More and more hospitals are using telemonitoring to support patients at home. Heart Guide, a digital care concept from the Netherlands’ Cardiology Centra (CCN), is an inspiring example within this field. Patients measure their own blood pressure, weight or heart rhythm at home. An app coaches the patient and alerts the right healthcare professional if necessary. Visits to the emergency care department have fallen dramatically among users.
HartGuide is currently used by people with heart failure, high blood pressure and atrial fibrillation. Amsterdam UMC and CCN are now investigating whether people with congenital heart defects are also better off with telemonitoring. This year, a Randomised Controlled Trial will start under the supervision of cardiologist, Michiel Winter. Luscii talked to him about the setup of the study and the future of telemonitoring.
A congenital heart defect, is that common?
‘Around 50,000 people suffer from the defect across the Netherlands. Thankfully, most disorders are mild. But there are also those born with a complex condition, such as patients with only one functioning heart chamber. Surgical techniques have improved in recent decades. The number of people living with congenital heart disease is therefore increasing. Babies who died shortly after birth in the 1980s now have much greater chances of survival’.
Can you grow old then, as a patient?
‘With a mild defect, your chances these days of growing old are almost equal to those of healthy people. Yet, this isn’t the case for serious problems. Some people undergo multiple operations in their childhood. Things may go well for many years, but at around 40, they inevitably develop heart failure. In any case, a birth defect always has an impact, for example in the form of atrial fibrillation’.
Do you expect telemonitoring to make a difference?
‘Absolutely. Normally, these people go to a hospital with specific expertise. But that is expensive for society and the journey is stressful for the patient. With HartGuide, we can reassure patients remotely when everything is fine. If there is a serious problem, such as heart failure, then we see it arising sooner, as we monitor the patient’s weight, blood pressure and well-being at home. And we can therefore intervene earlier. The research will show whether it works that way in practice, but I am confident it will’.
What are your most important research questions?
‘We will look specifically at people who visit the outpatient clinic at least twice a year with complaints. Is it possible to prevent acute moments by guiding them remotely? We do not immediately expect visit clinics to decrease, as it is all so ingrained, instead we hope to really focus on preventing acute situations’.
And what will the research look like in practice?
‘We will assemble two groups. One group will be supervised at home via HartGuide. The other group will receive regular care. And in two years, we will compare the differences between the two. It is actually a nationwide research study. We are talking to a number of hospitals about including their patients. At least two hundred patients are needed to form a clear picture’.
What did the medical ethics committee think of the setup?
‘The handling of patient data in particular raised questions. Normally, this information remains secure within the hospital’s walls. With the e-health design, the data is sent from home via Luscii’s digital platform to the Medical Service Centre of HartGuide. There it is interpreted by doctors and nurses, and afterwards, I receive a call to discuss the findings. Questions were asked about that. Who exactly does the patient’s data belong to? And where is the information stored? In the end, we worked everything out and developed a clear protocol of how to deal with such concerns’.
How do you see the future of telemonitoring?
‘I actually expected digital development to go faster. Everyone nowadays has Netflix and Google Maps, but we are still a bit behind in the hospital. Collaboration with businesses, such as Luscii, is in my opinion the key to success. I am a cardiologist. I was not made to set up a company or deal with logistics. Moving care from the hospital to the home is such an adjustment. We definitely need the businesses, but with our own ideas, too. If we work well together, I believe that the entire cardio clinic can eventually switch over to remote guidance at home. Provided that an effective system of expert supervision has been built around it. Then patients only have to come to the hospital if something is really wrong’.
Are patients ready for that too?
‘I have eighty-year-old patients who Skype with their grandchildren. That is not the problem. Healthcare professionals are the ones who must make the switch correctly. But don’t underestimate that task. As a doctor, I am used to seeing patients. I trust my clinical view. Letting that go is complicated, although I believe video calling offers plenty of opportunities in that regard’.
More and more doctors and nurses are using the Luscii app to guide patients remotely. Who are these healthcare professionals? And what exactly do they do with Luscii? Today, we offer a portrait of Mark Schuuring, cardiologist in training.
Are you personally interested in technology?
‘I have always found IT fascinating. Building websites, playing around with server settings; I love it. I even attended lessons at the Atheneum, but I learned the most from a friend who is a professional. Later, I tried to set up a kind of online marketplace for DIY jobs with another friend. We put a lot of energy into it and even travelled to India to see if we could outsource parts of the site. And then the huge Werkspot suddenly came online, which was certainly a setback’.
Then why choose medicine?
‘In the past, healthcare was a common topic at home. My mother is a nurse and my father works in the purchasing department of a hospital. Which explains a little bit why I finally chose medicine instead of a career in IT. I find the human body and the effect of therapies equally as interesting as a computer’.
Was cardiology the right choice?
