In May 2022, the casualty clinic serving the seven municipalities of Søre Sunnmøre in west Norway went live with a cloud implementation of CSAM AMIS – the first “legevakt” to do so.
“There are just two of us running the clinic, two nurses,” says Erlend Bae, manager of Søre Sunnmøre. “It’s difficult for us to maintain data programs especially with data security being such a huge concern. But with the cloud it’s largely plug and play so we can concentrate on the jobs we were trained to do: delivering the best healthcare to our community.”
The bold step to take AMIS to the cloud has its origins in the decision by the Søre Sunnmøre municipalities to take over the management of out-of-hours health provision from the local hospital and set up their own casualty clinic. Municipalities are responsible for out-of-hours care, but Søre Sunnmøre had effectively outsourced its 116 117 services to the hospital. The choice to set up and manage an inter-municipal casualty clinic – or “legevakt” – in a separate location and without support from the hospital, had huge implications.
“Everything is new,” says Thea Bergmann, deputy manager of the Søre Sunnmøre clinic, “new premises, new beds, new medical equipment, new PC hardware and so on. We had to take so many decisions, big and small. What brand of band-aids are we going to order? And what software system do we use to handle calls?”
Søre Sunnmøre gave serious consideration to the question of whether to stick with CSAM AMIS, which the hospital had used for both 116 117 and emergency 113 calls, or to switch to a new vendor – and a different system. Two factors massively tipped the scales in favor of AMIS.
The first was continuity. The hospital had been using AMIS since 2012, and most of its 116 117 operators would move over to the new legevakt once the 116 117 function had been formally severed. Also, it is important that casualty clinics have seamless access to the ambulance services run by the hospital – and this is optimized by the two “speaking the same language”, as Bergmann puts it.
“I didn’t want us to adapt to a new system,” says Bae. “My view was: if we can find a way of going forward with a system that we know then that would solve a lot of problems.”
One of these problems was technical. Like the vast majority of Norway’s 356 kommunes, the municipalities of Søre Sunnmøre are small; the largest, Ørsta and Volda, have about 10,000 citizens, with the least populated, Vanylven and Sande, just over and just under 3,000 respectively. Overall, the new casualty clinics serve a population of around 50,000 as well as the many tourists that visit what is a particularly stunning part of Norway.
“We needed a safe and stable solution,” says Bae, “but the municipal IT resources were unfamiliar with the way we work and would not be able to handle support and maintenance of a complex and data-sensitive platform such as AMIS or any other medical emergency platform.”
When CSAM proposed offering the latest version of AMIS as a cloud solution, the die was cast: Søre Sunnmøre opted to roll out AMIS 3 as its call response technology platform.
This did not happen overnight; Bae and Bergmann admit the process took longer than they had anticipated. One unexpected obstacle was the legal complexity around access to historic patient data stored at the hospital. “Obviously, we needed to have the patient medical records of the people living in our communities; indeed, one of the benefits of AMIS is that it links to these data – but only if you have them!”
Data security was paramount, and CSAM thought very carefully about how to make the cloud platform 100% robust and secure, as Kjellrun Borgmo, Domain Manager, Prehospital Emergency, CSAM, explains. “The plan initially was to install everything on local clients, but it was then decided we wanted to have everything in one environment just to make sure that we had full control if something went wrong.”
CSAM partnered with managed service provider Basefarm to host the system.
The connection with Søre Sunnmøre hardware also required rigorous consideration. “We wanted to create VPN connections with the local IT infrastructure, but this was unsatisfactory from a data protection point of view,” Borgmo says. “For maximum security, the clinic now uses a remote desktop solution that goes through Norsk helsenett, the Norwegian digital health network.”
One integration that has not yet to be carried out is to link AMIS to the Norwegian telephone system. This will provide operators with the caller’s telephone number and associated information around caller ID, address, other members of the household, and medical histories – if the caller has contacted the local 116 117 service before.
While CSAM was implementing technical aspects of the cloud implementation, Søre Sunnmøre used the AMIS 2 version installed at the hospital. “This was a temporary solution,” Bergmann says, “but it worked because of course we were all familiar with AMIS.”
“We did get impatient,” Bergmann admits, “but the cooperation with CSAM was always good. Kjellrun included us as often as she could so we always knew when something would happen or when something would not happen. And anyway, our focus after we opened in February 2021 was dealing with the Covid crisis among many other things.”
The cloud version of AMIS 3 went operational in May. Apart from a few teething problems around self-service passwords, the implementation has been a success.
“It has been an interesting process,” says Bae. “It took some time. But it’s been positive. CSAM did what it could to help and were always cooperative. Basefarm, which is hosting the server, is a serious company. It is getting better every day.”
Bae and Bergmann are probably too modest about what they and Søre Sunnmøre have achieved. Last year, the legevakt handled 35,000 calls, 100 a day, in addition to treating patients who arrived directly to the clinic in person (“and every day there is a tourist,” Bergmann adds). A team of some 20 operators, working round the clock in shifts staffed by one or two, has been successfully transplanted from a hospital environment to a new location within relatively easy reach of the seven municipalities. Finally, the Søre Sunnmøre initiative was the impetus for CSAM to innovate its AMIS offering and make it accessible for even the smallest municipality.
The autonomy of the kommune is a cornerstone of the Norwegian way of life. We often hear about the disruptive effects of technological change, but the cloud adoption of AMIS 3 shows it can also do the opposite and protect time-honoured habits and traditions.