2002

Teledialysis - Establishing a common workplace between remote sattelite centres

Teledialysis- establishing a common work place between remote satellite centres Rumpsfeld Markus, MD, Medical department , Renal unit , University Hospital of North Norway, Arild Eli, Project Manager, Norwegian Centre for Telemedicine, University Hospital of North Norway

In order to meet patients need for dialysis treatment near their local rural communities, hemodialysis treatment in Norway is decentralized as much as possible. The University hospital of North Norway (UNN) serves three remote centres (satellites) located in the neighbouring county of Finnmark. Hemodialyis is a highly technical specified treatment modality in patients with end stage kidney failure. Highly skilled nurses administer dialysis to patients three times a week, each session lasting five hours. Dialysis patients treated at satellite dialysis centres do not have the same follow-up as patients at the central dialysis institution (UNN). In addition, the nurses feel professionally isolated.

Issues The aim of this project was to improve the quality of the patient care by providing patients and nurses at the remote centres the same follow-up as the patients and health staff at UNN. With the help of telemedicine we sought to create a common work place by integrating satellite staff into UNN's everyday routines.

Intervention Daily communication with the satellites was established by using IP (Internet Protocol) videoconference (broadband 2 Mbps). In addition we integrated medical technical devices (connected to the videoconferencing equipment) such as ultrasound and stethoscope to examine patients. Software was installed for monitoring both the hemodialysis machine and patient related information (electronic patient records). The server for the dialysis software was installed within UNN's net with a VPN (Virtual Private Network), a security encrypted tunnel, to the satellites. In this way it was possible for the nephrologists to have simultaneous access to other information sources provided by the hospital (digital x-ray pictures, patient's main electronically record). All dialysis patients at the satellites - seven in all - participated in the trial which lasted eight months.

Results The technical solution, together with new routines, have strengthened co-operation between UNN and the satellites. Increased medical information improved the quality assurance of decisions regarding treatment modalities, management of technical and patient care problems. Health staff at UNN had some difficulties integrating the new service into everyday routines. The benefit of providing better health care for patients and the integration of isolated health staff at the satellite stations clearly surpassed the time consuming inconvenience of introducing a new technology in a hectic hospital environment. The yearly costs for this solution were 560000 NOK. Due to sufficient diagnosing via telemedicine, costs could be saved by reducing ambulating frequency of the nephrologists to the satellite stations, avoiding planned readmission and preventing acute admission. Based on the positive results of the pilot, UNN and the satellites have decided to implement the service on a routine basis (January 2002) and plan to connect the third satellite which was not included in the pilot.

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