Publicerad: 2017-04-17

Real challenge to implement Cambio COSMIC on the world’s largest island – in the middle of the Arctic

The world’s longest “commute”? Danish Christina Silseth Bartholdy commutes more than 3,500 kilometres to work at the Dronning Ingrids Hospital in Nuuk, Greenland. And when she arrives, she often faces more travelling – by aircraft or helicopter across the huge ice cap. The island’s most northerly health facility is 2,000 kilometres from its most southerly health facility…

Christina Silseth Bartholdy is in Greenland to complete the implementation of the healthcare information system Cambio COSMIC. Work has taken two years and is scheduled to be complete in autumn 2017. Cambio COSMIC will then have been introduced into the entire healthcare sector in Greenland – with about 800 employees and almost 75 different healthcare facilities varying in size, from hospitals to small care centres. A total of 56,000 people live in Greenland.
“Cambio COSMIC provides us with IT support where all patient information is assembled in a single journal system. It feels fantastic that the goal is now within reach,” says Christina Silseth Bartholdy, who has been part of the entire implementation.

Active project group
Cambio COSMIC is replacing the previous journal system being used in parts of institutional care. During the implementation, the two journal systems are being used in parallel, but the older system will subsequently be phased out.
The practical work will be run by a small project group of four people – supported by Cambio Healthcare Systems in Denmark. Christina Silseth Bartholdy is project manager and her team includes an IT consultant, a head doctor and a superuser coordinator.
“The project group is responsible for implementation, configuration, testing, upgrading, coordinating, support, training, information, guidance… Well, more or less everything,” says Christina Silseth Bartholdy.

Major challenge
Christina Silseth Bartholdy is an intensive-care nurse, but also has a Master’s degree in health informatics. She has previously been responsible for implementing Cambio COSMIC in the Danish defence force’s healthcare system. Implementing a complete journal system in Greenland involves new and different challenges, according to Christina Silseth Bartholdy. One of these is the technical infrastructure.
“Data communication in Greenland uses submarine cables, radio links or satellite. But geography and the extreme climate can impact the technology, which means there is a risk that the journal system is not always online. Cambio has therefore developed a solution that offers caregivers constant access to a reading state with saved information,” explains Christina Silseth Bartholdy.

Heavy weather and high staff turnover
Greenland is the largest island in the world, with a surface area five times larger than Sweden. The distance between different healthcare facilities is large and the road network is poor. It takes time, and is also very expensive, to move across the island. Instead of driving, you travel by aircraft or helicopter – but the timetable is often disrupted by snow and storms.
Another challenge is the uneven level of education among caregivers, and the high staff turnover. Only 250 people have been employed for more than two years. The healthcare system is otherwise maintained using temporary doctors and other short-term temporary staff.
“In practice, this means that just over 2,000 employees circulate through the organisation during a year, despite the fact that there are only about 800 jobs,” says Christina Silseth Bartholdy.
The large staff turnover also means there are constantly new members of staff who need to learn to use the journal system.
“The official language in Greenland is now Greenlandic, but as many temporary staff are from Denmark, we provide information in both languages,” explains Christina Silseth Bartholdy.

Method of implementation
The project group developed a method for implementing the new journal system at the various care units. Initially, there is always a physical visit.
First, superusers are trained, followed by the standard users. The system is then deployed step by step.
“Staff train using the new functions and we are available at the location during a few intensive days to offer advice and support. When we leave, the system is being used fully in day-to-day operations. But it is important to use the time efficiently as it may take one to two years before our next visit,” explains Christina Silseth Bartholdy.
In the interim period, distance meetings are available – both telemedicine and videoconferencing are common in Greenland. In addition, within the framework for Cambio COSMIC, video meetings can be arranged between doctors and patients, as well as multidisciplinary conferences and various training activities.
“Considering the distances involved, I believe this function in Cambio COSMIC will eventually be heavily used,” says Christina Silseth Bartholdy.

Increased patient safety
Together with the rest of the project group, she is looking forward to finishing the extensive implementation phase.
“Soon, Cambio COSMIC will be widely introduced in Greenland and we can coordinate a patient’s healthcare progress across all professional boundaries and forms of care,” says Christina Silseth Bartholdy.
She adds that the need for planning is particularly great within Greenland’s healthcare system.
“Specialist doctors are sent to the regions a few times each year. Logistics must then work perfectly. Otherwise, patients must travel to the Dronning Ingrids Hospital, which entails long journeys and unnecessary waiting times. Thanks to COSMIC, we can now provide better planning, which will increase patient safety and healthcare quality,” states Christina Silseth Bartholdy.

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