3rd Dec 2015 Modesto Sierra

ccVC and how to make it a successful experience

Is there any difference between a telephone conversation and a VideoConference session when working in Collaborative Environments between Primary Care and Specialized Care? All the professionals who are participating at the Aragonese (Spanish) pilot of ccVC (Video conference for Collaborative Care and treatment of depression) in the Mastermind Project are clearly in favour of the visual technological alternative.

The idea of the pilot is quite simple: Professionals from the Healthcare Center of Lafortunada (Huesca, Spain) and from the Mental Health Care Unit from Barbastro General Hospital (both belonging to the SALUD – Aragonese Public Healthcare Service) share a one hour videoconference once a month. During this session they discuss about the evolution of the patients they have in common and they make joint decisions about their care plan and follow-up.

Is it videoconference a solution in its own? Definitely not. The most obvious advantage of videoconference: the visual (“human”) interaction between the participants without the need for travelling is far from being enough. Three main lessons have been learnt and are continuously enhanced from this pilot experience:

1.- The “common weal” approach is not realistic.

The first and most important question is: Is the patient’s quality of care truly improved with this service? If so, how? What is the added value for the Primary Care Professionals? And what are the advantages for the Mental Health Care Professionals? Are there any disadvantages?

Each professional must identify the added value of the service for the patient but also for his/her routine practice. Moreover, the collaborative environment stakeholders should be able to check whether expectations are really met.

The sessions carried out at the Aragonese pilot include: diagnosis orientation, therapeutic orientation, medical treatment, generic follow-up and specific follow-up of the adherence to the treatment. The design of the pilot was made taking into account the priorities of each participant, and after a few months their expectations have been met.

  • Primary Care teams are more empowered and have gained self-confidence in the treatment of depression and other mental health care disorders. Their relation with the specialists is closer and the number of consultations (physical and inter) referred to the Mental HealthCare Unit has been slightly lessened since the pilot started.
  • The Mental Care professionals have delegated some follow-up activities to the Primary Care teams. They think that the quality of the service provided to patients has improved as there has been a change from subjective frequentation (based on periodic schedule) to objective frequentation (based on the extra information and on the follow-up made by the Primary Care teams). The number of consultations referred to the Mental Healthcare Unit is lower and the Mental Health Care Professionals claim to have a better knowledge about the patients.
  • And last but not least, the quality of the service provided to patients has been improved as the number of consultations in the Mental Healthcare Unit has decreased (and the number of trips), the professionals from both sides have more information about the patient, and the follow-up of their pathologies is deeper and closer than before.

2.-  ICTs must support VideoConference. The videoconference system is not enough.

The Videoconference System is something equivalent to the “table” in a physical meeting. Its only mission is to arrange the participants in a way so they can speak to each other.

Is it the Videoconference system a solution on its own? How the ICTs can enhance the Videoconference experiences? How can they contribute to make the sessions more useful, effective and also efficient?

In the Aragonese experience, the participants (Primary Care and Mental Health Care Unit) are able to share information about the patients during the sessions. This is possible thanks to the EHR access that each professional depending on his/her own profile. Besides this, three software modules have been developed in order to optimize the resources during the sessions:

  • A module to pre-select the patients to be discussed during the sessions. This selection includes:
    • Patients who have an appointment at the Mental HealthCare Unit scheduled within the period between the next two Videoconference Sessions
    • Patients who were included in the interconsultations made from the Healthcare Centre to the Mental Health Care Unit since the last VideoConference session took place.
  • A module to adapt the generic interconsultation form from the Healthcare Centres to the Mental HealthCare Unit to the specific context of the Mental Health Collaborative Environment.
  • A module to record information about the sessions (clinical information but also statistics and results)

With these extra functionalities, the videoconference sessions allow the professionals to work together almost as if they were on a face to face meeting but staying at their daily work locations, they can have all the data they need available, and they can record the information they might consider relevant.

3.- Some preliminary work and a few closing tasks are recommended before and after each session

Productive, adequate and dynamic meetings are always difficult to accomplish. When the people who participate at the meeting are not face-to-face, it is even more difficult to achieve this goal.

What are the previous activities that optimize the results of these meetings? How can the results of the sessions go beyond the scope of the sessions? What is the impact of this service?

In the Aragonese pilot:

  • The preliminary tasks include the pre-selection of the patients to be discussed during the sessions. This is made through the software module developed with this purpose. Besides this pre-selection, a previous study about each patient is made before the session.
  • During the sessions, relevant information is collected and recorded in the patient’s EHR. Professionals from both locations can access and modify through their own profile the patient’s info.
  • Some tasks might be performed after the sessions. The most common activity is the re-scheduling of appointments in the Mental Health Care Unit and the arrangement of consultations for Primary Care.

These are our three main statements to make ccVC a successful experience: look for the added value of the ccVC for each stakeholder in your organisation, integrate other ICTs to underpin the VC sessions and do not limitate the ccVC work to the time-slot in which the sessions take place. Do you agree with these ideas? Would you prefer to discuss them by phone or by VideoConference?

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