Helhetlige pasientforløp. med IKT og telemedisin. Health World 2011 Ellen Rygh, Gro Berntsen, Gerd Ersdal

Transkript

1 Helhetlige pasientforløp muligheter og utfordringer med IKT og telemedisin Health World 2011 Ellen Rygh, Gro Berntsen, Gerd Ersdal

2 «Pasientbehandling er i stor grad et lagarbeid. Når ett sentralt ledd i laget mangler, forblir pasientens problem uløst, eller spørsmålet oppstår om pasienten skal flyttes til et annet sted der laget er komplett» Telemedisin kan tilføre laget den spesialkompetansen som mangler Telemedisin som virkemiddel for økt samhandling. Rapport NST/PWC 2003

3 Tilførsel av spesialkompetanse der pasienten er Tilførsel av spesialkompetanse der pasienten er Samhandling mellom to eller flere parter innebærer: Utvikling av nye kulturer og nye holdninger for samarbeid mellom sektorer Teambygging og teamkompetanse Viktig å se hverandres arbeidsforhold og utfordringer Continuous and Integrated Health Care Services in Rural areas. A Literature study. E Rygh, P Hjordahl Foto: Ellen Rygh

4 Møt fru Hansen 75 år Diabetes type II Ellers frisk Bor alene, enke 4 barn og 7 barne-barn Pasjonert hobbymaler Glad i friluftsliv

5 The image cannot The image be displayed. cannot be Your displayed. computer Your may computer not have may enough not have memory enough to open memory the to image, open or the the image, or may the have image been may corrupted. have been Restart corrupted. your Restart computer, your and computer, then open and then file open again. the If file the again. red x If still the appears, red x still you appears, may have you to may delete have the to image delete and the then image insert and it then again. insert it again. The image cannot be displayed. Your computer may not have enough memory to open the image, or the image may have been corrupted. Restart your computer, and then open the file again. If the red x still appears, you may have to delete the image and then insert it again. Pasientforløp A Diabetes ikke optimalt regulert > Insulin beh Redd for føling -> dårlig regulert blodsukker - UVI Alene overveldet - angstanfall Planlagt oppfølging av Diabetes Føling -> Fall - > Hoftebrudd Forverring av UVI - > Konfusjon Tid Hjem Førstelinjetjeneste Pleie og omsorg Spesialisthelse - tjeneste Rtg Kir avd Geriatrisk avd

6 The image cannot The image be displayed. cannot be Your displayed. computer Your may computer not have may enough not have memory enough to open memory the to image, open or the the image, or may the have image been may corrupted. have been Restart corrupted. your Restart computer, your and computer, then open and then file open again. the If file the again. red x If still the appears, red x still you appears, may have you to may delete have the to image delete and the then image insert and it then again. insert it again. The image cannot be displayed. Your computer may not have enough memory to open the image, or the image may have been corrupted. Restart your computer, and then open the file again. If the red x still appears, you may have to delete the image and then insert it again. Teamet rundt fru Hansen Diabetes Diabetes Tid Hjem Førstelinjetjeneste Pleie og omsorg Spesialisthelse - tjeneste Rtg Kir avd Geriatrisk avd

7 Kontinuitet i behandlingsforløpet «Et sammenhengende, koordinert og tverrfaglig tilbud fra mange forskjellige tjenesteytere fra ulike nivåer og med forskjellig organisatorisk tilknytning over tid» BMJ. 2003: Haggerty et al. Continuity of care: a multidisciplinary Review. Oversatt fra engelsk av E.R..

8 Prosjekt FUNNKe Organiserer meldingsløftet i kommunene i region nord 88 kommuner; elektronisk meldingsutveksling mellom legekontorer PLO Helsestasjoner 4 Helseforetak

9 IKT-verktøy Elektroniske meldinger Interaktive meldinger Bilder, lyd og video-opptak Kjernejournal Medikamentopplysninger Videokonferanse VAKe liknende løsninger legevakt Tverrfaglige team

10 Øyeblikkelig hjelp Videobasert Akuttmedisinsk Samhandling - VAKe Foto: Oddvar Hagen, NST

11 Halv-øyeblikkelig hjelp Interaktiv meldingsutveksling «E-vakt» Spørsmål-svartjeneste, vedlegg: EKG, bilder, lydfiler, videoopptak osv. Lettere tilgjengelighet av veiledning og informasjon Indremedisin Geriatri Kreft Psykiatri

12 Tverrfaglige samarbeidsmøter på Videokonferanse - Sunnaasmodellen Flerfaglige team i samarbeid på tvers og på langs Planlegging av innleggelser, utskrivning m/opplæring og oppfølging etter innleggelser Tilrettelegging av hjelpemidler Helsesenter Sunnaas Hjemme

13 Tele-hjemmeløsninger Kols-, hjertesvikt, dialysepasienter Pasientkoffert hjem, eks Dalane DMS Pasientterminaler eks Lovisenberg Hjemmesykehus barn, Ullevål

14 The image cannot The image be displayed. cannot be Your displayed. computer Your may computer not have may enough not have memory enough to open memory the to image, open or the the image, or may the have image been may corrupted. have been Restart corrupted. your Restart computer, your and computer, then open and then file open again. the If file the again. red x If still the appears, red x still you appears, may have you to may delete have the to image delete and the then image insert and it then again. insert it again. The image cannot be displayed. Your computer may not have enough memory to open the image, or the image may have been corrupted. Restart your computer, and then open the file again. If the red x still appears, you may have to delete the image and then insert it again. Pasientforløp B Hva om Eksempler på applikasjoner: Few touch diabetes dagbok Diabetes sykepleier Tid Hjem Førstelinjetjeneste Pleie og omsorg Diabetes pasient støtte Spesialisthelse - tjeneste Rtg Kir avd Geriatrisk avd

