Treatment quality increases with digital patient involvement
Lovisenberg is like other health trusts – The employees experience the daily challenge of resource limitations. This challenge forced the hospital management search for a system that could free up the clinicians’ time. At the same time, they wanted to include and make the patients play a bigger part in their own treatment.
Treatment quality increases with digital patient involvement
With CheckWare, Lovisenberg found the system they were looking for:
The possibility to use measures that create clinically relevant reports for patients in substance abuse and mental health. When the patients feel that the questions are relevant to their treatment, they will more readily and acurately respond. The clinicians use the answers to improve the treatment for each individual patient.
With automatic assignment of measures and automatically generated reports from the submitted answers, many of the administrative tasks can be removed from the clinicians. They now have more time to treat their patients.
Lovisenberg Diaconal Hospital
Lovisenberg Diaconal Hospital AS is a local hospital for approximately. 200,000 inhabitants of several city center districts in Oslo. Lovisenberg's primary areas are internal medicine and mental health care.
LOVePROM is Lovisenberg's register based on patient-reported outcome measures (PROM), administrative data and cost figures.
A desire for less time spent on administrative tasks and manual scoring of reports, and more focus on the patient’s voice
In 2013, Lovisenberg wanted to investigate whether patients in their project “Raskere tilbake” actually did return faster to their desired work function. They also wanted more knowledge about which benefits the patients personally had from the treatment and how to create a greater commitment to the treatment.
The solution Lovisenberg was looking for had to be useful in both the individual patient process and be able to summarise data in a quality register. It should include improved quality of reported data and the creation of a working patient record system. Lovisenberg was particularly concerned with moving away from manual paper-based forms that were copied and scanned into a patient record system.
Reporting caused additional work for the employees, and the commitment decreased when the employees felt that reporting in a local quality register did not contribute to solving the clinical tasks.
Many registration initiatives have failed because they create extra work without any benefit to the clinic. Commitment is weakened when reporting does not contribute to solving the clinical tasks. We were sure that we had to find out how the patients experienced the help they received from us, both before, during and after treatment, says Holman.
What’s fantastic about the CheckWare solution is the huge collection of good measure tools that is offered. We have not seen this anywhere else.
"Many registration initiatives have failed because they create extra work without any benefit to the clinic. Commitment is weakened when reporting does not contribute to solving the clinical tasks. We were sure that we had to find out how the patients experienced the help they received from us, both before, during and after treatment", says Holman.
Psychologist and project manager for the quality register at Lovisenberg DPS
Wide range of different measure tools for self-reporting
An automated, digital solution that could assess patients' health and experiences, without imposing additional work for the clinicians. This was the answer they came up with after a thorough survey that started already in 2013.
- What’s fantastic about the CheckWare solution is the huge collection of good measure tools that is offered. We have not seen this anywhere else, says Even Halland. He is a psychologist and project manager for the quality register at Lovisenberg DPS.
- Yet, the biggest advantage of the system is the automation. This frees up time for the clinicians because the patients have submitted their measures ahead of their scheduled appointments. If we compare with the way other hospitals have facilitated data collection, our system is very time-saving, says Halland.
Head of Analysis Per Arne Holman at Lovisenberg Diakonale Hospital believes that their systematic way of working and evaluation of the processes can be used by health trusts across the country.
- CheckWare's software solution ensures that important questions are asked to the patients. The clinician gets a better overview of what is most important for the patient and can prioritize accordingly. In an effective way, the planning, measures and evaluation of patients' treatment within substance abuse and mental health is systematized. In addition to system and efficiency, we wanted to create a quality register. When we collect this data, we reuse it in our local quality register, which we have given the name LOVePROM, he explains.
The patients have a response rate of 70-90%
There is a high acceptance among patients to participate. At times, the response rate has been more than 90%, but it is now a little lower, likely due to an increase in patients being assigned measures.
Patients can answer from home, on their mobile device, tablet or computer. The answers are presented as a graphical report in the patient’s medical records and are immediately available to the clinician.
How the results are being presented is an important factor for success for the clinicians to actively use it, and to keep track of the ongoing treatment, Even Halland believes.
What is a bit revolutionary is that patients write in their own electronic medical record. The clinicians can compare the referral from, e.g. the patients’ general practitioner and what the general practitioner has written in the medical record, with the patients' own thoughts about what they want help with. This is something new and important for the clinicians.
More contact with the patient
Clinician Lina Elise Hantveit at Lovisenberg DPS is always interested in reviewing the feedback in the reports before the patients arrive for their appointments.
- I use the information at the beginning of the appointment. I will inform the patient about the progress, and potential factors explaining improvement or deterioration. Then we talk about it, she says. In addition, Hantveit looks at the relationship between the referral and the answers submitted by the patient.
- These are not always consistent. The referral may sound nice and straightforward, and then there is a patient I do not know from before with severe symptom pressure. It can be surprising, says Lina, who is a big supporter of the solution.
- I love this solution, I feel like it is a great source of security! The patients also follow their own development, look at their graphs, and reflect on the situation themselves: What is the reason for the changes to the graph?
Psychologist Kaja Asbjörnsen Betin is satisfied that she receives significant clarifications right from the start and can quickly initiate a conversation with the patient.
- I can be more present and actually meet the person who walks through the door, because I do not focus on assessing to the same degree as before. Since the scoring report is automated into a system, I can be in closer contact with the patient. It becomes easier to establish a good relationship in the first appointment when I have this tool with me, she says, and believes it is a very useful tool when the treatment does not work 100 percent.
- What is a bit revolutionary is that patients write in their own electronic medical record (EMR). The clinicians can compare the referral from, e.g. the patients’ general practitioner and what the general practitioner has written in the medical record, with the patients' own thoughts about what they want help with. This is something new and important for the clinicians, Even Halland believes.
Openness about results provides a basis for learning and development
The individual clinician and section can use the information to reflect on their own practice and improve the quality of treatment.
- We use the data for learning and development, not monitoring and control. As a clinician, I get a system that gives me an opportunity to provide better treatment to patients. I can learn from my own practice and reflect on what works and does not work in my own treatments, says Halland.
The data is automatically transferred to the local quality register LOVePROM. Lovisenberg uses data from the quality register to, among other things, explore correlations between treatment duration, the intensity of the treatment and the outcome.
-The public health service will always be under pressure in relation to financial limitations, and that is why it is important to prove that a great framework results in a good treatment, says Halland.
Innovation in close interaction
Lovisenberg reports that more than 15,000 patients in the specialist health service part of the clinic have used CheckWare so far. There has, without exception, been positive feedback from the patients.
In collaboration with CheckWare, Lovisenberg has taken on an innovation role to further develop the solution. Lovisenberg works closely with CheckWare and is constantly looking for functionality that more people will want.
- When we combine the patient-reported data with the administrative ones - rejections, waiting lists, number of contacts, duration, frequency, diagnoses and procedures and codes for normative patient treatment - we have the basis for a register that can also meet the needs of management, bureaucrats and politicians, Per Arne Holman adds.
- This applies to easier registration of relevant information, sharing of information with municipal employees and general practitioners, and data from sensors and biomarkers that can be sent directly to the patient record system, says Holman.
I love this solution, I feel like it is a great source of security! The patients also follow their own development, look at their graphs, and reflect on the situation themselves: What is the reason for the changes to the graph?
Kaja Asbjörnsen Betin