UNN's history with CheckWare dates back to 2010 when the Center for Mental Health and Substance Abuse Treatment in Mid-Troms (ref: Northern county in Norway) received an information letter in the mail. During this period, Vemund Myrbakk was unit manager at the outpatient clinic. Parts of the professional community saw already then that it was a good idea to systematize and collect assessment tools.
Five years later, the letter resulted in a meeting between the Mental Health and substance abuse clinic and CheckWare. Not soon after, the pilot was started, and it was quickly discovered that the expectations that had been set were met. The integration with DIPS is a prerequisite for success. There has been great support and positive feedback from both patients and staff.
After an extended period with CheckWare in a pilot project, the University Hospital of Northern Norway HF signed an agreement with CheckWare in June 2017. CheckWare will now be used in mental health clinics, both for children, adolescents and adults, including child rehabilitation.
Success through dialogue, anchoring and integration
Vemund Myrbakk is a psychology specialist at the Professional Development Unit at the University Hospital of Northern Norway HF (UNN) and says that the success of introducing CheckWare at UNN is based on three important factors, namely:
Dialogue with employees along the way
Anchoring with both management and employees
Integration with DIPS
There have been differing opinions on how CheckWare should be used, but clinicians have largely welcomed the tool. Part of the reason is probably that clinicians have been involved in choosing which tools to use since day one. Easily available support at both UNN and CheckWare has solved challenges that have arisen along the way, and it has been
crucial that the integration with DIPS has worked with the transmission of reports.
Focus on user participation and research
As of today, UNN has 4 focus areas:
Balanced operating data
Further development of location-independent services
CheckWare is central to all of these, but in particular there is potential for greater patient participation and further development of location-independent services. Extensions are envisaged here for self-documentation, video conferencing, information packages and research.
During the pilot period with CheckWare, UNN has changed its focus from digitization and standardization of assessment tools to a focus on patient participation and research.
Especially in research, they now see great synergies. Tools that are integrated into the daily treatment make it easier for both clinicians and researchers to achieve seamless integration. By ensuring balanced operational data, both quality and quantity, it is desirable in the long run to strengthen management and information systems that support all focus areas at UNN.
Inclusion and support
At UNN, the strategy for implementing CheckWare has been to make the software available to everyone who uses assessment tools.
It took about six months from the time CheckWare was introduced until its its use increased. As of today, there are about 340 registered clinicians in CheckWare, a number that will soon be increased to 500 with the escalation plan that has been laid down.
Patients have also welcomed the digital solution. UNN has experienced that the vast majority of patients use new technology very well. The challenges can be greater when new technology is to be introduced to healthcare professionals who often have to deal with many different systems and passwords. Patients have expectations of digital use both in terms of solutions and communication. Many are positive about digitalization, such as video conferencing, studies and surveys at home. Especially young people are used to digital technology, but also the older users have taken this quickly.
All patients have received a standard letter with information about login, and no problems with patient login have been registered. As of today, there are about 1,200 active patients in CheckWare, and in the short-term plans, this number will quickly approach 4,000.
Can get 5.5 man-years more for patient treatment
Until now, child and adolescent psychology and adult psychiatric clinics have been a priority. In short term, broadening is planned for all adult psychiatric outpatient clinics. For day units, CheckWare is used for self-documentation, which means that patients write their own medical records.
UNN has documented a saving of about half an hour per assessment for both mercantile staff and clinicians. With a rough estimate of 5 assessments per patient, and 4,000 patients a year, this will result in a reduction in patient administrative work of 10,000 hours a year, and can free up 5.5 man-years for patient treatment.
Collaboration and solution orientation
Vemund Myrbakk talks about a good and constructive collaboration with CheckWare. "We experience being heard and that our input is taken into account," he says.
The collaboration with UNN, CheckWare and HelseNord IKT has also been good and is a prerequisite for being able to implement the solution. "We have experienced collaboration and solution orientation from CheckWare," says Myrbakk. He has also found it very positive to get to know more CheckWare employees.
As a member of the CheckWare Community, UNN gets an extra voice when it comes to influencing further development of the system. CheckWare Community provides extra contact with other professional environments that they greatly appreciate. "You need innovation work between the private and public sectors," says Myrbakk firmly.
The road ahead
Together with the CheckWare planner, UNN is looking at opportunities to use content packages and self-mastery programs. Research will have a greater focus, and it is crucial that the same platform can be used in both somatic and mental health care.
The professional communities will have a greater responsibility for communicating and adapting content to individual patients and to standardized package processes.
The focus will now change from secure infrastructure, which is now in place, to innovation and development in the professional environments. There will be more coordination in the use of surveys and closer collaboration between the professional communities to reap further benefits.
UNN also has a goal of developing services that are independent of location. The admission area to the Mental Health and Substance Abuse Clinic extends from North Troms to Nordland, and by having the services location-independent, they become less vulnerable. As of today, there is a strong focus on the use of video conferencing and Skype is approved for clinical use. In the EU project MasterMind, video calls have been piloted with patients that are at home. This is an exciting development.