Meet our partner eMeistring – Helse Bergen

Foto: Anne Christine Olsen

Forhelse has three eMestring-partners, and eMeistring in Helse Bergen is one of them. They offer internet-based treatment for anxiety, panic disorder and depression. They are also working on the development of digital treatment programs for patients with insomnia and ADHD.

We have had a chat with the subject manager, Gunn Elise Sætre, about the work they do in eMeistring and why they wanted to be part of the center.

Gunn Elise Sætre, Head of eMeistring Health Bergen

What was your motivation behind joining the center?

eMeistring in Helse-Bergen has used evidence-based digital tools in the treatment of anxiety and depression in the specialist health service since 2013. We receive good feedback from patients who have received treatment from us, and we want our participation in the center to help motivate decision-makers to make use of digital treatment interventions to a greater extent, by providing increased knowledge about how it can be done in a cost-effective way.

eMeistring Helse Bergen is part of two work packages – cost/benefit and implementation. They will contribute with number materials, knowledge and experiences with the use of digital psychological treatment in studies that will examine the extent to which such interventions are cost-effective and that look at the effect of different implementation strategies.

Why is digitization important in the health sector?

The use of digital health services has the potential to reach a larger number of patients than traditional treatment and provide an equal offer regardless of factors such as demographic and social conditions. It can also contribute to the professional resources in the health services being distributed in a better and more efficient way.

What do you want to achieve during the 8 years the center will exist?

We want even more patients to be offered treatment in eMeistring. We also want efforts to be made to develop and facilitate the implementation of treatment programs for more conditions than we currently have.

If you want to read more about eMeistring in Helse-Bergen, you can do so here.

Visit by experts from the Scientific Advisory Council to Forhelse

Visit by experts from the Scientific Advisory Council to Forhelse

On May 19th and 20th, Forhelse received a magnificent visit from researchers from the Scientific Advisory Council (SAC). The two days were characterized by useful and good conversations about digital health services.

The three experts were Professor Nick Titov at Macquarie University in Australia, Professor Heleen Riper at the Free University of Amsterdam and Professor Lee Ritterband at the University of Virginia. The purpose of the visit was to get input and professional discussions about the center’s work with various research projects.

– We have been very lucky with our SAC experts who have generously shared their years of experience in the development of, and research, on digital health services, says center manager Tine Nordgreen.

Center leader, Tine Nordgreen, opened the gathering by introducing the researchers to the center and the research, and giving them insight into the challenges Forhelse wanted to get input on.

The research in Forhelse is divided into different work packages and several of these were presented during the meeting.

Read more about the work packages here.

Leaders from the work packages and PhDs attended the gathering and helped present the work packages and the research associated with them. Along the way, they received useful input, questions and feedback from the experts and the other participants.

Day one ended with a panel debate on the themes in the work packages.

On day two, Forhelse had invited a research project related to the work in the center. One of these was the recently started project UngMeistring.

Read more about UngMeistring here.

UngMeistring is a project aimed at young people with various mental disorders and the youth group as users of digital health services were specifically discussed. In addition, Solli DPS participated with its project eMeistring – Health and work, which was presented by Henning Monsen.

The collaboration between SAC and Forhelse will continue closely in the years ahead by SAC following up the center with semi-annual reports and digital meetings, as well as a new physical meeting this year.

See more photos from the day below.

Meet our partner St.Olavs hospital

St. Olav’s hospital is one of Forhelse’s eMeistring-partners. They have extensive experience with digital health services and have this as one of their main focus areas.

We had a chat with the section manager in Nidaros DPS, Liv Sigrun Sættem Engvik, about their work and why they wanted to be part of Forhelse.

Section manager Liv Sigrun Sættem Engvik

Read more about Senter for eTerapi here.

What was your motivation for joining the center?

Digitization is one of the main focus areas for St. Olav’s hospital. The goal is to develop and use digital health services where it is suited and provides value. Today’s technology has opened up a large opportunity for further development of our health services. Nidaros DPS at St. Olav’s hospital established Senter for eTerapi in collaboration with Helse Bergen in 2018. We want to develop our digital health services and think it is important to have collaboration across various health trusts in that regard. We see Forhelse, with the aim of increasing the use and effect of digital health services, as a good and important partner in this work.

What is your role/contribution to the work package you participate in?

Senter for eTerapi, which offers eMeistring for panic disorder, social phobia and depression, will contribute to work packages 2 and 4. The work packages will look at the extent to which guided internet treatment is cost-effective and experiences and strategies for implementation. There are key professionals associated with the Senter for eTerapi at Nidaros DPS who contribute with experience from the center, from implementation and figures from operations.

