This is how Bodø municipality implemented digital supervision and safeguarded privacy

Privacy and consent in connection with the implementation and use of safety and coping technology is an important topic and something that can be solved in different ways by the municipality.

One of the municipalities that have found a good way to take care of this is Bodø Municipality. In the webinar we held on digital supervision at the end of August, we addressed this topic together with Bodø municipality. You can see the recording here.

Bodø municipality at the forefront with digital supervision

Anette Skogstad, the adviser at ForUT in Bodø municipality, says that their work with digital supervision and privacy/information security started in 2017 in connection with the implementation of RoomMate. Bodø municipality has been a central contributor in the development of the sensor and the service. Today, Bodø municipality uses RoomMate in the home service and in institutions. They started the rollout to home residents, largely on the basis that it simplified consent, since the users were competent to consent, i.e. they could consent themselves.

Bodø municipality has 174 devices placed among home residents, but there are not 174 users as some of the users require more sensors in more rooms. At the institution, 81 resident rooms have the technology.

Anchoring in the personnel group

What Anette clarifies is the importance of working with information for users and relatives, as well as anchoring in the staff group, especially for the night guards. The night watchmen have long carried out physical inspections and are confident about this.

When transitioning to digital supervision, it is important that this security is still ensured for the staff, the night watchmen often feel that they lose some of their control when digital supervision starts.

Close follow-up at the start is therefore important. Digital supervision will significantly improve the night's rest among patients, as long as the use of digital supervision is needs-tested.

Bodø has integrated RoomMate with Gerica through the Welfare Technology Hub (VKP) since 2019. Integration with the VKP contributes to the quality assurance of documentation. This means that all events are recorded in Gerica, making everyday life easier for healthcare personnel and giving the user a comprehensive overview of the record.

Receiving health care constitutes consent

For people who can consent to digital supervision themselves, it is relatively easy. Bodø municipality started in 2017 by creating a separate consent for the use of digital supervision that the user signed. These written consents have now been removed for those users who have consent competence.

This is on the basis that the municipality must provide health care and process health and personal data. As regards the processing of health and personal data, is regulated by the Health Personnel Act and the Patient Record Regulations. The obligation for documentation is laid down in these laws and gives the municipality the right to process this information, as long as it is for the purpose of providing health care.

Explicit consent is written consent, but is not a requirement.

You must have consent to provide health care, and this can be consented to implicitly. This means that if you get a decision and receive health care without objecting, you have given implicit consent. This means that you do not need separate consent, given that the patient/user is able to object.

Valuable to involve the State Administrator

Digital supervision can be categorized as intrusive technology, largely because the user does not take an active action himself, but a warning is triggered by, for example, leaving the bed.

Bodø invited the State Administrator and the Habilitation Service to a demonstration of the technology, and dialogue on how this can be used for users without consent competence. The state administrator makes the final decision on whether the technology can be used or not. Bodø found it valuable to have the state administrator with him throughout the process.

Involve relatives early on

It may be beneficial to involve relatives as early as possible to ensure the safety of those around the technology the municipality wishes to adopt. By inviting understanding through demonstrations of the technology, you can have an open dialogue about how everything works. The municipality then has the opportunity to answer questions and provide good training on how the technology works in practice.

Ethical considerations

In all cases of implementing new technology, it is important to make ethical assessments. You gain access to information you did not have access to before, and this must be used in the right way. As for RoomMate, it has built-in privacy protection and is not designed to be able to monitor. Each inspection generates a journal note, which is security.

But what is really the most invasive? Does RoomMate give an alert when an event occurs? Or 1:1 staffing or 2:1 staffing as you have supervision all the time and are not alone. Institutional residents have supervision x 3 per night.

As a municipality, you should make some assessments about what is most invasive and look at what is best for the lives of people in vulnerable situations.

User history from Bodø municipality

Terje(51) feels safer after the introduction of digital supervision (anonymised).

Use of RoomMate in Bodø Municipality

Terje has a moderate developmental disability, unspecified cerebral palsy, disease of the nervous system, and epilepsy. He has severe epileptic seizures which involve the risk of falls and injuries. Because of this, he has an epilepsy alarm in bed, as well as the fact that he previously received physical supervision every hour at night.

Terje did not think this was sufficient to meet his need for security and health care. He is not always able to trigger the patient to alert himself when he has a seizure. In addition, all the physical inspections had a very negative impact on his sleep quality. The service providers also noticed that the solution was not sustainable.

Based on this, Terje and his relatives were informed about the possibilities for digital supervision with RoomMate, which they thought would be a good solution. They also concluded that Terje was competent to give informed consent so that the service could start up.

At the request of the allocation office, the service made a decision to the State Administrator in accordance with Chapter 4A of the Patient and User Rights Act. It was reported back that the decision was not necessary with the assessment of Terje's competence to consent which was the basis. At the same time, the state administrator clarified that it is important that people with developmental disabilities have the same rights as other citizens. RoomMate was therefore installed together with other welfare technology (patient notification and epilepsy alarm). Terje wanted all the physical inspections at night to be replaced by digital inspections so that he could trust the technology himself.

Benefits of digital supervision

There have been no unfortunate incidents, and Terje himself feels that the technology gives him both security and the necessary health care. The service feels that Terje has more privacy in his everyday life, despite his extensive need for health services. He also sleeps better at night, which is important to reduce the extent of epileptic seizures.