Regional elections “You can even on the phone” – A revolution is starting all over Finland that will change our perception of medical care

An experiment is underway in Espoo and Vantaa, which is still modest in size. However, it says a lot about the huge change in health services that is going on all over Finland.

One the doctor in turn Arja Kobylin was in a dreamy bed with little to start with in her nightgown and not in her casual clothes. Although this has already been discussed: should a doctor always have a doctor’s jacket, even at a video reception?

Even such hilarious details are being considered as hospitals build new electronic services. What matters is, of course, not the doctor’s ability to be at home casually, but the fact that the emergency patient is allowed to be at home and still feel safe.

The emergency services in Jorvi and Peijas are now testing video recordings for some patients as the first emergency service in Finland.

The experiment is small, but part of a huge change in social and health services.

One there is also a video connection and a reception room. What matters is encounter, eye contact, trust.

“Talking from person to person,” says Kobylin.

Remote services are being developed because some patients want them. They are forced to be created, due to the tightening economy, the shortage of key professionals and the massive maintenance debt raised by the pandemic.

The election commissioners who will be elected in the January elections will have to think about the ways in which the services will be organized in the future. Therefore, we present in more detail what is currently being done in Jorvi and Peijas and how it may soon be visible throughout the Helsinki Metropolitan Area and Uusimaa.

Peijas and Jorvi’s telemedicine is a 2.5-month pilot trial.

Video receptions have long been a daily occurrence for private physicians. During the pandemic, they have been added at many health stations, for example in Kilo, Espoo.

Emergencies have not dared to do the same in the past because the most sick patients are selected there.

Kobylin says that’s why patient safety comes first in the experiment. It is important to identify both the patients who benefit from the videologist and those who are on-call.

The goal is to make the patient feel better. Not everyone is forced to travel to the emergency room and sit in the waiting room at worst for hours when they are sick, tired or with small children.

If some stay at home, waiting times for those arriving on call may be reduced. Nursing time is saved when the need to care for video patients does not have to be assessed twice, first on the phone and then face-to-face at the reception. The doctor will have time to treat a little more patients when there is no time left for transitions. It has been easy to attract doctors to work because part of the profession specifically likes telecommuting.

At least during the pilot, the remote doctors are on duty extra. There is no less doctor on call on site than would otherwise be the case.

Kobylin makes the video shifts himself, but he’s really a ward chief. In addition to him, it is the turn of six remote doctors to tour. One is at a time during peak hours, ie on Friday evenings from 4 pm to 10 pm and on Saturdays and Sundays from 8 am to 10 pm.

Department Chief Arja Kobylin also makes video shifts herself.

Electronic There is both a desire and a must for the wider use of services throughout Finland.

Digital services are promised to be improved in the SOTE reform so that help is available more quickly.

In the Helsinki metropolitan area, for example, various chat services have been used and rehabilitation has been arranged for the elderly. Some of the home care visits have also been handled remotely. At the latest during Korona, most people have ended up using at least Omaolo or coronabot – a service that gives people instructions based on their symptoms.

Video receptions used to be common on the private side and rare on the public side. The pandemic forced change. Now the strategy of the Helsinki and Uusimaa Hospital District (Hus) would be to further develop this as well.

In Hus, long-distance traffic grew rampant in 2020, but this year a step back has been taken. In part, this may be because remote connections were used in the face of coercion, even where they don’t really fit.

“But there has been too much backpacking here. Now we don’t want to increase the number of visits mechanically so much as to identify the groups of patients who benefit most from them, ”says Hus’s Director of Development. Visa Honkanen.

In psychiatry, for example, the number of long-distance visits is still about 50 percent this year.

In other diseases, Honkanen estimates that something may go unnoticed at the first visit and at the time of diagnosis if you do not meet face to face. Video visits should only be introduced where they are an effective treatment.

Its instead, follow-up visits would often be sufficient for adults. Discussion and laboratory results are important, for example, in the treatment of diabetes.

In addition to video visits, an important role is played by the electronic transaction service Maisa, which allows a person to both communicate with professionals and see their own research results. Honkanen says that patients and customers often find Maisa useful. On the other hand, the staff still need to be reassured that the time spent in Maisa will be rewarded later by the fact that less time is spent on telephone work, for example.

“There is a lot of international research showing that a person’s ability to see health information about themselves more broadly also benefits the system.”

“You can come to the emergency room if you find it easier.” – Nurse Heidi Puustinen

Nurse Heidi Puustinen is working in the emergency room. Most days he sits answering the phone.

Route the emergency doctor goes to the emergency room anyway: first call the emergency number 116 117.

For example, an experienced nurse is answering the call Heidi Puustinen. Anyway, his job is to assess whose ailment belongs to the emergency room, who has adequate instructions for home care, and to whom an ambulance is ordered.

The possibility for a videologist also does not change the fact that the assessment of the need for treatment is as systematic as possible. The nurse has considered battery issues and the opportunity to consult a doctor. For the same condition, the decision may be different, depending on, for example, the patient’s underlying conditions and the caregiver’s findings.

“Take breathing difficulties, for example. Even on the phone, you can hear, for example, whether a person can only speak single words or whole sentences, ”Puustinen explains.

If the patient is expected to benefit from video reception, it will be offered to him. Otherwise not.

Then there is the technology. Making a video connection is not impossible, but you need to be able to implement both the Maisa electronic transaction service and a separate video application.

“Technical skills are not age dependent. Some find this too difficult. Some don’t just want to connect remotely, and that’s just enough. You can come to the emergency room if you find it easier, ”says Puustinen.

Video connection it does not make sense to suggest for an emergency patient whose diagnosis or treatment requires contact. The ankle cannot be plastered remotely.

So these are diseases that a doctor identifies by looking, listening, and questioning: various types of respiratory ailments, back pain, and mental health problems are typical.

“For example, breast inflammation in a breastfeeding mother can also be seen on the skin through a video. In addition, I ask, for example, if my breasts are hot. With back pain, I can ask the patient to show how even if the bending forward is successful, ”Kobylin describes.

Treatment instructions can be given remotely, as well as prescriptions and sick leave certificates or consulting with another professional. If tests are needed, the patient can be referred to the laboratory despite the telemedicine.

Pilot experiment During the time, about fifteen percent have needed treatment elsewhere after a video connection. These are not only those who have proved to be emergencies, but also people whose illness has been prolonged and who have subsequently applied to a health center.

Feedback from patients has been exhilarating. In the coming weeks, it will be decided whether to extend the model to other emergency services in Uusimaa. In Helsinki, Malmi and Haartman offer similar services for adults.

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