Read more about the work packages in Forhelse here.

Why is digitization important in the health sector?

The demand for treatment for mental health problems is increasing in the population and we are challenged to think differently. Technological developments have made it possible to communicate securely with patients in new ways. Digitization is important for developing better and more flexible healthcare services and for providing a more equal healthcare service to patients regardless of where they live. Digitization also increases the patient’s choice, with the opportunity to choose digital solutions if patients want this. Overall, this will increase the quality of the health service, improve resource utilization and increase patient satisfaction.

What do you want to achieve during the eight years the center will exist?

The issues related to cost-benefit and implementation are very relevant in relation to further development of the digital health service. We think that collaboration with the SFI will provide us with valuable information and expertise related to these areas. We want supervised internet treatment, eMeistring, to become a better known treatment-option in the population, and for more patients to be offered this treatment. We also see the opportunity to develop more treatment programs either in the form of guided internet treatment for several conditions or the development of digital tools to support ordinary treatment.

Two new online treatments for eMeistring in Helse-Bergen

In collaboration with DigiHub in Forhelse, eMeistring has developed two new online treatments for people with insomnia and ADHD.

– We at eMeistring are very pleased with the results of the new programs for Insomnia and ADHD. We are also grateful for the collaboration with Intromat/Forhelse and DigiHub, says section leader in eMeistring, Kjersti Skare

Before Christmas, the work on developing an online treatment program for people with insomnia started. The treatment and the academic content have been developed by Kerstin Blom, sleep expert and researcher at Karolinska Institutet in Stockholm. DigiHub has in collaboration with Blom developed the visual profile and the digital content.

In addition to a strong academic content and method, the program is equipped with a digital sleep diary, a toolbox with information and large amounts of illustrations and interactions that will promote user participation and learning for the patient.

Both treatments are module-based, as you can see an example of here.

After Christmas, the work on an online treatment program for adults with ADHD started. The academic content, and the program, was first developed by psychologist and researcher Robin Kenter, who is also the work package owner in Forhelse.

The treatment which Kenter first created was a self-help program that was used in research into the use of online treatment for adults with ADHD. With feedback from the clinicians in eMeistring, DigiHub has made adjustments and changes to the program so that it can be used with therapist support.

The end product is educational, user-friendly and modern programs that we look forward to using, says Skare.

The ADHD program uses, among other things, videos as a tool.

She says that they are planning a pilot of the insomnia program after the summer vacation and hope they can start using them ordinarily during the autumn of 2022. This also applies to the ADHD program.

-eMeistring is a good offer and we want to reach as many patients as possible with our treatment. Now that we have more treatment programs, we can offer even more patients treatment. Treatment for insomnia and ADHD is in demand in the health service and we have experienced great interest in when programs can be used. We are excited about how the new programs will be received by patients and colleagues.

– It has been very educational and exciting to work with eMeistring in the development of these programs, says team leader in DigiHub, Ingeborg Kløve-Graue.

She says that it as been important in the development to work with eMeistring, who has used online treatment for many years, and to learn from them.

– At the same time, I think they have benefited from our team which has an interdisciplinary background and can help make programs both visually fine, but also user-friendly, says Kløve-Graue.

Both programs are created on business partner Youwell’s platform.

-In addition to a good collaboration with eMeistring, it is also important to have a steady and innovative business partner like Youwell on the team, and I hope and believe this will be a program that is well received, says Kløve-Graue.

Meet our partner Mage-tarmskolen

Mage-tarmskolen is located at Haukeland University Hospital and was the first in all of Norway to establish a digital treatment offer in somatics for patients with irritable bowel syndrome.

They are in the process of a study where 2000 patients will go through a 12-24 week training and treatment program where the patients are supervised through five interdisciplinary digital modules. The aim of the study is to demonstrate beneficial effects in the form of improved quality of life, reduction of abdominal symptoms, provide new knowledge about the interdisciplinary patient approach, and form the basis for a future national project.

Data from this study will also be used in Forhelse to look at predictors of good outcome, which will be important knowledge during implementation.

We talked to the people behind the project and their thoughts on the center.

What was your motivation for joining the center?

Mage-tarmskolen is the first digital health service in somatics. The treatment involves both the physical and the mental aspects of living with chronic stomach ailments. 

