Lovisenberg Diaconal Hospital is like other Norwegian healthcare institutions; daily, the staff face challenges with having a lot to accomplish in a very short time. Therefore, the hospital management began searching for a system that could free up time for the clinicians. At the same time, patients’ own assessments were to play a stronger role in the treatment.
At CheckWare, Lovisenberg found the system they were looking for:
The ability to use questionnaires that create clinically relevant reports for patients within substance abuse and mental health. When patients feel the questions are relevant to their treatment, they respond. The clinicians use the answers to improve the treatment of each individual patient.
With automatic sending of forms and automatic generation of reports summarizing the patients’ responses, much of the administrative tasks for clinicians are freed up. They now have more time to treat patients.
Desire for less time on administration and manual calculations, and more focus on the patient’s voice
In 2013, Lovisenberg wanted to gain insight into whether patients in the project "Back to Work Faster" actually returned quickly to their desired work function. They also wanted to know to a greater extent the personal benefit patients had from the treatment and how greater engagement could be created.
The solution Lovisenberg sought had to be useful in each patient pathway and capable of summarizing data in a quality register. It had to include improving the quality of reported data and establishing a functioning patient register. Lovisenberg was particularly keen to move away from manual forms that were copied and scanned into a patient record.
Reporting caused extra work for the staff, and engagement was lukewarm when employees experienced that reporting into a local register did not help solve clinical tasks.
- Many registry initiatives have failed because they impose extra work without any benefit to the clinic. Support weakens when reporting does not help solve clinical tasks. We were certain that we had to find out how patients experienced us and the help they received, both before, during, and after treatment, says Holman.
The amazing thing about the CheckWare solution is the enormous menu of good assessment tools offered. We have not seen this anywhere else.
Wide selection of various self-reporting assessment tools
An automated, digital solution that could map patients’ health status and experiences without imposing extra work on the clinicians. That was the conclusion they reached after a thorough survey that started back in 2013.
- The amazing thing about the CheckWare solution is the enormous menu of good assessment tools offered. We haven’t seen this anywhere else, says Even Halland. He is a psychologist and project manager for the quality registry at Lovisenberg DPS.
- But the biggest advantage of the system is automation. This frees up time for clinicians because patients have answered the surveys in advance of the appointment. Compared to how other hospitals have arranged data collection, our setup is very time-saving, says Halland.
Head of Analysis Per Arne Holman at Lovisenberg Diaconal Hospital believes the systematic approach and evaluation of processes can be used by healthcare institutions across the country.
- CheckWare’s software solution ensures that important questions are asked to the patients. Clinicians get a better overview of what is most important for the patient and can prioritize accordingly. In an efficient way, the planning, assessment, and evaluation of patients’ treatment within substance abuse and mental health are systematized. In addition to systematics and efficiency, we wanted to establish a quality register. When we collect this data, we reuse it in our local quality register, which we have called LOVePROM, he explains.
Patients have a response rate of 70-90%
There is high acceptance among patients to participate. At times, the response rate has been above 90, but it is now slightly lower, probably because even more patients have been assigned the questionnaire.
Patients can respond from home using a mobile phone, tablet, or computer. The answers are presented as a graphical report in the patients’ journal and are therefore immediately available to the clinician.
How the results are presented is an important success factor for clinicians to actively use it and monitor progress during treatment, according to Even Halland.
What is somewhat revolutionary is that patients write in their own journal. Clinicians can compare the referral, for example from a general practitioner, and what the GP has written in the journal, with the patients’ own thoughts on 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 always makes a point of reviewing the feedback in the reports before patients arrive for their appointment.
- I use the information at the start of the session. I talk about which direction things are going and what may explain why it’s going up or down. Then we discuss it, she says. In addition, Hantveit looks at the relationship between the referral and the answers provided.
- These do not always correspond. The referral might sound pleasant and straightforward, and then a patient I do not know shows up with serious symptoms. That can be surprising, says Lina, who is a great advocate of the system.
- I love the setup; I feel it provides great reassurance! Patients also follow their progress, look at their graph, and reflect on their situation themselves: What causes me to go up and down?
Psychologist Kaja Asbjörnsen Betin is satisfied that she gets significant clarifications from the start and can quickly initiate a conversation with the patient.
- I can be more present and truly meet the person who comes through the door because I do not need to focus as much on assessment. By having the assessment report integrated into an automated system, I can connect better with the patient. It becomes easier to establish a good relationship at the first meeting when I have this tool with me, she says and considers it especially useful when treatment doesn’t work 100 percent.
- What is somewhat revolutionary is that patients write in their own journal. Clinicians can compare the referral, for example from a general practitioner, and what the GP has written in the journal, with the patients’ own thoughts on what they want help with. This is something new and important for the clinicians, says Even Halland.
Transparency about results provides a basis for learning and development
Each clinician and section can use the information to reflect on their own practice and improve treatment quality.
- 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 what doesn’t in my treatments, says Halland.
The data is transferred automatically to the local quality register LOVePROM. Lovisenberg uses data from the quality register to explore, among other things, connections between treatment length, treatment intensity, and outcomes.
- There will always be pressure on healthcare services regarding financial frameworks; therefore, it is important to demonstrate that good frameworks provide good treatment, says Halland.
Innovation in close collaboration
Lovisenberg reports that over 15,000 patients within specialist healthcare at the clinic have so far used CheckWare. The feedback from patients has been unanimously positive.
In collaboration with CheckWare, Lovisenberg has taken on an innovation role to further develop the tool. Lovisenberg works closely with CheckWare and is constantly searching for features that more people will want.
- When we combine patient-reported data with administrative data – refusals, waiting times, number of contacts, duration, frequency, diagnoses, procedures, and care pathway codes – we have the basis for a register that can also meet the needs of management, bureaucrats, and politicians, adds Per Arne Holman.
- This includes easier registration of relevant information, sharing information with municipal employees and general practitioners, and data from sensors and biomarkers that can be sent directly to the patient journal, says Holman.
Lovisenberg's use of CheckWare
Customer of EG CheckWare since 2013.
Approximately 120,000 assessments through EG CheckWare for about 6,000 patients in 2020.
Lovisenberg's CheckWare solution includes integration with DIPS and QlikView for automatic transfer to the medical records system and presentation of aggregated data.
Innovation in close collaboration
Lovisenberg reports that over 15,000 patients within specialist health services at the clinic have so far used CheckWare. Feedback from the patient side has without exception been positive.
Lovisenberg, in collaboration with CheckWare, has taken on an innovation role to further develop the tool. Lovisenberg works closely with CheckWare and is constantly searching for functionalities that more users will want.
- When we combine the patient-reported data with the administrative data – refusals, waiting times, number of contacts, duration, frequency, diagnoses, procedures, and care pathway codes, we have the basis for a registry that can also meet the needs of management, bureaucrats, and politicians, adds Per Arne Holman.
- This includes easier registration of relevant information, sharing information with municipal employees and general practitioners, and data from sensors and biomarkers that can be sent directly to the patient record, says Holman.
