Bringing Healthcare Home

Pioneering WiMAX solutions transform quality of home care in northern Sweden

Faced with a growing and aging population, Sweden’s healthcare system is under increasing pressure. In an effort to provide quality care to more people while minimizing costs, the government wants to increase healthcare provision in the home. In the region of EMEA, in northern Sweden, a local initiative known as TilliT has equipped its homecare workers with WiMAX-enabled cars, enabling them to access important digital patient records from the patients’ home.

Faced with a growing and aging population, Sweden’s healthcare system is under increasing pressure. In an effort to provide quality care to more people while minimizing costs, the government wants to increase healthcare provision in the home. In the region of EMEA, in northern Sweden, a local initiative known as TilliT has equipped its homecare workers with WiMAX-enabled cars, enabling them to access important digital patient records from the patients’ home. Rather than travel to the hospital, voice patients receive a remote speech therapy session via WiMAX supported video conferencing in the comfort of their own homes.

The Challenge

• Region of Umeå wanted to increase the quality and efficiency of homecare to cope with increasingly large and ageing population.
• Caregivers lacked access to important healthcare and patient information systems at point of care in patients’ homes.
• Lack of information sharing between social and medical caregivers reduced ability to provide integrated care to patients.
• Home visits recorded through handwritten notes had to be entered into information systems at later time, resulting in errors and inefficiencies

The Solution

• Healthcare professionals provided with WiMAX and Wi-Fi-enabled cars, allowing them to access and update patient records from Intel® Centrino® mobile technology-based laptops while in patients’ homes.
• Caregivers given improved access to healthcare systems resulting in better information sharing and continuity of care.
• Mobile connectivity to data and applications improves productivity, service and safety, and reduces redundant paperwork and potential transcription errors
• Temporary WiMAX antenna and video conferencing equipment installed at voice patients’ houses, enabling remote speech therapy session with the hospital specialists from the comfort of their own home.

Assessing the Situation

The healthcare system in Sweden has earned a reputation for excellence, quality and innovation. It has consistently been ranked among the top healthcare systems in the world and was recently ranked fourth best in Europe¹. However, Sweden is facing a major healthcare challenge — one that is shared by many countries across the world.

“Our population is growing quickly and at the same time the percentage of elderly people is increasing,” explained Eva Andersson, the Chair of the Social Committee for Umeå. “This is placing a great deal of strain on our healthcare system.” The pressure is heightened further by the declining proportion of the population in employment. Consequently, the country is looking for ways to provide quality care to more and more people while reducing its overall healthcare costs. One was to meet this challenge is to shift the focus of care from traditional clinical settings to the home and, as a result, such initiatives are well underway throughout the country.

TilliT is a cooperative healthcare initiative located in Umeå, a city and municipality in the vast county of Västerbotten. Established in 2000, TilliT is led by Landstinget County Council (in Västerbotten) and involves the close co-operation of Umeå University, local authorities and private healthcare organizations. Activities are focused on increasing the effectiveness and efficiency of the region’s public healthcare system. Intel, drawing on its extensive experience of both WiMAX and using technology to meet the needs of healthcare providers, patients and caregivers, has acted in an advisory role for many of TilliT’s activities. Great progress has already been made and, for a region where travel is hampered by mountains, large rivers, vast forests and sub-zero temperature winters, much of the focus has been on the area of homecare.

Soon after TilliT was established, it started evaluating the benefits of providing mobile phones and PDAs to caregivers to improve communication and access to information. However, by late 2005 the region was aware that there were still significant shortcomings in its homecare services and that further significant improvements could be made. In terms of telecommunications and Internet infrastructure and usage, Sweden is one of the most advanced countries worldwide. The region of Umeå is a shining example of this, and has been developing its own WiMAX network for a number of years. TilliT wanted to make use of this advanced wireless technology to provide its healthcarers with better access to information when out in the field.

The public healthcare system in Umeå is divided in two, each with its own healthcare information system and this affects how patients are cared for in their homes. Social workers employed by the municipality primarily provide care such as preparing meals and helping patients to get washed and dressed. Medical nurses employed by Västerbotten County Council have responsibility for monitoring patients’ health and the administration of medication or medical aid. Doctors may also carry out patient visits to deal with more advanced medical care needs. This means that for most home-based patients, a community of carers — rather than a single nurse — is responsible for each individual’s well being.

In the past, when visiting a patient at home, the carers have had very limited access to health systems to help them carry out their responsibilities. Some doctors were equipped with notebook PCs, others had mobile phones and PDAs but the majority had to rely on paper-based systems and information at the point of care. In the few instances when they did have the IT equipment to access healthcare information systems, social carers employed by the municipality were unable to access the system used by the doctors and nurses employed by the county council and vice versa.

Spotlight: TilliT

• TilliT is a co-operative healthcare initiative based in Umeå in the county of Västerbotten which aims to improve the effectiveness and efficiency of the region’s healthcare system
• It is led by Umeå University and involves the close co-operation of the local authorities and private healthcare organizations
• The population of the county of Västerbotten, the region which TilliT aims to help, is 260,000
• Travel for health treatment can be challenging as the county has mountains, great rivers and vast forests while its severe climate results in sub-zero temperature winters

This lack of integrated digital information throughout Umeå’s healthcare system was adversely affecting the quality of care provided in the home — for both the care providers and the care recipients. For example, social carers were sometimes unable to check the outcome of the medical nurse’s previous patient visit. The patient may have asked a question about the medication they were being given but because the social nurse could not access the council’s system, the patient’s enquiry would often go unanswered.

