Psychogeriatric SOS: A unique clinician-to-clinician web-based service for rural and remote clinicians

Introduction: The Norwegian Anti-Discriminatory and Accessibility Act adopted in 2008 states that web based electronic services geared towards the public should be accessible to all. Today, the web content accessibility guidelines (wcag-2) is an agreed standard in Norway. However, it should be fair to state that the developers of Norwegian e-health services have not focused on universal design to any particular extent. To obtain a brief estimate of the status in the field, we have investigated the accessibility to some randomly selected e-health services, applying a ad hoc user panel of 4 persons.

Methods and materials: We have during 2015 set up a Windows 7 machine with NVDA synthetic speech output and a Brazie Powerbraille display installed. Using Mozilla Firefox, we have investigated the accessibility to 11 Norwegian web based health services. Our investigation included state, municipal and private service providers. The wcag-2 standard and “Referansekatalogen for e-helse” constituted the point of offset for our evaluation. Four users were given specific tasks in connection with each website, and we observed and interviewed the informants as they interacted with each service.

We focused especially on the users' ability to operate the services with the keyboard, and if all the functionality on the web pages could be utilized without applying a mouse.

Results: The Helseportalen (https://helsenorge.no) provides access to the electronic health record for Norwegian citizens and constitutes a major national initiative in the field of e-health. To which extent can this service be regarded as universally accessible? The html code was found to be robust and consistent, and the functionality, which we investigated, could be operated by the keyboard.  This was not true for all of the services, which we evaluated. The login to Helseportalen can be done with mobile bank id, or by a code generator equipped with synthetic speech. However, the initial registration of login method could not be performed by our users. The login to Helseportalen relies on services from private enterprises, and are not necessarily free of charge.  The quality of the code on the various sites varied considerably, which potentially causes problems for users of peripheral equipment. Inconsistent use of html headline-tags slows down navigation on several of the evaluated pages.  Multimedia content is not followed by a descriptive text (not required by wcag-2 level aa).

Discussion: If the construction of e-health services is regarded a work process involving planning, prototyping, implementation, testing, refinement and documentation, the users should be involved in each of this phases to ensure accessibility to the services made. User oriented design methods have a stronghold in Scandinavia, but if for economic or practical reasons such approaches are not regarded feasible, expert evaluations with emphasis on accessibility should be performed on each stage in the development cycle. Background:

Rural mental health services are under-resourced and over-burdened. Given the aging population and escalating health costs, we need to innovate to solve this resourcing crisis. Psychogeriatric SOS is a unique service that offers information, advice, supervision, training, education and case conferencing to rural and remote clinicians working with older adults across all disciplines, allowing them to establish a supportive professional relationship with our psychogeriatric multidisciplinary team via a web-conferencing platform. This nascent service has the potential to be a pathway for more efficient use of time for primary clinicians and specialty psychogeriatric services.

Aims:

To describe rural clinician/user demographics, delineate how this model satisfies unmet clinician professional needs, and determine whether it improves clinician confidence. It will also provide a forum in which members of the Australian GP community can make comments and suggestions.

Methods:

Rural and remote clinicians in three under-resourced local health districts in NSW and one NGO were provided this service in 2015. During the first 12 months, demographic data, uptake rates, user satisfaction, and pre- and post- intervention clinician confidence measures were collected.

Results:

100 registrants participated in a combination of 15 education forums, 25 case conferences and 14 supervision sessions. Confidence questionnaires indicated confidence depended on clinician, context of practice, and number of years practicing (with those having worked 1-5 years being the most confident followed by those having worked more than 21 years). The most prominent areas of need identified by clinicians were educating patients’ carers, and education and case conferencing around clinical psychogeriatric issues. All users returned to use the service more than once.

Conclusion:

There is a need for the Psychogeriatric SOS model of e-health rural outreach, which may constitute a step towards the more efficient and effective use of mental health resources in rural and remote Australia.