2011-10-21 asip santé conférence télémédecine "présentation du système norvégien de...

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?

eli.arild@telemed.no

Photo: Grytøy in Troms, North of Norway

Photos by Oddvar Hagen