‘Absolutely! Cardiology is so challenging and varied. It has the contemplative side of internal medicine and the invasiveness of surgery. Doing the rounds with nurses at the CCU, discussing echocardiograms, discharging patients or admitting them; it all happens in one day. Sometimes, I provide acute care. This mainly involves acting quickly and in accordance with protocols. But I can really add something to the support of chronically ill patients, too. In that respect, I am grateful that I worked for a period in the pulmonary medicine department. It was there especially that I learned to develop an eye for quality of life. For cardiology as a discipline, that is still a bit of a concern. We should perhaps sometimes ask a little less about blood pressure and a little more about the feelings of the patient’.
What is it like to work with Luscii?
‘We use Luscii technology in the HartGuide care concept. Through HartGuide, we monitor patients with congenital heart defects remotely. Considering my IT background, I naturally find it very interesting. I can see many opportunities for digital technology. But in the beginning, it took some getting used to for everyone. Since then, we have gained experience and developed clear protocols. As a result, patients, doctors and nurses are becoming more enthusiastic. We expect that the use of HartWacht will lead to less outpatient visits and a decrease in hospital admissions. But we don’t know that yet for sure. We are currently investigating this theory in a randomised controlled trial’.
But you do have faith in the technology?
‘When it comes to diagnostics, I am already completely convinced of the added value of telemonitoring. I had a patient who suffered frequently from heart palpitations. She received a Holter ECG four times from the outpatient clinic, but she never succeeded in catching a rhythm deviation that caused the symptoms. With HartGuide, we were able to monitor her heart rhythm at home for much longer and we eventually found atrial fibrillation. That’s great for her: she now knows exactly what is going on and we were able to start her on appropriate medication straightaway’.
Luscii’s Amsterdam office is home to no fewer than ten different nationalities. What motivates people to emigrate and to choose a career at Luscii? Today, front-end developer Cem Ekici, tells us about his choice.
A brief introduction?
‘I’m Cem and I’m from Eskisehir. Eskisehir is a relatively small city by Turkish standards, but it is probably about the same size as Amsterdam. I didn’t hang around for long. As a front-end developer, I soon moved to Istanbul. That is where the most innovative companies are located, so all IT people are naturally drawn there.
The company I worked for in Turkey supports start-ups with their software. The work itself was quite interesting and the business successful, but the work culture was disappointing. It was rather hierarchical and the balance between work and private life was not well respected.’
So you thought of Amsterdam?
‘Amsterdam had been on my mind for some time. Friends of mine already lived there and the city made an impression on me during a visit. The lifestyle and culture appeal to me. It’s all a bit more informal and relaxed here. When I heard that a job was available at Luscii, I applied immediately. Then it all went quickly and Luscii engineered a smooth transition to the Netherlands. Paperwork, temporary accommodation; everything was arranged. Even my airline ticket was paid for by the company. I now live in the great Old-West neighbourhood and have really built up a life for myself here in Amsterdam.’
Do you like it at Luscii?
‘As a front-end developer, it is really special to work for Luscii. The users of the digital platform are healthcare professionals and chronically ill seniors. Doctors and nurses are busy. They want their dashboard to be as simple as possible and find it important that all the information within the file is linked. Every click that can be removed is significant.
For the elderly, the interface must be very clear and accessible. With everything you do, you have to keep in mind that the user may not be experienced with apps and websites. As a front-end developer, I am very happy that I can contribute to the well-being of the elderly. One day, I will be old myself. I hope then that young people use innovative technologies to make my life more pleasant.’
There is a growing demand across the UK for telemonitoring provided by Luscii. To steer expansion on the British side of the Channel in the right direction, Rob Brougham will be joining the team. He will begin his role as Managing Director for the United Kingdom on the 1st of May.
Impact on healthcare
Rob is a successful entrepreneur, and has also worked for large companies including British Telecom (BT) where he became CEO of the e-health division. The division built on the Whole Systems Demonstrator; a global, randomised controlled trial studying various tele-health systems. The positive impact of modern technology on the lives of patients with a chronic illness made a big impression on Rob. The number of hospital admissions (14-20%) and visits to emergency care (15%) were reduced significantly within the study population.
“Selling networks and systems to businesses is challenging”, Rob explains his decision, “but it doesn’t provide the same satisfaction that telemonitoring offers. Making a difference to people in a difficult situation is an important incentive for me”.
When BT shifted its strategic course and ventured away from tele-health, Rob decided to switch definitively to the e-health industry. First, as an advisor to various English e-health companies. Later, as UK Managing Director of Ieso Digital Health, which is one of the top 50 fastest growing e-health companies in the country. And, from the 1st of May onwards, as Managing Director for Luscii UK.
Rob sees plenty of opportunities for Luscii in the UK. “There are some players on the market, but we haven’t seen the levels of quality and accessibility of Luscii here, as yet”.
At any rate, Rob is set for a busy summer ahead. A number of British hospitals are about to start working with Luscii, while others are eager to discuss the possibilities that Luscii offers. The ambitions of Luscii are therefore perfectly in line with the “Long term plan”, presented in the past quarter by the NHS. Just like the Netherlands, the United Kingdom is struggling with increasing demand and staff shortages within the healthcare sector.
Now that Rob Brougham has been brought in to strengthen the UK division, many British patients and healthcare professionals will experience Luscii’s telemonitoring in the near future. We have faith that Rob will keep enough time free for his wife and daughters. Likewise, his five a side football team and waterskiing club won’t accept too many absences either!
