Safe medical advice over the phone

25 August 2020

The idea to give medical advice safely over the phone originates from over a decade ago. The joint development of the cluster has now grown into the personalised consultation service provided on the Family Doctors’ Advice Line – the doctor answering the phone can see the callers’ personal health data with their permission to be more accurate in their advice.

According to Klarika Kallikorm-Rannamets, service manager of the Family Doctors’ Advice Line, the team working at Arstlik Perenõuandla had the idea for a personalised consultation service 10 years ago. “We were looking for a way to bring this idea to life,” says Kallikorm-Rannamets, “and an opportunity presented itself in 2016 with the joint development project of the Connected Health Cluster. We were immediately able to engage interested IT partners such as Esecom International OÜ. There was no such service in Estonian medicine 10 years ago and Esecom shared our view that there was potential for an authenticated phone service.”

“The initial version was born as part of a joint development project with the cluster in spring 2018,” says Kallikorm-Rannamets on the project. “We presented it to the Health Insurance Fund and filed an application to include the personalised remote consultation service on the list of healthcare services. At the beginning of 2020, the solution was officially included in the list of healthcare services.”

The project did not get off to an easy start. “We have come a long way and learned quite a lot from the ordeal,” says Kallikorm-Rannamets. “The country was probably not ready for a service as innovative as this back in 2018. We were thorough in our preparations to explain how everything is compliant with regards to data protection. At the beginning of 2020, we were able to say that the service is ready for use. The service was provided from January to mid-March when the coronavirus hit and we stopped personalised consultations temporarily to divert more resources to anonymous consultation. Usually, we have 600 to 800 calls in 24 hours, but in the days following the establishment of the emergency situation, we answered over 2000 calls per day.”

Klarika Kallikorm-Rannamets says that the technical solution they employ may no longer be quite as unique, as there are now others offering similar solutions. However, they still consider themselves pioneers when it comes to creating an authentication method.

Medical advice over the phone

Kallikorm-Rannamets describes the Family Doctors’ Advice Line service as being provided only over the phone. “The call starts with an introduction of the line the caller has reached,” she describes the counselling service, “we then present the consultation options: they can press one for an anonymous consultation and two for a personalised consultation. In the latter case, the caller is asked further whether they prefer authentication via Mobile ID or Smart ID.

Once they have entered PIN1, the counsellor will see the caller’s name and personal identification code on their screen and can use that to access the healthcare system for necessary information. For example, if the person has a chronic illness and they are considering taking an over-the-counter medicinal product, our counsellor can see from the information system or the Estonian Medical Prescription Centre which medicinal products the caller is already taking, how their illness has progressed and view epicrises where necessary to give the best possible advice.”

“No big undertaking happens quickly”

“What I learned from the process,” says Kallikorm-Rannamets, “is that no big undertaking happens quickly. I have headed large projects before, but in this case it was more than just service development – we actually learned a lot about our partners’ areas of activity and vice versa.

We took into account that the provision of any such service would have to involve the Health Insurance Fund and they have their own team of experts who review applications for new services. The first time around they found it to be too innovative. It took some time to prove and highlight that the service is safe.

There were no particular disputes, it was simply the case that implementing a new service requires analysis and expert assessments. By now, we have the approval of experts and the service has proved itself in practical terms.”

At the beginning of this year, the health insurance fund received a monthly analysis: there were on average 200-300 personalised calls per month. “In most cases,” summarises Kallikorm-Rannamets, “personalised calls concern seasonal illnesses or so-called common topics that are also addressable on the anonymous line. Around a quarter of calls ask about children; however, in this case, we can give general recommendations, we cannot provide personalised advice on children.” “The average caller is 20-45 years old,” she adds, “probably the same target group who is uses Mobile ID.”

The call is recorded in the Patient Portal as it constitutes important information for family doctors. “This leads to one of our next objectives,” says Kallikorm-Rannamets, “our entries in the Patient Portal are currently not sufficient grounds for family doctors to retroactively open a certificate of incapacity for work. Say for example that someone works in shifts and has to work on a Saturday – should they fall ill, they are currently forced to either call an ambulance or go to an emergency care centre to record their medical condition. We also believe this solution has the potential to reduce doctors’ workload, there is no reason for an ambulance to record a temperature of 37 °C.”

The Family Doctors’ Advice Line does not yet issue prescriptions, but this is also something to be addressed in the near future. “We want to come to a detailed agreement with family doctors,” says Kallikorm-Rannamets on their plans for the future, “to what extent and with which medicinal products could a prescription renewal be made? Those with chronic illnesses usually have their prescriptions renewed well in advance, but occasionally there may be urgent need for a particular medicinal product. It is important to make the appropriate entry in the Patient Portal so that family doctors can see which medicinal product was requested or which recommendations were given for home use.”

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