COVID-19 accelerated the digitisation of Norwegian health services. But can the success stories bring a lasting change - and not just a temporary stream of activity?
Norsk Helsenett (NHN) has announced an explosion in the use of video services. The use of virtual meeting rooms on NHN has more than doubled since the pandemic broke out. GPs have started using video, and the number of e-consultations has increased from 15,000 a week to 130,000 in week 13, according to an overview from the Directorate of E-Health.
Community follow up
At the same time, municipalities are monitoring COVID-19 patients using digital home follow-up. Larvik Kommune now uses the app to monitor residents with a positive corona test. Citizens respond to a questionnaire and take measurements of their health status from home. In this way, the municipality gets an awareness of the patients falling in the "red zone" who need quick follow-up by a doctor or hospitalisation. At Nordland Hospital, video has been used to coordinate patient care for psychiatric patients who are being discharged to the municipality, and to resume therapy groups for gambling addicts that were shut down during the coronavirus storm.
Express digitisation is a stepping stone to implementing the government's strategy. Municipalities, enterprises and GPs must cooperate better so that a patient's course of treatment is experienced in one seamless way. Through digital services, health professionals can work across the silos.
The National Health and Hospital Plan states that services that previously required physical attendance by health care professionals should be provided to a greater extent through video, patient-reported data, sensor technology, and online treatment programmes.
Express digitisation as a result of COVID-19 is a stepping stone to implementing the government's strategy, but key measures must be in place for the development to be a lasting one:
Profitability. It must pay to conduct e-consultations.
Health services in Norway are financed in various ways: The municipal health service outside GPs is financed through framework transfers that are, among other things, based on population and demographics. The financing of health enterprises and GPs is controlled to a greater extent. The important thing is that the financing - the tariff system in Health Norway - must take advantage of the use of digital services at all levels. Following pressure from the Medical Association, the GPs' tariff system is, among other things, facilitated by the extended use of e-consultation. The increase in the number of regular consultations clearly shows that good financing schemes help stimulate digital behaviour.
The next major tax category is the funding of outpatient consultations in the specialist health service: It must not be penalised if the service prioritises video consultation where this is in the best interest of the patient and the system as a whole. Healthcare DRG funding should therefore be reviewed so that hospitals have the right incentives to facilitate e-consultations.
Many physicians lack trust in digital treatment due to uncertainty regarding its reliability and efficacy. Therefore, good guidelines for the reliability and effectiveness of digital processing have been needed.
GPs are showing the way during the corona crisis, and treating patients from their home office. However, many are uncertain about whether they are providing the proper treatment and what the outcome is for the patient:
Citizens can provide feedback on their user experience of digital solutions, but it is understandable that clinicians want research-based knowledge of new treatment options. Therefore, better studies into the effect of digital processing are needed. Such studies can make clinicians safer in the future - and help ensure future doctors and nurses are better equipped to provide digital therapy.
Patients are not concerned about who provides the services, but about good quality.
It is not acceptable for patients to be passed between specialist and primary health services, each of which operate in silos and have different medical records, home follow-up systems and a variety of medical devices:
Municipalities, health trusts and GPs must therefore establish better cooperation better so that a patient's course of treatment is seamless. Through digital services, health professionals can work across the silos such as when the patient is discharged from a hospital to a home treatment where video and technology provide interventions and can be discussed by a hospital specialist and GP at the same meeting with the patient.
Implementation of these solutions requires the municipalities, health authorities and GPs to work together and establish common IT systems, processes and division of roles and responsibilities.
The Covid-19 pandemic has created a huge momentum towards digitisation in the health sector. Let's continue the good work of creating robust, efficient and patient-friendly health services.
Grete Kvernland-Berg and Just Haffeld are public sector and healthcare experts at PA Consulting.