Joining forces supports hospitals in moving care towards the home
Luscii, the e-health application for remote monitoring once developed as part of FocusCura, continues as an independent company. Healthcare entrepreneur and FocusCura founder Daan Dohmen, has acquired the majority of the shares and formed a strategic partnership with Omron Healthcare, known among other things, as the largest manufacturer of blood pressure monitors in the world. Part of this cooperation includes an investment, with which Luscii can accelerate its development further in the coming years. Omron will also support launches in more European countries, as the two companies announced today.
In European countries, efforts have been made for some time to make e-health available for chronic patients in order to prevent hospital visits and admissions. Despite that, a breakthrough is yet to be achieved. However, Luscii is one of the first digital healthcare concepts capable of bridging the important barriers in implementation. For example, Luscii successfully managed to integrate with large electronic patient records and secured reimbursement from insurers for their concept. Scientific research showed that using Luscii for specific target groups, such as patients with COPD, heart failure and resistant hypertension, can reduce hospital costs significantly and make patients feel safer.
FocusCura will continu its activities in home care under CEO Raoul Zaal. Dohmen handed over the CEO’s baton to the former Booking.com and Essent director a year ago. Under Zaal’s management, the number of users of FocusCura innovations continued to grow and 2018 ended with a strong operating result. Dohmen remains involved as a consultant and shareholder of FocusCura. Just like Medux, known for it’s brands Medipoint and Harting-bank.
Today there is good news for thousands of Dutch heart patients. After the largest insurer Zilveren Kruis announced to fully reimburse the e-health service HeartGuard, four other major healthcare insurers (VGZ, DSW, ONVZ, De Friesland) will also follow and reimburse HeartGuard in 2017. Cardiology Centers The Netherlands (CCN), together with Luscii, founding partner of HeartGuard, announced this news today.
HeartGuard enables continuous monitoring of cardiovascular patients suffering from heart failure, hypertension or atrial fibrillation. Patients can measure their vital signs at home with the Vitals App (formerly cVitals), developed by the Dutch healthcare innovation company Luscii.
The vital signs, like blood pressure or weight, are sent in remotely through the Vitals App on the patient’s iPhone or iPad to the cardiology centres and are automatically added to the Electronic Medical Record of the patient. Doctors and nurses will be alerted in case of detection of an increased health risk. Following that alarm, the staff will reach out to the patient and/or general practitioner. Hospital admissions and outpatient clinic visits are reduced by the HeartGuard service.
Fast scale up possible because of reimbursement
”Contracting with any of these four insurances companies makes it possible to offer the service to thousands of patients”, according to Cecile Goldman, VP of Operations at CCN. ”Now we can offer the service to patients insured at these insurers as well. This number can grow even further, when insurers CZ and Menzis will start reimbursing HeartGuard too. ”We are in dialogue with them to offer HeartGuard as well”.
CCN: “Dutch insurers are setting an example”
By reimbursing HeartGuard, Dutch insurers are setting an example. They are showing that they are not only retaining traditional care delivery, but are willing to support innovation. ”HeartGuard is at the forefront of further evolution in healthcare and by opening up the service to these new patients, we can increase our insights into the effects of this innovative healthcare service on an even larger scale”, says Cecile Goldman.
Insurer ONVZ: “enthusiastic about possibilities of eHealth”
Chairman of the Board of insurer ONVZ Jean-Paul van Haarlem is enthusiastic about the possibilities of HeartGuard for its clients: ”This is an innovation that provides patients with personalised care. HeartGuard will have a positive impact on quality of care and on efficient use of resources. Because it monitors the patient’s health remotely, HeartGuard will lead to a reduced number of hospital visits. This is a major improvement for the patient. Reimbursing HeartGuard is an important step for heart patients insured at ONVZ.
Insurer Zilveren Kruis: “good that others are following”
“We are very happy with the fact that we have realised this breakthrough last summer with Luscii and CCN to bring chronic cardiovascular care close to our clients. The fact that others follow this example towards innovative care, making it available to more patients is great”, says Erik-Jan Wilhelm, VP of Strategy and Innovation of Zilveren Kruis.
Dutch Patients Federation: “positive development”
The Dutch Patient Federation is happy that more and more insurers reimburse eHealth. ”We are glad that other insurers are following the example of Zilveren Kruis”, says Director Dianda Veldman. ”I hope more of these eHealth initiatives will be developed so all patients can enjoy this modern form of healthcare.”
Collaboration with hospitals and GPs
At this moment, only patients of Cardiology Centers the Netherlands are eligible to use HeartGuard, but, according to Cecile Goldman, this will change soon: ”We are already having conversations with GPs and hospitals to offer HeartGuard from their own locations to their own patients. We will monitor the patients in that case in commission of their own doctor. Scale is an important factor to eHealth, sharing our resources and expertise reduces the need for every hospital to reinvent the wheel“.
This press release was published by Cardiology Centers The Netherlands and Luscii (previously FocusCura) on 6th March 2017.