Norwegian Centre for Integrated Care and Telemedicine

The Norwegian Centre for Integrated Care and Telemedicine (NST) is the world’s largest centre for research and development in telemedicine and eHealth. The centre has strong interdisciplinary expertise, and aims to shape health care of the future. NST has about 200 employees and is situated in Tromsø in northern Norway.

Through user-oriented research and development, NST has contributed to integration of care between levels in the health sector since 1993. Telemedicine solutions and eHealth give patients easier and better access to health services. Effective collaboration makes the skills and services of health personnel available to more people, and society’s resources are used more effectively.

Telemedicine, eHealth and welfare technology are very important tools in the realization of the Integrated Health Care Reform. The NST has valuable knowledge and experience in this field, and has a responsibility to ensure that the reform will have the best possible outcomes for both patients and health professionals.

NST is an internationally known organization and was chosen as a World Health Organization Collaborating Centre for Telemedicine in 2002. Norwegian Centre for Telemedicine co-founded the Tromsø Telemedicine Laboratory (TTL) in 2006 together with industrial and academic partners. TTL is a Centre for Research-based Innovation combining human caring with new technologies, in order to provide better health care for those with chronic diseases, and reduce the growing burden on the health care system.

NST’s responsibilities are assigned by the health authorities. The centre’s aim is to contribute with:

• advisory services related to organization and implementation of eHealth and telemedicine practice in the health sector
• research on future solutions in collaboration, telemedicine and eHealth
• development of telemedicine technology from ideas to products and services

University Hospital of North Norway (UNN)
The presence of the University Hospital of North Norway (UNN) in the northern regions provides security for the resident population, as well as thousands of visitors and the many people who travel to North Norway to work. As the leading healthcare provider and health trust in the region we offer medical expertise at several levels. Premier class treatment, research, education and training form the very foundation of our efforts to save, prolong and improve lives.

The UNN cares for patients who require highly specialized treatment in a range of specialist areas. The UNN also serves as the local hospital for residents of Troms and parts of Nordland, providing the full range of hospital functions required of Norwegian local hospitals by the authorities.

The UNN runs psychiatric clinics in Tromsø with integrated addiction treatment centres and several regional psychiatric centres in Ofoten, Southern Troms, Central Troms and Tromsø. The UNN operates the regional medical emergency communications centre (AMK), as well as a number of ambulance stations in Nordland and Troms. The UNN also provides healthcare staff for the air ambulance service.

General Psychiatric Clinic
Department South in the General Psychiatric Clinic (APK) at the UNN  has a catchment area of about 30 000 and is responsible for the provision of general psychiatric specialist services to the people of South of the Troms.

For many years it has been challenging to recruit enough psychiatrists to our regional psychiatric centres to create robust on-call systems to ensure access to psychiatrists throughout the day.  Department South is very keen to find good and stable solutions for using the combined academic resources available in the department in the best possible way. We are working hard to tie communities together in the department, quality control assessment and treatment and ensure good coordination and patient flow between the different units.

With this background we have established a project entitled “Decentralised on-call system using videoconferencing”(DeVaVi) which was implemented in clinical practice in 2011. We have established new studios for videoconferencing at our three regional psychiatric centres and in the homes of the psychiatrists taking part in the on-call system. Ambulant psychiatricteams and local psychiatric wards can establish contact with the psychiatrists using videoconferencing within the Norwegian Healthnet, making it possible for the psychiatrists to take part in direct patient-consultations even though they are located in a studio many kilometres away.

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MasterMind services

cCBT:

The treatment program within cCBT consists of two parts. Part one is a registration and information part called iPSYK (http://ipsyk.no/) followed by the well-known treatment part MoodGYM.

The patients are offered pure self-help, guided self-help, assisted cCBT in 2 modalities. These two modalities are firstly, assisted cCBT where the patient is guided by the GP alone. Secondarily assisted cCBT where the patient and the GP are together at the GPs office and a psychologist is on video. The GP and the psychologist together assist the patient.

The main personnel are the GPs. They have varying degree of qualifications in CBT. The trained cognitive psychologist works directly with patients from the waiting lists.

The patients can be invited to join by their GP, if the patient feels depressed or the GP agrees the patient is depressed.

ccVC:

The Norwegian patient flow is very complex and the treatment can be started in many different ways.

One of many patient flows could as follows: A patient tries self-help ICBT at home. The patient realises that she or he needs more help, and contacts the GP. The patient and GP together try assisted self-help where the GP motivates the patient to work on the ICBT. This is not enough, and the GP increases the assistance by offering more motivational consultations, typically a consultation between each module in the ICBT program. If that does not work, the GP may offer therapeutic consultations or ask for ccVC from a psychologist in the specialist healthcare. The GP and patient in the GP’s office participate together with the psychologist in therapeutic consultations, typically six consultations, but this will be decided jointly between the three parties. If this does not work, specialist healthcare takes over, and the patient is cared for in the policlinic. After an initial consultation at the policlinic where the patient meets the therapist face-to-face, the patient is offered ccVC with or without cCBT or ICBT.

The patient and GP can also ask for assistance on therapeutic or diagnostic problems using ccVC with psychologists or psychiatrists. If the patient is very ill, ccVC can be used for the GP and patient to consult specialist healthcare personnel to form a plan for the optimal acute treatment.

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NST team members:

	Role in project Advisor and resarcher.Specific role in WPs:Responsible for the primary health part of WP3
Name: Nils Kolstrup Organisation: NST and UiT The Arctic University of Norway Title: GP, MD,MPH, PhD, Senior Researcher, Senior advisor Email: Nils.Kolstrup@telemed.no	Expertise relevant to project GP, Cognitive Terapist, leader of a research project on the use of ICCBT in primary care.

 

	Role in projectVideoconference and cCBT Specific role in WPs:                          Part in etablishing cCBT treatment, clinical aspects
Name: Vemund Nordnes MyrbakkOrganisation: University Hospital of North Norway, Tromsø Title: Advisor/specialist in clinical psychology Email: Vemund.n.myrbakk@unn.no	Expertise relevant to projectSpecialist in clinical psychology. Leader and project experience. Some experience with eHealth solutions

 

 

	Role in project Working on work package 7 Collaborative care for depression facilitated by video conference, and on the Norwegian trial.Specific role in WPs: Leader of WP7.
Name: Erlend Bønes Organisation: Norwegian Centre for Integrated Care and Telemedicine Title: Senior Advisor Email: erlend.boenes@telemed.no	Expertise relevant to project Master in Computer Science. Experience from several projects that have been using video conference.
	Role in project Working om Workpackage 7, Collaborative care for depression faciliated by videoconference, and on the Norwegian trial.Specific role in WPs: Implementation of the Norwegian solution
Name: Siv Hege Fagerheim Organisation: Norwegian Centre for integrated Care and Telemedicine Title: Advisor Email: siv.hege.fagerheim@telemed.no	Expertise relevant to project Several years in clinical work in mental health care (specialist health care) as a psychiatric nurse. Experience with projects that are using video conference in the mental health care system.