“I can’t do it anymore. My husband has late-stage dementia and my children live far away. I just don’t know what to do anymore. Please help me”. Wow, that hit home. I looked up and saw an older woman sighing with frustration at the health-care counter. The woman at the desk was doing her best, but didn’t really know how to help. I was sitting in the waiting room, watching it all unfold. For some reason, I couldn’t stop thinking about it. Is this vulnerable group of people being left behind? Are we expecting them to be too self-sufficient? Are we doing enough to help them?
Technology back in the day
When I first started working with FocusCura in 2003 (the company which I founded and of which Luscii became a spin-out brand), the world was relatively simple. iPads and iPhones didn’t exist and technology was reserved for cool youngsters and nerds, not for senior citizens. That’s why a lot of people called me crazy when I came up with the idea of using technology to help older people maintain their independence. But I did it anyway. And the senior citizens loved it. You can see how it looked on the picture below (made in 2004).
Things are very different today. Technology plays a dominant role in the lives of young and old alike. We use computers, smartphones, and tablets for everything. In fact, our devices are the first thing we see when we wake up and the last thing we see when we go to bed.
Last year, 86% of Dutch people used a smartphone (source: Dutch Smartphone Users report by Telecompaper). The majority of this growth was found among older people, given that most young people already used smartphones. In fact, smartphone use among people in the 65-80 age bracket increased from 9% to 63% in 2016.
Self-sufficiency and technology
Technology is playing an increasingly important role in our lives and is therefore becoming a determining factor in our ability to remain self-sufficient. However, there are a lot of vulnerable people who don’t understand these advancements – like the woman in the story above – and are afraid to ask for help. They are limited in their ability to take care of themselves and manage their lives. In many cases, the children live far away or have no interest in caring for their parents. It’s important that we don’t forget these people. And we aren’t: ten thousand nurses, caregivers, and volunteers are committed to helping this vulnerable group every day.
At home with dementia
I recently had the opportunity to shadow a dementia nurse at a healthcare organisation we work with. Dementia nurses help old people with dementia and their relatives, such as husbands, wives, and close family members, the entire time that person lives at home. During my work, I try to have this kind of ‘days in the life of’ with the users of our products once in a while (see also our way of working in the keynote below).
Together, we biked around visiting several clients. One of those clients was a couple and the wife had severe dementia. The husband was faced with a tough decision: put her in a nursing home or keep her at home. Their daughter was there too and I had so much respect for how they handled the situation. They explored all of the possibilities and thought long and hard about ways to avoid this difficult decision. “The last thing you want is to have your own wife committed”, he explained to me. The case manager and community care services were extremely supportive.
We visited another older gentleman that day who lived alone. He was vulnerable but very happy. He was eager to share his stories with us, with no real connection between them. He didn’t know a thing about technology. He was still coming to terms with the passing of his wife. As we were walking out the door, he explained that his children were worried about him. They all live far away and don’t really know how to help.
Technology to alleviate concerns
I was very impressed that morning and it really got me thinking. All of these people have their own challenges and problems, but were extremely happy with the support of the community care services and the case managers. To them, self-sufficiency was about as abstract a concept as technology. Although, that’s not entirely true with respect to the latter. Lots of people asked me to explain what FocusCura does. So I told them about partnering with healthcare institutions to help vulnerable people live at home safely and independently.
These people in particular, who didn’t really understand technology at all, were the ones who encouraged me to continue. While the sensors may be too late for them, they would have certainly made life easier. It also would have been nice to stay in the comfort of their own home for dementia check-ups, instead of having to take their partner with them to the hospital.
Plenty of work to do
This day made me realise all the more how important technology is. While it may not help dementia patients directly, it does give them the opportunity to enjoy the personal attention of their own warm, loving, and dedicated caregivers.
I don’t want to be a doomsayer, but the statistics don’t lie. With the number of healthcare users on the rise and a shortage of healthcare workers, our problem won’t be a lack of budget in the future. The real problem is a lack of qualified nurses, caregivers, and case managers.
The clever use of technology can provide support to these caregivers in helping their clients. In this way, we can help them maximise their limited time so they can also focus on offering personal and warm care. After all, they’re the ones who know the type of care someone needs and when they need it.
How great would it be if they could use wearables to check on their clients and take immediate action when something goes wrong? And how comforting would it be for the client’s children to be able to hop by using Luscii videocare, to join a visit of the nurse?