TilliT recognised that many of these challenges could be overcome with a coordinated approach to sharing necessary patient information between the two systems. The uncoordinated approach was also wasting time and costing money. After a patient visit, the carers had to return to their office to update the healthcare information system with information they had recorded in handwritten notes during the visit. This increased data inaccuracies, resulted in lost information and was highly inefficient.

Delivering the Solution

Working closely with TilliT, Intel advised on the definition, development and roll-out of a highly innovative solution to overcome the frustrations of the nurses and patients. For the first part of the project, nurses have been provided with ‘nomadic hotspots’ that enable them to access and update healthcare systems while in a patient’s home. Three cars have been equipped with WiMAX and Wi-Fi capabilities and when parked outside a patient’s house, create a wireless hotspot in the home. Using Intel® Centrino® mobile technology enabled notebook PCs, nurses can securely access and update important patient information via the wireless hotspot.

The WiMAX antennas on the cars have a high-speed, wireless connection to antennas on the roof of the University Hospital of Northern Sweden in Umeå, providing access to welfare information, medical records and information stored in the hospital’sdatabases. Equipment in the cars transforms the WiMAX signal into a wireless local area network (WLAN), providing a wireless connection between the car and patient’s home.

The county council and municipality have also collaborated to provide each other’s health carers with limited access to their unique patient information systems. The ability to quickly access shared patient records, data and applications, combined with the ability to research and locate important medical and welfare information, results in improved decision making, information sharing with the patient and ultimately better quality of care. Nurses have reported that with the increased communication and collaboration, they feel much more confident in the care that they are giving. Similarly, patients have a stronger sense of security that they can rely on the care being provided. Their increased productivity and efficiency, in part due to the reduction of redundant paperwork and potential transcription errors, means nurses are spending more of their time caring for patients. For the nurses involved in the project, reports of increased job satisfaction are high.

The second part of the groundbreaking solution enables speech therapists located at the University Hospital to provide remote treatment to voice patients in the comfort of their own home. A temporary WiMAX antenna is installed at the patient’s home along with video conferencing equipment which includes high quality sound transfer, a wide screen display monitor and camera. The antenna at the patient’s home connects to the WiMAX antenna on the hospital roof which in turn connects to the hospital’s technologically advanced speech therapy studio. “The sessions are not hindered in anyway because the patient isn’t in the studio,” explained Käte Alrutz, Head of The Speech Department. “ The sound recordings are just as high quality and you can’t notice any time delay when talking to the patient. The experience is so real and so intense that sometimes you forget that you haven’t actually met the patients in person.” To date, more than 200 sessions have been conducted this way. The patients are typically working in professions that make high demands of their voices — teachers and telephonists for example. They receive a weekly session that lasts up to an hour for a period of six to 12 weeks. They live across the vast county of Västerbotten and this type of remote therapy means they don’t have to travel potentially hundreds of miles to and from the nearest hospital for each session.

While the remote speech therapy doesn’t save the hospital much time, it provides a much more convenient approach for patients and the department is benefiting from a very low level of cancelled session in comparison with ordinary hospital sessions.

Intelligent healthcare solutions that maintain essential human contact with patients

Concluding

TilliT will soon conduct a detailed evaluation of the WiMAX initiatives to measure the economic cost savings and efficiency gains as well as how the quality of care has improved for both recipients and providers. Feedback at the moment is primarily qualitative. Decisions will then be made about how to further develop and expand the solutions. However, there is already an expectation that investment will be made in developing more of the nomadic hotspot cars and that users will be equipped with the latest Intel® Centrino® Duo mobile technology-based laptops which provide even better performance while using less power. The speech therapy department is also looking to the future and is keen to equip health centres across Västerbotten with similar equipment. This will allow patients living in more remote locations to also benefit from remote speech therapy.

Even without the formal evaluation, it’s clear that the pioneering WiMAX-based solutions implemented by TilliT are having a very positive impact on the quality of homecare provided throughout the Umeå. “Using WiMAX and Intel technologies, we’ve developed intelligent solutions that are enabling our health professionals to be effective in their jobs. At the same time, we’re ensuring our patients maintain essential human contact and that we keep our administrative costs as low as possible,” concluded Eva Andersson.

Key Technologies

• The hotspot cars and speech therapy solutions took advantage of WiMAX, an advanced technology solution, based on an open standard, designed to meet the need for high-speed data in a low-cost, flexible way
• Homecare workers access the healthcare systems through wireless-enabled Intel® Centrino® technology-based notebook PCs, providing high performance, reliability and lasting battery life

Integral Answers

• With a sustained and proven commitment to developing healthcare IT solutions, Intel drew on its wide-ranging healthcare experience to advise TilliT on the development and implementation of the WiMAX solutions
• Intel had a lead role in facilitating collaboration between diverse healthcare organizations, technology suppliers, homecare workers and the University, to produce an innovative, reliable and high-quality solution for TilliT

Return on Investment

• Fast access to shared patient records, medical information and applications results in increased productivity and efficiency, faster decision-making and improved quality of care
• Increased communication and information sharing gives healthcare professionals more confidence in the care they are providing, resulting in increased job satisfaction
• Patients have a stronger sense of security that they can rely on the care being provided
• Elimination of redundant paperwork significantly increases efficiency and reduces the potential for transcript errors, allowing homecare workers to spend more time caring for patients
• Remote speech therapists are experiencing fewer cancelled sessions
• Voice patients are saving time by eliminating travel to the hospital for therapy sessions

¹Health Consumer Powerhouse: The Euro Health Consumer Index 2006

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