Digital home monitoring from CheckWare became the lifesaver for the Department of Neurology at Drammen Hospital when waiting lists increased and resources remained the same.
Since 2019, epilepsy patients have been offered a digital user-driven outpatient clinic and a much more unified and efficient service. Before this, the Department of Neurology at Drammen Hospital in Vestre Viken Health Trust faced challenges that many other healthcare providers can relate to.
Despite an increasing number of patients requiring healthcare, the available resources were not increased accordingly. This resulted in long waiting lists and a focus on sending patients back to their general practitioner for follow-up after diagnosis.
Digital home monitoring with CheckWare thus became a highly anticipated solution. For two years, Vestre Viken Health Trust has offered digital epilepsy follow-up to all patients who have had a consultation at the clinic. The department has been able to follow up 13 times more patients than before.
Marte Syvertsen, a doctor at the neurology department at Drammen Hospital, is full of praise for the solution they have used:
- The service is now more uniform and equal for everyone, and not as dependent on the individual doctor as it was before. This means we get standardized follow-up that ensures all patients are asked the same questions. This way, we can be a bit proactive and notice if there is a trend going the wrong way, contact the patient, and address it much faster.
Today, patients are offered digital remote follow-up when they come for their first consultation at the clinic. Syvertsen finds that patients are largely satisfied with the digital self-reporting solution and appreciate being able to participate in their own treatment from home, without having to take time off work to attend appointments with the department.
- Traditionally, it has been somewhat difficult for patients to reach the doctor, and we feel this is resolved when we work this way. Many patients are pleasantly surprised that we are the ones who initiate contact because they are used to waiting in phone queues with a secretary and feeling like they are bothering someone to get healthcare. We specialists become more accessible, and I as a clinician can have closer and more dynamic dialogue with the patient than before, says Syvertsen.
The service is now more uniform and equal for all, and not as dependent on the individual doctor as before. This results in standardized follow-up that ensures all patients are asked the same questions. This way, we can be proactive and notice if there is a trend going the wrong way, contact the patient, and address it much faster.
Cumbersome guidelines
The clinicians at the department have felt there was a large gap between national guidelines and what was actually feasible in practice. The national guidelines for epilepsy treatment stipulated that all epilepsy patients should have annual contact with a regular neurologist. Clinics were applauded internally if they could meet this goal by ending the control appointment and sending patients back to follow-up with their GP. This freed up resources to treat more patients.
Patients also experienced the treatment process as cumbersome and uncertain. If the patient's symptom burden was low and stable, follow-up was ended. If symptoms recurred, it meant another round with busy general practitioners for referrals. The GP often had to describe the illness course again. Then the patient was placed on yet another waiting list before meeting a new neurologist unfamiliar with the patient or their medical history.
Marte Roa Syvertsen, who also wrote her doctoral thesis on epilepsy follow-up, says the following about the situation they were facing:
- Many newly diagnosed patients felt insecure and alone. They felt they were given a diagnosis and sent home. They were in a kind of vacuum, scared and uncertain. In cases where the neurology department believed the patient should be followed up, the follow-up appointment was set 12 months later. Many patients had to take time off work to attend these appointments, often symptom-free and essentially without need for healthcare.
The consequence was an overburdened on-call system because many patients did not show up for scheduled appointments, while others felt they did not get help when they needed it outside the annual follow-up agreement.
CheckWare’s system frees up resources
For patients, the follow-up has improved. Where patients were previously sent back to their GP for all inquiries outside scheduled appointments, the clinic now handles follow-up. They are no longer sent back and forth between clinic and GP and can use the digital home monitoring service as long as they want.
- Epilepsy is a chronic diagnosis and will not go away. Therefore, follow-up should not end just because the patient at a given time experiences low symptom burden, explains Syvertsen.
All patients today receive the same assessment at startup, and then every six months. Patients receive a text message with a link to the assessment. Responses are automatically sent to the hospital and given either a green, yellow, or red color code.
For red (worsening symptoms), the clinician will quickly respond to the patient. The patient is then offered consultation by phone or at the hospital. For yellow, the clinician needs more information and will retrieve patient history from the medical record. The clinician can then evaluate symptom burden and contact the patient if needed.
If all answers are green, there is no need for the clinician to contact the patient, who then does not need to come in for an appointment. If patients experience changes in disease activity, they can log in at any time and report their own health. These responses will also be color-coded and followed up in the same way as regular reports.
- The threshold is very low for a patient response to receive a yellow code, so we feel very confident that responses with a green code are safe, says Marte Syvertsen.
For me as an epilepsy-competent doctor, it is a huge difference in how many patients I can oversee and monitor compared to before CheckWare. I have observed an increase from ten patients annually to the current 131 patients, while not spending any more time on patient-related work than before.
Able to follow up many more patients than before
Marte Syvertsen is employed in a full-time research position but also follows up a number of patients at the clinic. Previously, the number of patients she had time and capacity to follow up was very limited. Today, a nurse with a 20 percent permanent position handles 84 percent of all inquiries related to assessments. Doctors only get involved in the remaining 16 percent of inquiries that received a yellow or red code.
The clinic’s responsible doctor acts as a backup and advises the nurse who receives all patient inquiries. This has enabled increased capacity and follow-up services for more patients:
- For me as an epilepsy-competent doctor, it is a huge difference in how many patients I can oversee and monitor compared to before CheckWare. I have observed an increase from ten patients annually to the current 131 patients, while not spending any more time on patient-related work than before.
This corresponds to a 1210 percent increase in the number of patients. The clinic has also seen other positive outcomes from the solution:
Only three percent of patients need to show up at the hospital as a result of patient-reported responses.
- We have gained a tool that allows us to follow patients more closely and provide them better healthcare services, without using more resources than before. We now receive health information from patients regularly, enabling us to assess the real need for doctor contact. Unlike before, when we roughly guessed when the next appointment was needed, we can now do it based on actual reported patient health, says Syvertsen.