We still have a long way to go and there’s still plenty to do and develop in terms of healthcare technology. As great as the commercials are, it’s extremely challenging to develop technologies that perfectly address the needs of users, be they healthcare providers or clients.
We also have to reform our healthcare budget system if we want to achieve this. We don’t even have to replace the current rules and regulations with new ones; in fact, I believe that almost everything we want is possible in our current healthcare system. We just have to do it, which requires courage on all sides: healthcare providers, insurance companies, and businesses. If they create the room for healthcare providers to determine their own care methods, we can make good on our promise!
It all comes down to one thing: the people.
Of course, the gadgets, robots, and new technologies are super exciting, but they really play a minor role. It’s all about the people who use these technologies: the case managers who trust that these devices will be their eyes and ears; the caregivers who know that the smart sensors will alert them if something goes wrong.
Of course, this extends beyond the technology used in dementia care. The same applies to telemonitoring for COPD and heart failure, whereby patients send their measurements to their healthcare providers. Technology plays an important and welcome role for this group as well. It does, however, have to be extremely user-friendly and often also requires a detailed explanation from our technicians. But when I hear how happy patients and caregivers are and how much calmer they feel, I know we’re on the right path.
Extra help for an extremely vulnerable group
Is eHealth only suitable for independent, trendy, and healthy people? Or for people with a strong social network? Absolutely not! We can’t forget the extremely vulnerable group of people, like the older woman at the healthcare counter. They deserve special attention and help. After all, they’re the ones who will benefit most from the support of modern technology.
Not necessarily from the technology itself, but from the warm and personal attention of caregivers who are always at hand. This personal care can continue to exist for all those who need it in the future!
*The situations were modified slightly for privacy reasons, without sacrificing the essence of the story.
THE HAGUE – Collaboration in the healthcare sector is becoming increasingly important. It is therefore vital that patient data can be shared easily between healthcare providers and with patients themselves. Unfortunately, the multitude of different systems in the healthcare sector has always complicated matters. But that’s about to change. The Reinier Haga Group is the first organisation to put Zorgplatform (the Care Platform) into use, which enables simple, structured and secure exchange of patient data.
The Reinier Haga Group (consisting of Reinier de Graaf Hospital in Delft, Haga Hospital in The Hague and LangeLand Hospital in Zoetermeer) has become the first to put Zorgplatform into action. Using this platform, patient data in the electronic patient file can be shared in a simple, secure and structured manner between healthcare institutions and eHealth solutions, such as the Luscii Vitals (formerly cVitals) app. The introduction of Zorgplatform is a welcome boost to the cabinet’s ambition to promote collaboration in the healthcare sector by actively developing ICT standards and making them compulsory. Today, Secretary General Erik Gerritsen talked about this development during a working visit.
“The Reinier Haga Group strives to offer its patients the right care in the right place at the right time. To achieve this ambition, it is essential that healthcare is tailored to suit individual patients as much as possible, increasingly making patients the directors of their own care processes. The introduction of a home-measurement app to measure vital statistics, such as blood pressure, weight and pulse rate, will facilitate this greatly. In addition, the availability of a patient file to our doctors and nurses is vitally important”, explains ICT manager Marcel Slingerland. “An increasing amount of the patient data we use is now obtained from other healthcare organisations and innovative apps used by patients at home. Zorgplatform has allowed us to tap in to these rich wells of data”.
Standard data exchange
A long-held desire among doctors and nurses is to have a total picture of each individual patient’s health. This is often impossible as the data required is locked away in a maze of separate systems. “We specially developed Zorgplatform to solve this problem simply and securely”, explains ChipSoft’s Remko Nienhuis. “Zorgplatform allows data to be shared with the hospital’s electronic patient file in a standard manner with the aid of the Healthcare Information Building Blocks (Zorg Informatie Bouwstenen or ZIBs) developed by the government. In this way, hospital EPFs can connect to other patient files and even to other innovative healthcare technologies”.
