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Telemedical consultation for remote islands

Telemedical consultation for remote islands DE GRUYTER Current Directions in Biomedical Engineering 2020;6(3): 20203004 Lukas Dölger*, Robert Wendlandt, Jan-Thorsten Gräsner and Niels Renzing Results from the mid-term evaluation of the HALLIGeMED project Abstract: The following work gives an overview of In addition to better networking of the partners involved in telemedical consultation in emergencies based on a research emergency care, this contributes to a significant increase in project. A telemedical centre located at a university hospital patient safety. offers medical expertise for rural islands independent from It is necessary to bridge the physical distance between place, time and urgency. Medical employees on the islands the remote Hallig and the telemedicine centre in Kiel and to were relieved in matters of responsibilities and received transfer the patient's medical data. The primary goal is to medical support whenever it is necessary. Results from the improve the medical care of the inhabitants and the visitors at projects mid-term evaluation compare the innovative concept any types or urgencies. Furthermore, telemedicine enables a with the conventional approach. medical treatment for all patients at an early stage, which otherwise can only be initiated by helicopter when the Keywords: telemedicine, emergency medicine, eHealth, emergency physician arrives. Even while the emergency Quality of life physician is still on his way by ship or in the air, the telemedicine specialist can support the Hallig’s nurse via https://doi.org/10.1515/cdbme-2020-3004 video and audio transmission by delegating the administration of medication or instructing him in medical measures. In addition, the medical expertise helps to assess 1 Introduction the medical severity and urgency of treatment and thus reduces the number of expensive helicopter missions. The The so called “Halligen” are small islands in the North research project has to face the unique circumstances of the Sea close to the coast. The acute medical care there with the Halligen and their special concept of care. The main geographical peculiarities poses an enormous challenge. The challenges are to deal with the heterogeneous mobile network spectrum of diseases ranges from abdominal pain in a child coverage, which is necessary for an optimal data to a heart attack in a visitor or resident of the islands. In all communication and to reach a high user compliance on the medical issues ranging from prophylaxis to emergency site of the Halligen. HALLIGeMEDs experience in treatment there is only one nurse responsible. Ambulance telemedicine will find further application in a new project services or located physicians don’t exist on these islands. approach. Through the establishment of a telemedical consultation The MOMENTUM research project, funded by the system within the framework of the "HALLIGeMED" Federal Ministry of Education and Research, aims to develop project, which is funded by the Ministry of Social Affairs, a standardised interconnection of medical devices used in Health, Youth, Family and Senior Citizens and the Ministry preclinical emergency services as well as a completely of the Interior, Rural Areas and Integration, the specialist integrated communication approach between all medical personnel deployed on site can be decisively supported and entities involved in emergency care. In pursuing this project, instructed in initial assessment and care by specialists from we are trying to supersede the limited capabilities of current the University Medical Centre Schleswig-Holstein (UKSH). telemedical systems for emergency medical services. In this paper, we highlight the most important findings from the mid-term evaluation of the HALLIGeMED project. ______ *Lukas Dölger: University medical centre Schleswig-Holstein, Institute of emergency medicine, Arnold-Heller-Str. 8, Haus 808, 2 Material and Methods 24105 Kiel, Germany, e-mail: lukaskonstantin.doelger@uksh.de Robert Wendlandt: University medical centre Schleswig-Holstein, Clinic for Orthopaedic and Trauma Surgery The setup of the telemedicine centre within Jan-Thorsten Gräsner: University medical centre Schleswig- HALLIGeMED is similar to other institutions using the Holstein, Institute of emergency medicine “Telenotarzt” system. Several screens show incoming general Niels Renzing: University medical centre Schleswig-Holstein, Institute of emergency medicine Open Access. © 2020 Lukas Dölger et. al., published by De Gruyter. This work is licensed under the Creative Commons Attribution 4.0 License. Lukas Dölger et. al., Telemedical consultation for remote islands — 2 and medical live patient data, a documentation screen of the time. Often, they were asked only to support in finding a telemedical emergency physician, a list of standard operating diagnosis or rate an ECG. procedures, which include all the emergency diagnosis The average time interval of the whole consultation keywords and give a hand in relation to the approved differs from the conversation interval. It includes additionally treatment and finally a map with the current location of the the documentation tasks, which is required by law. The place of action. average consultation interval constituted 29:54 minutes. Especially the medical documentation software is the The advantages of telemedical systems vary depending basis for an essential part for the project evaluation. It is on the use cases and the operators. Thus, the concept of possible to generate statistics containing results of general HALLIGeMED can’t be compared to systems with digital field