ICT solutions and new health technology facilitating integration in home care

Why was this example implemented?

There is a need to develop more productive and functional ways of supporting older people to sustain a good quality of life and to be able to continue living at home longer.

Home care patients are increasingly old and frail with multiple service needs. Acute illnesses and decline in functional ability increases the need for service support. There have been problems with the information transfer across organisational boundaries, in how services work together to provide care, and in the integration of services between hospital and home care as well between doctors and nurses.

The transfer of information, as well as cooperation between doctors and home nurses and between hospital and home care can be made more effective by using a broadband connection.  For example, if an older person at home has an infection in an open ulcer, a home nurse can take a photograph with a digital camera and send this to the GP or to the hospital. The GP is able to consult a dermatologist when necessary, and instructions and prescriptions can be provided to the nurse. The patient is able to stay at home during this process and there is no need for a hospital stay or doctors' home visit. Without technology solutions the patient’s hospital stay could cost around €300 to €1500  per day depending on the unit. 

Description

Care of older people with chronic diseases requires close cooperation and seamless transfer of information between professionals and between home care and hospitals, which can be made more effective by using a broadband connection. A new service model for nursing care at home has been developed based on a partnership between a local authority, health and nursing entrepreneurs, as well as technology and communication companies.  In this model, the emphasis is on cooperation between home care personnel, patients/relatives particularly with respect to how reaction times can be improved when problems arise.

Solutions include remote doctor contact using webcamera, broadband or video phone. These models also include new ways of operating. For example, equipment is available to home care nurses to enable them to undertake biochemical testing (e.g. CRP, Hb, INR, HbA1c, Kol, PLV, urea test). The nurse can send the results to a doctor via broadband, who can then analyse and interpret  the results and give instructions directly to the nurse while she is still in the patient’s home. The compatibility of the patient data system between private and public sectors was also developed in the project.

The new ICT solutions and operating models enable older people with chronic diseases to continue living at home longer despite acute illnesses or a decline in functional ability. They are also able to maintain a good quality of life. The solutions increase the productivity of professional work as the transfer of information is faster. New operating models increase productivity by allowing professionals to concentrate on their specialised areas as the responsibilities and work load are spread in a more functional way between different actors (local authority, doctors, nurses, entrepreneurs, older people and relatives). Collaboration with third sector actors (e.g. different societies and clubs for older people) provides one channel for Eksote to give information about the possibilities of ICT in home care to older people and their relatives.

The project has been carried out in South Karelia situated in the South Eastern part of Finland. The project lasted three years (2004 – 2007). The project received funding from the municipality (€150,000) and Tekes - the Finnish Funding Agency for Technology and Innovation (€150,000). The private sector contributed to the project with their own funding.

185 clients participated in the project of which 30 participated during the whole project period of three years. The project employed 1 GP, 2 full-time nurses and several part-time home care workers as well as 2 part-time ICT engineers and several ICT workers. Additionally, ICT and social and health care students participated in the project.

The employees were trained using peer coaching, and learning benefited from knowledge that has been accumulated within the project partnership (HyLa team, technology companies, and pharmacies). The Tekes FinnWell-programme, a five-year (2004-2009) technology programme of the National Technology Agency of Finland, also offered training. Training of health care professionals was organised twice a year.

What are/were the effects?

Some of the operating models and forms of cooperation developed and tested in the project are being used today in daily health care work. The development and fine tuning of the operating models and technical solutions continue based on the experiences of every day work.

An action research-method was used in the development work. The operations were evaluated and improved throughout the project. During the whole project ICT engineers, nurses, doctors, home workers and older people  had discussions and learned to understand common language in order to develop activities and better ways of operating.

Evaluation framework

Resident Assesment Instrument (RAI), an instrument which contains measurements to assess the needs of older people as well as their quality of life (such as ADL Activities of Daily Living and IADL Instrumental Activities of Daily Living) and the quality of given care, was used to compare the results of the project with the results of the usual home care in the city and the average results of home care units in Finland. The Finnish average results (of 2007) were derived from the database of STAKES, a Finnish expert agency providing information on welfare and health. Client satisfaction was surveyed using interviews. A cost analysis was also made. Social and health statistics were used in the analysis.

Monitoring of working hours and calculation of costs were used when measuring allocation of working hours in the project. The results were compared to the traditional way of operating in home care. Among others the results show that the consultation of a remote doctor is approximately 50% more economical, for example in cases where patients have certain types of diabetes or need INR monitoring (INR is the International Normalized Ratio that is used to monitor the effectiveness of blood thinning drugs). 

User experiences were evaluated by the patients and results were measured using RAI. According to the assessment 27 out of 29 interviewed patients considered the home care services to increase their sense of safety. HyLa project’s patients used less medication (5.9% compared to the 7.2% of comparison group) and their social isolation was decreased from 30% to 9%. The comparison group’s social isolation remained at 30%. These results would suggest that there are increases in the quality of older people’s lives.

The new model will save time and money as well as potentially increasing the quality of older people's lives. Older people were able to stay at home despite having acute or chronic diseases and frailness. Visits to accident and emergency as well as hospital stays were avoided, which is preferable for all, especially in rural areas where distances are long.  

As a result of the project a new home care team offering short term intensified home nursing and home care was established. The team consists of health and social care professionals working in cooperation with entrepreneurs operating in the same field as well as third sector actors, older people and their relatives/friends. Different technical solutions (webcamera, broadband or video phone as well as testing equipment) were found to be useful tools in home nursing. The work with discovering and fine tuning suitable ICT solutions that will increase service productivity continues.

What are the strengths and limitations?

Strengths

• Cooperation between different actors is more effective.
• The transfer of information is in real time.
• The model supports older people to live at home longer with potentially better quality of life.
• There are cost savings from reduced hospital or GP attendance.
• Services to older people are provided in a more flexible and user-friendly way.

 Weaknesses

• Some ICT problems.
• It takes time and know-how to train the personnel to use new operation models.
• The integration of information across programme interfaces is challenging.

 Opportunities

• Using ICT solutions and improved cooperation between different actors can facilitate integration of services and enhance productivity of work.
• Such models can be rolled out across different areas and be sustainable.

 Threats

• Slow diffusion rate.
• Changing the traditional ways of operating and thinking is challenging.
• People can be suspicious of new technical solutions.

Credits

Author: Merja Tepponen, the South Karelia Social and Health Services (Eksote) & Teija Hammar, National Institute for health and welfare (THL)
Reviewer 1: Jenny Billings
Reviewer 2: Kai Leichsenring
Verified by:

External Links and References