Connected care in the Lofoten Islands

How can people in remote places get access to good healthcare? Dr. Alexander Skau has been working on an answer to this question for many years and firmly believes that new paths to health are possible. That's why, together with ZEISS, the ophthalmologist has launched a pilot project on the Lofoten Islands. The goal was to make it easy to examine patients remotely using a device and software. A recent study1 proves the success. The connected care solution could improve healthcare around the world.

The Lofoten Islands in northern Norway are known for their midnight sun, northern lights and small fishing villages. The scenery is stunning, and the nature is breathtaking. This is one of the reasons why the group of islands is a desirable place for those who want to escape the hustle and bustle of our technology-driven world and seek peace and solitude. They will find it there. And that is the problem.

While outsiders appreciate the remoteness of these places, it is precisely this remoteness that makes it difficult for local people to access something fundamental: medical care. Local facilities, with limited staff and tight budgets, usually do not have specialists on site. And when they do, there are often not enough of them to provide ongoing care. It is not uncommon for the nearest point of care to be hundreds of kilometers away and difficult to reach. In Lofoten, people might have to travel at least a full day, sometimes more – either by plane or by ferry – to reach the right healthcare specialist.

Overcoming distances in remote areas

How ZEISS enables access to healthcare with Dr. Skau and connected care

Dr. Alexander Skau

If you take away the question of money and give people time to think about it, they would say the same thing: health is the greatest good.

Dr. Alexander Skau

Ophthalmologist | Norway

Dr. Alexander Skau

Across the country – to the nearest ophthalmologist

Dr. Alexander Skau is familiar with these problems. With over two decades of professional experience, he now practices ophthalmology in his clinic in Bodø, a small coastal town on the skerries, approximately 1,200 km north of Oslo. His belief is that everyone should have access to good healthcare, no matter where they live. “If you are not mentally healthy, if you have a problem with your body or your senses, then you have a problem in society. So, if you take away the question of money and give people time to think about it, they would say the same thing: health is the greatest good,” Dr. Skau says.

Dr. Skau says his perspective was shaped greatly by two mentors. One was an anatomy professor at the University of Ulm, Germany, and the other worked in cardiology in Bodø. According to Dr. Skau, he admired these teachers for two greatly different reasons. “Professor Herman in Germany, a master of precision, shaped my understanding of anatomy and the importance of accuracy. His influence was profound and continues to resonate through how I approach my work. Then, a cardiologist at our local hospital became my guide in the delicate art of communicating with sick patients. He was able to talk to them with such ease and empathy and still be so personable,” Dr. Skau says. He tries to combine both teachings into his work while still being an active partner and father to his two children.

Connected care in the Lofoten Islands

Dr. Skau approaches innovation in medicine and technology as a logical next step in healthcare. When he talks, his conviction about not overcomplicating medical approaches is evident. It makes you almost believe that, despite the complexity of the subject, you could have done the same thing he does if you had just thought about it a bit longer.

In his pursuit to improve medicine, Dr. Skau studied the medical care system scientifically. In 2012, he looked at the capacity issues in healthcare and found that the challenges involved will continue to grow: as Norway undergoes demographic shifts, there will be more elderly people in the future. The number of diabetes patients, as well as those suffering from cataract diseases, is also increasing significantly. At the same time, Dr. Skau found out that by the end of the decade, people would have to travel across the country for eye exams because there would be too few medical services available. In 2018, after three years of planning, which Dr. Skau also contributed to, the Norwegian Directorate of Health published new guidelines for diabetic retinopathy, a disease of the retina that occurs in advanced diabetes and leads to vision loss. These new guidelines pointed out the need for change. ”And if it takes three years to develop guidelines, it probably takes 20 years to change anything in the system itself,” Dr. Skau says now, nearly five years later.

That's why Dr. Skau took matters into his own hands. ”My motivation to simplify and improve things has been an important part of my life for many years,” he says, explaining what drives him. His key to solving the problem: technology. In his ophthalmology practice, he saw an opportunity to use technology to help people receive care where they live – because digital health technologies allow him to examine them from anywhere. But how is this possible?

  • Approx. 5.5%

    of the inhabitants in Nordland, Norway suffer from diabetes and need regular eye examinations.1

  • 1 eye department

    is available for the necessary specialist treatments in Nordland, Norway.1

  • 1 day

    is approximately how long it takes patients from the Lofoten Islands to reach the closest eye clinic.1

  • More than 2,000

    people at five locations have already benefited from connected care in Norway.1

  • 97%

    of all eye examinations can be carried out remotely with the help of connected care.1

Connected care in the Lofoten Islands

Digital health solutions: pilot project in Lofoten

The answer is connected care. It is fundamentally changing healthcare for people in remote areas. They no longer have to travel far for their annual or biannual checkup. The checkup is done where they live. This is made possible by the digitalization of medical technology.

