure
• VC link established this week to first
home dialysis patient
Do you want more information?
Photo: Grytøy in Troms, North of Norway
Photos by Oddvar Hagen