For us, this is demand-driven innovation and research with patients in focus. Although this patient group has a great need for health care, this disease is not dangerous or life-threatening. Thus, they are at the bottom of the priority list for the specialist service, and it is challenging for both patients and healthcare professionals.

We want to increase capacity, be able to offer our quality-assured information and health services equally, to everyone in need in Norway, regardless of the patient’s place of residence or their local hospital. We also want to be able to contribute to research on and development of digital health services but also be part of a professional environment.

What is your role/contribution in the work package you participate in?

We are part of work package 4, Implementation with Mage-tarmskolen. This is the only contribution from the somatics in the center. 

In work package 4, the Mage-tarmskolen will research how they/the center can carry out the implementation in a good way, map inhibitors and promoters, and research sustainable implementation.

Read more about work package 4 here.

What challenges do you envision in the project?

As there is no other digital solution in somatics, we have not had anything to lean on and much is therefore new. 

It is important to put in place good financing schemes to ensure hospital financial sustainability. New procedure codes were granted in 2021. These are important for providing earnings that are sustainable for hospital operations. This will also be able to contribute to more resources for the project so that the patient receives good follow-up.

A challenge for the project is to identify who our digital health service is best suited for, and especially who gets the best benefit from the treatment. This is a heterogeneous group that will require different and personalized treatment and follow-up. Funds have been set aside for a PhD project to map this. 

In addition, this PhD project will research effective ways to increase the spread of the digital treatment, map barriers and facilitate implementation of the program so that the treatment becomes available to as many people as possible.

Why is digitization important in the health sector?

As the rest of the world digitizes, it will be important for the health sector to also be involved in the development. 

Digitization means that we can offer the same treatment regardless of place of residence. It will also be able to be cost-effective/resource-saving for both the health services and the patients.

What do you want to achieve during the 8 years the center shall exist?

We also want to implement and national broaden Mage-tarmskolen. Out 2023, this is mainly an offer for patients in Helse-Vest. 

Read more about Mage-tarmskolen here.

Opening seminar for UngMeistring

This week it was time for the opening of UngMeistring. Several of the partners were gathered to get information about the start-up and the way forward.

UngMeistring is a new project in Forhelse in collaboration with several partners. The project’s main goal is to develop and evaluate eight digital online and game-based self-help and treatment programs for young people between 13 and 18 years of age. These programs will address four diagnoses; eating disorders, anxiety, ADHD and depression.

The project was awarded 25 million NOK from the Research Council of Norway under the Pilot Health program. Through its DigiUng project, the Norwegian Directorate of Health has provided additional funding, and is a partner in the project. The project is rented by Helse Bergen and Kristin Bruvik is the project owner.

UngMeistring has an interdisciplinary and broad composition of partners:

  • Helse Bergen HF
  • Helse Fonna HF
  • Helse Stavanger HF
  • Universitetssykehuset Nord-Norge HF
  • Ministry of Health and Care Services
  • Helse Vest IKT (Western Norway Regional Health Authority ICT dept)
  • Sjukehusinnkjøp
  • University of Bergen
  • Bømlo kommune
  • Attensi
  • Youwell
  • SkillUp AS

Project leader Kristin Bruvik was very satisfied with the day;

It was nice to see such great commitment from the partners. This project will challenge new aspects of online treatment that we do not know the answer to, among other things related to how to take care of privacy for young people who do not have a bank ID, says Bruvik.

According to Bruvik, there has been a sharp increase in the need for mental health services for young people in the last two years.

It will be interesting to work with user involvement to understand the needs of the young people we want to help. In the project, we will link technology and professional content in a way that engages young people and that has a positive health effect. We will target both digital platforms such as ung.no where young people can find help on their own, we will collaborate with the municipalities to strengthen their services for young people, and we will strengthen specialist health services with digital tools that can help more people more effectively, she says.

The opening seminar was characterized by a committed and competent group with large knowledge in various subject areas. The project will include clinicians from the BUP services, business partners with experience in developing digital health programs and representatives from both primary and specialist health services.

If you want to read more about the project, you can do it here.

Focuses fully on digital health services for young people

Last week, representatives from UngMeistring were in Oslo to have a workshop with the Norwegian Directorate of Health’s DIGI-UNG. They are one of the partners in UngMeistring and aim to make it easier for young people to access digital health services.

DIGI-UNG wants young people to easily find information and services in one place, rather than looking in a jungle of public enterprises. One of the offers in DIGI-UNG will eventually be the self-help interventions that will be developed by UngMeistring.

Read more about UngMeistring here.

