How Bent Høie can reach his digital goal

This article was first published in Dagens Medisin

To increase the use of video, a change of attitude is needed at all levels, from top management in the clinics to the administrative personnel who request patient transport.

Minister of Health and Care services Bent Høie has decided that 15 per cent of all the country's hospital consultations will take place by telephone or video by the end of the year. So far, the proportion is one percent. But it is not health personnel's abilities that matter in making this happen.

The corona crisis has shown that healthcare professionals can use technology if they have to. While there were only 60 video consultations across all the country's health trusts during January 2020, the number increased to 8600 in May of the same year. But then it turned around.

As infection rates fell, support for digital consultations fell. At Christmas, the number provided for general consultations had halved, and accounted for only one percent of all doctor visits.

PHYSICAL CLOSENESS

We are therefore a long way from Bent Høie's goal outlined in his hospital speech in January 2021.

Why did the corona crisis not provide the digital kick-start Høie wanted? Much of the answer can be found in the fact that the whole system is rigged around physical consultations. Clinical education and practice are based on four cornerstones:

• Inspection - look at the patient!
• Palpation - touch the patient!
• Percussion - tap the patient!
• Auscultation - listen to the patient!

CORNERSTONE

The close physical contact between therapist and patient is the cornerstone of health services. We have an expectation that we will meet the doctor or nurse in person. This is due to professional neeeds, tradition and culture, but also framework conditions.

Most medical examinations and treatments require physical proximity between patient and therapist. It is often also preferred because it is where the specialist competence and the medical equipment are located, such as in hospitals. For example, you have to go to the cardiac ward to have an ECG examination.

VIRTUAL MEETING ROOMS

In many cases, it is also the case that patient transport to hospital is set up automatically, without alternatives being considered. The use of video is therefore easily perceived as something new and perhaps also unsafe, both for clinicians and patients. But is it really?

Video services, sensor technology, algorithms and artificial intelligence are in daily, but sporadic, use by Norwegian health trusts. Good digital tools already exist. It is possible to create secure virtual meeting rooms easily. The use of sensor technology can provide detailed measurements for digital consultations, and algorithms and artificial intelligence can be used as decision support, for example when interpreting ECGs. There is also a supplier market with innovative players who can make a contribution to service development.

CULTURAL CHALLENGE

Efficiency is also a significant factor. The proportion of video consultations increased significantly when the rate was compared with physical attendance. But when the rate for telephone consultation was compared with video, the traffic largely switched to telephone. This may be due to cultural preferences, but may also be related to the fact that outpatient clinics operate with different logins to the video solution in each room, or that the booking and waiting room function for video is perceived as complicated when this comes in addition to established systems.

Minister of Health and Care services Bent Høie's problem seems to be a cultural and organisational one, not a technological one.

ADAPTED TRAINING

How can Høie reach his goals?

It is crucial that both patients and healthcare professionals are involved in developing a common, simple and understandable system for video consultation. This ensures ownership and necessary functionality. For clinicians, video use can also be experienced as a requirement for increased efficiency. Many clinicians say working over video is more tiring. This especially applies to older employees.

Adapted training is therefore needed to make video use safer and easier, and capacity issues must be carefully considered. Simple and accessible infrastructure such as standardised software and functional video rooms must be established to reduce barriers for clinicians and patients. Only in this way can video consultation become an "off the shelf item" that can be used by everyone.

VIDEO CHECK?

Video consultations must have clear financial incentives behind them, especially where they help to reverse the flow of patients so that hospitals lose revenue. Increased video use therefore challenges the main rule of effort-driven financing, and presupposes better mechanisms for process financing.

Regulations and organisation of joint services, such as patient travel, hospital partner / ICT and hospital purchasing, must be reviewed to uncover the mechanisms that lead to unnecessary attendance at consultations. For certain patient groups, it may be necessary, for example, to assess the use of video before a patient journey is requested, or that compatibility with video is assessed separately when purchasing EPR and patient logistics solutions.

CHANGE ATTITUDES

To increase the use of video, a change of attitude must be facilitated at all levels, from top management in the clinics to administrative personnel who request patient transport. The health services in all parts of the country must also be able to build on each other's experiences, and knowledge, routines and procedures can be shared and disseminated for reuse. This means developing and sharing knowledge about which patient processes, services and procedures require patient attendance, and which can be dealt with via video. As part of this, the needs of key patient groups must be studied - and then consideration given to how those needs should be met in alternating between physical consultations and video consultations.

A crisis can be a catalyst for change as long as it lasts, but if Minister Bent Høie is to achieve his digital goals, the crisis response must now be translated into broad and targeted efforts. The technology is there, and everything is in place to make it a success if these measures are implemented.