data, e.g. frequency of consultation and the number of physician to patient consultations nor to those which have a claims of the telemedical system per Hallig. Additionally, physical rescue service or early transport possibility. To get even medial evaluation becomes realizable due to software an individual overview and to proof the advantages in this documentation, e.g. time intervals until medication is project the Hallig nurses were asked to be part of a survey. dispensed. These measurements are possible due to automatic Figure 1 shows the individual perception of the applied timestamps whenever medication is dispensed. concept. To extend the quantitative mid-term evaluation with qualitative aspects two surveys were conducted. The main objective was to identify individual perspectives of the users, mentioning the telemedical physicians as well as the Hallig nurses at the far side of the application. Due to the fact the project team at the institute works in directly face to face contact only with the physicians, it’s even more challenging to get into the perspective of the Hallig part, finding out their stance over the telemedicine concept. The intention was to identify possible negative attitudes against the system at an Figure 1: Advantages in the HALLIGeMED concept (multiple early point before the operators cease using it. The surveys selection was possible) own illustration were designed with mostly closed questions with a possibility of adding an additional free text note after each item. The It illustrates the high relevance of physician’s support in range of approval regarding a statement was from 1 (low) to finding the right diagnosis as well as the relief of 7 (high). responsibility when a medical application is indicated. The results include propositions of thirteen participants Especially the administration of drugs is an often- from the Hallig nurses and seven returns from telemedicine discussed aspect in the research project. Due to the long physicians. distance and time the helicopter takes to the place of emergency, the telemedical consultation can bring an essential advantage in drug decisions. As soon as the Hallig 3 Results nurse arrives, the telemedicine is ready to start. There aren’t any limitations in accessibilities of place or time. Figure 2 The telemedicine centre is in ongoing operation since March compares on the one hand the time interval from telemedical 2019. It started in an only-day coverage for requests from the take off until the first drug is dispensed. On the other hand, Halligen. The 24/7 coverage was initiated in July 2019. The the time interval from answering the call at the emergency following results include results until the end of 2019. coordination centre until the helicopter arrives at the Hallig is In total, 43 emergencies where treated under telemedical shown. consultation and expertise. In all cases the Hallig’s nurses are free to call the telemedical physician whenever it’s necessary in their opinion. There are no medical keywords or suspected diagnoses that force the nurses to use the innovative concept. Figure 2: Comparison between innovative and conventional In average, each conversation took 19:43 minutes, process in relation to drug application, respectively arrival measured from answering the call until hang up. This time (minutes), own illustration duration can’t be seen as a full medical treatment because the telemedicine physicians don’t go along the whole case every Lukas Dölger et. al., Telemedical consultation for remote islands — 3 The meaning of this comparison is underlined due to the operations it is a secondary objective to economise these aspect the Hallig nurse must renounce of any team partners operations in relation to their high costs. and need to act on her own. Secondly it must be considered as well that the helicopter crew needs additional time to get from the place of landing to the place of emergency, has to decide to administer any medication and to prepare their 4 Discussion & Conclusion material. A helicopter operation is necessary every time a patient After a year of practising the innovative concept, the needs an inpatient treatment. It’s a task of the telemedical telemedical system became indispensable for the Hallig physician to ponder and decide whether this is indicated, or nurses and the inhabitants. Thus, it is a main objective to an outpatient care is possible. That decision has been in the keep this model available in the local health care structure. Hallig nurse’s responsibility in the conventional system To assure long-term financial support, further arguments are before. Figure 3 shows the number of patients treated in- or necessary. A focus purely on financial efficiency might be outpatient whenever the case was attended telemedically. misleading as the cost benefit ratio will be biased considering a quite small target group. It’s vital to acquire a bigger area of application. Thereby the validity of data would increase as well. Author Statement The author state besides the project funding of two federal ministries there is no funding involved. Authors state no conflict of interest. Informed consent has been obtained from all individuals included in this study. The research Figure 3: Follow up transfer and outpatient treatment, related to human use complies with all the relevant national own illustration regulations, institutional policies and was performed in accordance with the tenets of the Helsinki Declaration. Besides the intention to improve the quality of life of the Hallig’s inhabitants due to lower amounts of helicopter http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Current Directions in Biomedical Engineering de Gruyter