DIGI-UNG currently has seven projects, all of which focus on young people. These are Search, Chat and e-learning which can be found on ung.no, DigiFastlege, DigiHelsestasjon, Rettighetsautomaten, Ungdommens tjenesteportal, Snakk om PSA / SSA and UngMeistring.

Read more about the projects here.

On May 12th, these seven projects came together to get to know each other and learn from each other. UngMeistring competed strongly with three participants; post.doc Thomas Potrebny, PhD student Guri Elise Holgersen and project manager Kristin Hogstad Bruvik.

– We were happy to have the opportunity to meet others who work with digital services aimed at young people, and make contacts that can benefit the project over the next four years, says Kristin Hogstad Bruvik, project manager at UngMeistring.

Post.doc in eMeistring, Thomas Potrebny and project manager Kristin Hogstad Bruvik in the get-to-know-each other-exercise

Visit by the Ministry of Health and Care Services and exciting group exercises

The workshop had a packed and exciting program.

– We had a visit from the Ministry of Health and Care Services, heard about solution architecture in DigiUng and Missions where we were to see where DigiUng is in 10 years, and towards the end of the day a custom-made group exercise where each of the seven project managers were assigned a group of three people from the other projects who knew something that was relevant to a specific problem, says Bruvik.

UngMeistring submitted two issues for this exercise; “What experiences do the projects have with the use of game mechanisms and interaction for young people aged 12-15 and 16-18?” and “what experiences have you had with regard to the storage of personal data and different levels of security?”

– We were so lucky to be assigned three highly competent people for this work: Christian Elvsaas, Morten Nordanger and Robin Føyen. They willingly shared their expertise and experience related to security, privacy, storage of sensitive information, ROS-analyzes and legislation in their own DigiUng projects, says Bruvik.

Further collaboration across Teams

When project manager Bruvik was to present the results of the discussion to the rest of the group, there was only one point under Action points, namely Team meetings.

– The whole day was characterized by openness, warmth and a willingness to share and collaborate on developing good digital services for young people, says Bruvik.

Bruvik says that the project participants from UngMeistring managed to get to know others who have similar issues as themselves, and especially learn from others in the same field.

– We formed networks that we will greatly enjoy further in the project. We greatly appreciate being able to participate in the DIGI-UNG program, says Bruvik.

Meet our health service partner, the Municipality of Bergen

This spring, the Municipality of Bergen in collaboration with Youwell plans to start developing an app for young people who suffer from anxiety. They gained a lot of insight and feedback last year from adolescents in general and from adolescents with anxiety problems.

This spring, work will finally begin to fully produce content for the platform while focusing on user privacy, user testing and universal design throughout the project.

We had a chat with the project manager at the Municipality of Bergen, Ragnhild Thornam, about the project and why they wanted to be part of Forhelse.

What was your motivation for joining the center?

We joined the center to gain experience in developing and using digital health services. The Children and Families Agency places great importance on knowledge-based work. That is part of the reason why developing digital health service based on research was so appealing to us. We also found it exciting and instructive to collaborate with a commercial player who has experience in creating digital interventions.

What is your role/contribution to the work package you are participating in?

The digital treatment for adolescents with anxiety project is part of 2 work packages – efficacy studies and implementation. In addition to leading the project, we contribute heavily by developing a lot of the content and testing out interventions on our users.

Read more about Work Package 1 here and Work Package 4 here.

What challenges are you facing in your project?

Our project targets young people aged 13-16. Creating something that both appeals to them and is useful to your target audience is an exciting challenge. We have therefore placed a great deal of importance on gaining insight into our target group. Going forward we plan to prioritise testing the app among the target group. Other challenges relate to privacy and login. It is also a challenge to make the timelines harmonise when we are three different players working together.

The Municipality of Bergen will cooperate with our commercial partner Youwell, which is responsible for developing the platform on which the digital program will be located. DigiHub will also help us produce and develop program content.

Prosjektleder, Ragnhild Thornam, i Bergen kommune

Why is digitalisation important in the health sector?

For the Municipality of Bergen, we find that some young people do not want to use services that require physical attendance. That is why creating digital alternatives is so important, so we can reach out to more people.

As we expand the scope of the intervention, we hope to be able to help more people at an early stage. Of course, we also hope that digitalisation will allow us to use our resources smartly and efficiently.

What do you want to achieve during the 8 years the center will exist? Our desire is to gain experience in creating and using digital alternatives to the services that exist today. We hope that the knowledge that we gain through collaborating with the center can be used in other development work.