It sounds simple in theory, but what does it look like in practice? ”Why not just try it?” says Skau and smiles. He wanted to find out what he could do for the people with diabetes in Norway who need regular eye screenings and so launched a pilot project together with ZEISS in 2018. The program that was set up includes a device and corresponding software. The device, a camera with an ultra-wide-angle lens placed in an optician's office in a remote location, can take high-resolution images of a patient's retina. The software sends this data in real time via the cloud to the central clinic where an ophthalmologist receives the image. They can then examine the retina without the patient having to make an extra trip, contributing to sustainability by saving CO₂ and providing both comfort and time savings. ”What we are actually doing is we are transporting data, and not patients,” says Dr. Skau.

  • Connected care in the Lofoten Islands
  • Connected care in the Lofoten Islands

One of the biggest challenges at the beginning was the secure transmission and storage of sensitive patient data. However, Dr. Skau has found solutions for this as well, emphasizing that all data is encrypted and that strict security standards are maintained, based on national standards from the Norwegian government.

Dr. Skau has documented the success of the project in a study. The result: 97 percent of all treatments could be carried out this way – and did not have to be performed on site in Bodø. To date, the system has been used on more than 2,000 people at five locations in Norway. In the future, he hopes to help more than 320,000 Norwegians with diabetes, an ambitious goal. However, Dr. Skau believes in his idea. “We have this saying, ‘Don’t leave any stone unturned.’ But in my opinion, I think it's not about turning the stones, it's more about finding the new stones,” he emphasizes while talking about the need for innovative solutions in medical care.

Cecilie Naima Kristoffersen is a skilled optical technician in one of the optical shops on the Lofoten Islands. Here, she performs on-site checks with numerous patients of Dr. Skau. She recognizes that the patients also trust the innovative system. ”They appreciate having the service closer to them. Of course, they might enjoy the personal touch of visiting their doctor in person, but the majority truly embraces this system because it’s so simple. They no longer have to take an entire day off from work just for the examination.”

Of course they might enjoy the personal touch of visiting their doctor in person, but the majority of patients truly embraces this system because it’s so simple.

Cecilie Naima Kristoffersen

Optical technician | Norway

Connected care – a solution for global problems

The problem of medical care in remote areas doesn't stop at Norway's borders – it's much bigger in other parts of the world. And, of course, many people not only need regular eye exams but also other medical checks. Dr. Skau is convinced that connected care can be a key to solving these problems as well. ”I love progress, new technologies excite me. And it fills me with joy to witness the constant evolution of our world. Things are moving forward, not as fast as we would like, but they are moving forward,” he explains, proud to be doing his part to improve healthcare.

The ophthalmologist's work showcases the power of innovation, proving that groundbreaking change doesn't always require a complete system overhaul. By merging existing resources like ultra-widefield retinal cameras and cloud technology, Dr. Alexander Skau and ZEISS have not only transformed healthcare on the Lofoten Islands but have created an example for new remote care possibilities in medicine globally. As Dr. Skau aptly puts it, ”We are a part of something bigger. Not just me, but everybody.” If everyone looked at the world this way, they would find not just hope for tomorrow's healthcare but a shared commitment to humanity's well-being.

In focus: connected care and digital health solutions

  • Since the start of the Covid-19 pandemic, remote care has become a larger part of everyday life. More and more treatments are being carried out remotely, for example via video chat. This not only saves time and money, but also increases the comfort of treatment. Another trend is the digital patient record. Clinics can digitally store all of a patient's relevant health information in a file that can be accessed by the treating specialists, for example. Artificial intelligence (AI) has also gained a foothold in the healthcare sector. It can help examine blood counts, analyze tissue samples or evaluate MRT-ray images.

  • Connected care describes the networking of various technologies for the purpose of preventive healthcare. For example, connected, interactive digital health applications can help people improve their health early and on an individual basis. This includes remote monitoring, mobile applications, smart clothing and wearables. These are just a few examples of modern health technologies that share important information that supports health education, self-assessment, and preventive care.

  • In connected care, a variety of health-related devices or technologies are networked together to provide information about a person's health. A fitness tracker, for example, collects a variety of health data and compiles it into a picture. If a doctor can access it, it can help them make a diagnosis. Connected care can also be the digital patient record, which gathers all relevant information about a patient and is accessible to all doctors involved. This means that doctors can not only collect their patients' data in a decentralized manner, but also share it with colleagues from other medical fields at any time – for even better patient care.