15 The image cannot The image be displayed. cannot be Your displayed. computer Your may computer not have may enough not have memory enough to open memory the to image, open or the the image, or may the have image been may corrupted. have been Restart corrupted. your Restart computer, your and computer, then open and then file open again. the If file the again. red x If still the appears, red x still you appears, may have you to may delete have the to image delete and the then image insert and it then again. insert it again. The image cannot be displayed. Your computer may not have enough memory to open the image, or the image may have been corrupted. Restart your computer, and then open the file again. If the red x still appears, you may have to delete the image and then insert it again. Pasientforløp B Hva om Automatisk uttrekk fra journal, Eksempler: «SNOW», «RAVE» Tid Hjem Førstelinjetjeneste Spesialisthelse - tjeneste Rtg Pleie og omsorg Identifikasjon av høyrisikopasient Bor alene Diabetes + Hoftebrudd Forebygging: Osteoporose Falltendens Kir avd Geriatrisk avd Ta kontakt med primærhelsetjenesten for forebyggende tiltak

16 The image cannot be displayed. Your computer may not have enough memory to open the image, or the image may have been corrupted. Restart your computer, and then open the file again. If the red x still appears, you may have to delete the image and then insert it again. Pasientforløp B Hva om Eksempler: Web-Choice Virtuelt team Hjem Tid Førstelinjetjeneste Spesialisthelse - tjeneste Rtg Kir avd Geriatrisk avd Pleie og omsorg Team på plass før utskrivelse: Diabetessykepleier PLO Fysioterapeut gangfunksj/ smerter NAV hjelpemidler Hjemmesykepleier praktisk hjelp og sårstell Støtte til egenmestring Kurs Informasjon Hva betyr mine symptomer Likemannstøtte

17 The image cannot The image be displayed. cannot be Your displayed. computer Your may computer not have may enough not have memory enough to open memory the to image, open or the the image, or may the have image been may corrupted. have been Restart corrupted. your Restart computer, your and computer, then open and then file open again. the If file the again. red x If still the appears, red x still you appears, may have you to may delete have the to image delete and the then image insert and it then again. insert it again. The image cannot be displayed. Your computer may not have enough memory to open the image, or the image may have been corrupted. Restart your computer, and then open the file again. If the red x still appears, you may have to delete the image and then insert it again. Pasientforløp B Hva om Eksempler: E-vakt VAKE Hjem slege Geriatrisk avd Tid Førstelinjetjeneste Pleie og omsorg Spesialisthelse - tjeneste Rtg Korttidsopphold Kir avd Kommunal observasjons enhet Oppfølging fra E-vakt teamet på geriatrisk avd Geriatrisk avd

18 The image cannot be displayed. Your computer may not have enough memory to open the image, or the image may have been corrupted. Restart your computer, and then open the file again. If the red x still appears, you may have to delete the image and The then image insert cannot it again. be displayed. Your computer may not have enough memory to open the image, or the image may have been corrupted. Restart your computer, and The then image open cannot the file be displayed. again. If the Your red computer x still appears, may you not have enough memory The image to cannot open the be image, displayed. or the Your image computer may have may been not have corrupted. enough Restart memory your to computer, open the image, and then or the open image the file may again. have If been the corrupted. red x still appears, you may The have image to cannot delete the be displayed. image and Your then computer may The not image have cannot enough be displayed. memory to Your open computer the image, may or not the have image enough may have memory been corrupted. to open the Restart image, your or the computer, image may and have then been open corrupted. the file again. Restart If the your red computer, x still appears, and you then open the file again. If the red x still appears, you may have to delete the image and then insert it again. may have to delete the image and then insert it again. insert it again. Restart your computer, and then open the file again. If the red x still appears, you may have to delete the image and then insert it again. may have to delete the image and then insert it again. The image cannot be displayed. Your computer may not have enough memory to open the image, or the image may have been corrupted. Restart your computer, and then open the file again. If the red x still appears, you may have The to delete image the cannot image be and displayed. then insert Your it computer again. may not have enough memory to open the image, or the image may have been corrupted. Restart your computer, and then open the file again. If the red x still appears, you may have to delete the image and then insert it again. The image cannot be displayed. Your computer may not have enough memory to open the image, or the image may have been corrupted. Restart your computer, and then open the file again. If the red x still appears, you may have to delete The the image cannot and then be insert displayed. it again. Your computer may not have enough memory to open the image, or the image may have been corrupted. Restart your computer, and then open the file again. If the red x still appears, you may have to delete the image and then insert it again. Hvis B: Kunne mye vært forebygget??.. Hjem Tid Førstelinjetjeneste Spesialisthelse - tjeneste Ingen hoftebrudd Ingen UVI Pleie og omsorg Ingen konfusjon Ingen innleggelse i Geriatrisk avd Ingen besøk legevakt Mindre angst og større egenmestring i hverdagen

19 Hvordan kommer vi til plan B? HODs Veileder Samarbeidsavtaler Elektronisk kommunikasjon og telemedisinske løsninger, også VK VK-veiledning og konsultasjoner Organisasjons- og kompetanseutvikling Men det er fortsatt store utfordringer og hindringer av juridisk og økonomisk art!

20 Hvordan kommer vi til plan B? Organisasjonsutvikling, Organisasjonsutvikling, Organisasjonsutvikling! Ta i bruk IKT-verktøy på system nivå Forankring Nye måter å tenke- og jobbe på Felles prinsipper Lokal tilpasning Vi trenger et «FUNNKe»-organiseringsprosjekt for utvikling av slike løsninger

21 Takk for oppmerksomheten! Foto: Arvid Børretzen, Stord