Møt helsetjenestepartneren RBUP

The Regional Center for Child and Adolescent Mental Health, East and South (RBUP) is currently developing an internet program for pregnant women and new mothers called Mamma Mia. It is part of the MaMi research trials that aim to promote good mental health for mothers during pregnancy and the postnatal period.

Researcher Filip Drozd at RBUP

We had a chat with one of the researchers in the project, Filip Drozd, about why they wanted to be part of ForHelse and what thoughts they have about digitalisation in the health service.

What was your motivation to join the center?

RBUP’s motivation for joining the center was to evaluate budgetary cost/benefits for municipalities who are interested in using Mamma Mia. It would also be important in obtaining knowledge about important considerations and what impact it will have on costs if we have to adjust a little here and there to implement Mamma Mia in a sustainable way after the research project is over.

RBUP is part of Work Package 2 in ForHealth. You can read more about it here.

 What is your role/contribution to the work package you are participating in?

We offer Mamma Mia as a case and help the center carry out a cost/benefit evaluation of the health-promoting and preventive programme for pregnancy and postpartum depression in the primary health services. We will also contribute professionally for our partners, so that together we can make the best possible evaluation of a widespread problem, and where knowledge about the cost-effectiveness of measures for our target group is lacking.

According to HelseNorge, about 1 out of 10 women in Norway develop depressive symptoms during pregnancy or after childbirth.

What challenges do you see in the project?

There are always big and small challenges in all research projects, but until now the biggest challenge has been recruiting municipalities. We are still in a pandemic that affects the municipalities and the child health clinic services, while previous challenges such as the lack of midwives in the municipalities have become more visible during the pandemic.

In short – there is a shortage of professionals and resources in the services that keeps many municipalities from participating, or they need more time to solve other challenges before they can possibly join.

MammaMia is a digital program design for pregnant women and women who recently gave birth.

Why is digitalisation important in the health sector?

On a general basis, digitalisation is important for providing equality of services in Norway, regardless of where you live. Digitalisation can add knowledge about competence where professionals, resources and capacity are lacking if it is integrated in a good way into the services.

From a health-promoting and universal prevention perspective, it is difficult to envision how such work can be done in a good and systematic way without the use of digital tools, with all the major and important tasks to be covered in childbirth and maternity care and the within the child health clinic services.

What do you want to achieve during the 8 years in which the center will exist?

Our goal is to acquire new knowledge about the cost/benefits of digital self-help tools that are useful for all relevant operators in the maternity and postnatal care sector, and that can help us understand how Mamma Mia can be continued in a sustainable way to becomes a standardised service for all pregnant and postnatal women.

If you want to read more about Mamma Mia, you can do so here.

Cloncluded INTROMAT with good results

The partners of INTROMAT gathered on Mondag 6 December for a closing seminar. The research project started in 2016 and has been funded by the Research Council of Norway as an IKTPLUSS Lighthouse project.

All the research partners and three industrial partners spent the day presenting results from the research and innovation activities at the center, and thanked one another for an educational and exciting year together.

See some pictures from the event below:

There were several specific presentations on what came out of the project. Some of the presentation:

Smiti Kahlon presented findings from the study on the use of VR technology in the treatment of performance anxiety in adolescents. The programme is called Youth Spotlight (Ung Spotlight) and is available now online (Helsenorge.no).

Emilie Sektnan Nordby presented findings from the study on digital treatment programmes for adults with ADHD. This programme is now scheduled to be used in eMeistring.

Sunniva Brurok Myklebust presented findings from the digital treatment programme for those struggling with residual symptoms after depression. They are starting a new study and have begun lookin for participants.

Ragnhild Sekse and Sigrund Breistig presented their Gynea programme, which is designed for women who have had gynaecological cancer. Part of this treatment programme can be found online, in the the health library website (Helsebiblioteket).

Petter Jakobsen and Andrea Stautland presented the study on the use of digital tools to monitor symptoms of bipolar disorder in adult patients.

Many skilled people were responsible for INTROMAT’s success. Here is a list of the others not already mentioned above:

  • Eirik Hansen
  • Jan Rasmus Sulebakk
  • Yngve Lamo
  • Andreas Rimala
  • Jim Tørresen
  • Eivind Flobak
  • Youwell
  • Robin Kenter
  • Suresh Mukhiya
  • Ulysse Côté-Allard
  • Jo Wake
  • Yngvar Sigmund Skaar
  • Minh H. Pham
  • Amin Aminfar
  • Ketil J. Ødegaard