Telemedical consultation for remote islands

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Abstract

DE GRUYTER Current Directions in Biomedical Engineering 2020;6(3): 20203004 Lukas Dölger*, Robert Wendlandt, Jan-Thorsten Gräsner and Niels Renzing Results from the mid-term evaluation of the HALLIGeMED project Abstract: The following work gives an overview of In addition to better networking of the partners involved in telemedical consultation in emergencies based on a research emergency care, this contributes to a significant increase in project. A telemedical centre located at a university hospital patient safety. offers medical expertise for rural islands independent from It is necessary to bridge the physical distance between place, time and urgency. Medical employees on the islands the remote Hallig and the telemedicine centre in Kiel and to were relieved in matters of responsibilities and received transfer the patient's medical data. The primary goal is to medical support whenever it is necessary. Results from the improve the medical care of the inhabitants and the visitors at projects mid-term evaluation compare the innovative concept any types or urgencies. Furthermore, telemedicine enables a with the conventional approach. medical treatment for all patients at an early stage, which otherwise can only be initiated by helicopter when the Keywords: telemedicine, emergency medicine, eHealth, emergency physician arrives. Even while the emergency Quality of life physician is still on his way by ship or in the air, the telemedicine specialist can support the Hallig’s nurse via https://doi.org/10.1515/cdbme-2020-3004 video and audio transmission by delegating the administration of medication or instructing him in medical measures. In addition, the medical expertise helps to assess 1 Introduction the medical severity and urgency of treatment and thus reduces the number of expensive helicopter missions. The The so called “Halligen” are small islands in the North research project has to face the unique circumstances of the Sea close to the coast. The acute medical care there with the Halligen and their special concept of care. The main geographical peculiarities poses an enormous challenge. The challenges are to deal with the heterogeneous mobile network spectrum of diseases ranges from abdominal pain in a child coverage, which is necessary for an optimal data to a heart attack in a visitor or resident of the islands. In all communication and to reach a high user compliance on the medical issues ranging from prophylaxis to emergency site of the Halligen. HALLIGeMEDs experience in treatment there is only one nurse responsible. Ambulance telemedicine will find further application in a new project services or located physicians don’t exist on these islands. approach. Through the establishment of a telemedical consultation The MOMENTUM research project, funded by the system within the framework of the "HALLIGeMED" Federal Ministry of Education and Research, aims to develop project, which is funded by the Ministry of Social Affairs, a standardised interconnection of medical devices used in Health, Youth, Family and Senior Citizens and the Ministry preclinical emergency services as well as a completely of the Interior, Rural Areas and Integration, the specialist integrated communication approach between all medical personnel deployed on site can be decisively supported and entities involved in emergency care. In pursuing this project, instructed in initial assessment and care by specialists from we are trying to supersede the limited capabilities of current the University Medical Centre Schleswig-Holstein (UKSH). telemedical systems for emergency medical services. In this paper, we highlight the most important findings from the mid-term evaluation of the HALLIGeMED project. ______ *Lukas Dölger: University medical centre Schleswig-Holstein, Institute of emergency medicine, Arnold-Heller-Str. 8, Haus 808, 2 Material and Methods 24105 Kiel, Germany, e-mail: lukaskonstantin.doelger@uksh.de Robert Wendlandt: University medical centre Schleswig-Holstein, Clinic for Orthopaedic and Trauma Surgery The setup of the telemedicine centre within Jan-Thorsten Gräsner: University medical centre Schleswig- HALLIGeMED is similar to other institutions using the Holstein, Institute of emergency medicine “Telenotarzt” system. Several screens show incoming general Niels Renzing: University medical centre Schleswig-Holstein, Institute of emergency medicine Open Access. © 2020 Lukas Dölger et. al., published by De Gruyter. This work is licensed under the Creative Commons Attribution 4.0 License. Lukas Dölger et. al., Telemedical consultation for remote islands — 2 and medical live patient data, a documentation screen of the time. Often, they were asked only to support in finding a telemedical emergency physician, a list of standard operating diagnosis or rate an ECG. procedures, which include all the emergency diagnosis The average time interval of the whole consultation keywords and give a hand in relation to the approved differs from the conversation interval. It includes additionally treatment and finally a map with the current location of the the documentation tasks, which is required by law. The place of action. average consultation interval constituted 29:54 minutes. Especially the medical documentation software is the The advantages of telemedical systems vary depending basis for an essential part for the project evaluation. It is on the use cases and the operators. Thus, the concept of possible to generate statistics containing results of general HALLIGeMED can’t be compared to systems with digital field data, e.g. frequency of consultation and the number of physician to patient consultations nor to those which have a claims of the telemedical system per Hallig. Additionally, physical rescue service or early transport possibility. To get even medial evaluation becomes realizable due to software an individual overview and to proof the advantages in this documentation, e.g. time intervals until medication is project the Hallig nurses were asked to be part of a survey. dispensed. These measurements are possible due to automatic Figure 1 shows the individual perception of the applied timestamps whenever medication is dispensed. concept. To extend the quantitative mid-term evaluation with qualitative aspects two surveys were conducted. The main objective was to identify individual perspectives of the users, mentioning the telemedical physicians as well as the Hallig nurses at the far side of the application. Due to the fact the project team at the institute works in directly face to face contact only with the physicians, it’s even more challenging to get into the perspective of the Hallig part, finding out their stance over the telemedicine concept. The intention was to identify possible negative attitudes against the system at an Figure 1: Advantages in the HALLIGeMED concept (multiple early point before the operators cease using it. The surveys selection was possible) own illustration were designed with mostly closed questions with a possibility of adding an additional free text note after each item. The It illustrates the high relevance of physician’s support in range of approval regarding a statement was from 1 (low) to finding the right diagnosis as well as the relief of 7 (high). responsibility when a medical application is indicated. The results include propositions of thirteen participants Especially the administration of drugs is an often- from the Hallig nurses and seven returns from telemedicine discussed aspect in the research project. Due to the long physicians. distance and time the helicopter takes to the place of emergency, the telemedical consultation can bring an essential advantage in drug decisions. As soon as the Hallig 3 Results nurse arrives, the telemedicine is ready to start. There aren’t any limitations in accessibilities of place or time. Figure 2 The telemedicine centre is in ongoing operation since March compares on the one hand the time interval from telemedical 2019. It started in an only-day coverage for requests from the take off until the first drug is dispensed. On the other hand, Halligen. The 24/7 coverage was initiated in July 2019. The the time interval from answering the call at the emergency following results include results until the end of 2019. coordination centre until the helicopter arrives at the Hallig is In total, 43 emergencies where treated under telemedical shown. consultation and expertise. In all cases the Hallig’s nurses are free to call the telemedical physician whenever it’s necessary in their opinion. There are no medical keywords or suspected diagnoses that force the nurses to use the innovative concept. Figure 2: Comparison between innovative and conventional In average, each conversation took 19:43 minutes, process in relation to drug application, respectively arrival measured from answering the call until hang up. This time (minutes), own illustration duration can’t be seen as a full medical treatment because the telemedicine physicians don’t go along the whole case every Lukas Dölger et. al., Telemedical consultation for remote islands — 3 The meaning of this comparison is underlined due to the operations it is a secondary objective to economise these aspect the Hallig nurse must renounce of any team partners operations in relation to their high costs. and need to act on her own. Secondly it must be considered as well that the helicopter crew needs additional time to get from the place of landing to the place of emergency, has to decide to administer any medication and to prepare their 4 Discussion & Conclusion material. A helicopter operation is necessary every time a patient After a year of practising the innovative concept, the needs an inpatient treatment. It’s a task of the telemedical telemedical system became indispensable for the Hallig physician to ponder and decide whether this is indicated, or nurses and the inhabitants. Thus, it is a main objective to an outpatient care is possible. That decision has been in the keep this model available in the local health care structure. Hallig nurse’s responsibility in the conventional system To assure long-term financial support, further arguments are before. Figure 3 shows the number of patients treated in- or necessary. A focus purely on financial efficiency might be outpatient whenever the case was attended telemedically. misleading as the cost benefit ratio will be biased considering a quite small target group. It’s vital to acquire a bigger area of application. Thereby the validity of data would increase as well. Author Statement The author state besides the project funding of two federal ministries there is no funding involved. Authors state no conflict of interest. Informed consent has been obtained from all individuals included in this study. The research Figure 3: Follow up transfer and outpatient treatment, related to human use complies with all the relevant national own illustration regulations, institutional policies and was performed in accordance with the tenets of the Helsinki Declaration. Besides the intention to improve the quality of life of the Hallig’s inhabitants due to lower amounts of helicopter

Journal

Current Directions in Biomedical Engineering – de Gruyter

Published: Sep 1, 2020

Keywords: telemedicine; emergency medicine; eHealth; Quality of life

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