Luscii is the first to have its Vitals app (formerly cVitals) connected to Zorgplatform. This allows medical specialists to prescribe ‘Vitals home measurements’ directly via the electronic medical record (EMR), to access these home measurements and to receive alerts if any deviations are identified. They can then respond to these alerts, for example, via a video call using Luscii Contact (formerly cContact). Cardiologist Jan Willem Borleffs, who works at the Haga Heart Centre at Haga Hospital, is very impressed with the new possibilities. “Last year, we saw exactly how Luscii’s home measurements and video calls can provide vital assistance to patients with heart problems. Patients feel safer and we can take action earlier, which means hospital admission is often prevented”.
The right care in the right place
Mr. van der Hoeven, a heart patient, agrees. “This new form of care means better check-ups for me and that works really well”.
To connect more patients to this system, it is vital that these home measurements are integrated into ChipSoft’s EMR HiX, as this will prevent a whole separate system from being required simultaneously. “I am very happy that Zorgplatform has made all data available in our EMR”, says Borleffs. “This is a key step in gaining acceptance of eHealth”.
The connection of the home-measurement functionality in Zorgplatform means other healthcare institutions who connect to Zorgplatform can also access this data. The Netherlands has therefore made an important medical breakthrough in the field of sharing patient data.
The integration of Luscii into EMR Chipsoft:
A team of Luscii and Chipsoft HiX (the biggest EMR vendor in the Netherlands) integrated Luscii deeply into Chipsoft using ‘Zorgplatform.’ The integration has three features: 1) sign up of patients for telemonitoring directly from the EMR, 2) alarm handling of Luscii alarms in the EMR workflow and 3) all data measured with Luscii delivered directly into the EMR. The first hospital system to use the integration is Haga Group (three hospitals in The Hague, Delft and Zoetermeer).
This press release was published by Luscii and Chipsoft at the beginning of 2018.
The initial results of the eHealth service HeartGuard are impressive, with 64% of resistant hypertension patients able to manage their high blood pressure more effectively. Zilveren Kruis began paying for its clients’ use of this modern version of heart care in 2016. Patients take their measurements themselves at home, while their cardiologist monitors remotely. “HeartGuard helps us bring care into the home safely, which is a major consideration in our view”, says Olivier Gerrits, director of care procurement at Zilveren Kruis.
HeartGuard is available to patients suffering from heart failure, cardiac arrhythmias, or resistant hypertension. Cardiologie Centra Nederland (CCN, Cardiology centres of the Netherlands) systematically monitor patients who are insured by Zilveren Kruis and are using HeartGuard, to determine the clinical effects, as well as the effects on quality of life. The initial results are very promising.
Patients who used HeartGuard showed an average decrease in blood pressure from 157/89 mmHg to 132/84 mmHg. 64% of patients with resistant hypertension have even been able to control their blood pressure. These are patients who have been referred by their family physician after various medicines failed to lower their blood pressure.
From Waiting Room to Living Room
Since the introduction of HeartGuard in 2016, hundreds of Zilveren Kruis policyholders have used the technology. “The number of applicants is shooting up. This offers good prospects for the future of telemonitoring and eHealth in general”, Gerrits explains. “By bringing healthcare into our clients’ homes in a safe manner, we improve their quality of life, prevent symptoms from getting worse, and avoid unnecessary visits to the hospital”.
The data collected over the past year also shows that patients have an increasing sense of self-management. “In the long run, this means fewer trips to the emergency room or family physician, as well as shorter waiting times in the hospital. eHealth is going to take on an ever more prominent role in Zilveren Kruis’s procurement policy”, says Gerrits.
Dr. Igor Tulevski, cardiologist and co-founder of CCN adds, “The first results show that eHealth is no longer a promise, but a practical solution that really works”. Tulevski continues, “The patients feel a greater sense of freedom and experience an improved quality of life. They also feel safer because they can be in touch with a cardiologist 24 hours a day, seven days a week. It enables them to exercise more control”.
Viable, Scalable, and Affordable
By using Luscii’s Vitals app (formerly cVitals), patients can monitor and send measurements, such as blood pressure and heart rate, to their cardiologist. “For normal treatment, we often only see the patient once a year and have to define our policy based on that. Thanks to HeartGuard, patients can send us many more measurements and vitals from the comfort of their home. This gives a very in-depth understanding of our patient’s situation”, Tulevski explains.
“If any of the patient’s measurements deviate from the norm, we can provide remote care by tweaking the prescription, so as to prevent the situation from worsening. Last year’s data shows that we can prevent sudden changes in the patient’s health status, which leads to a reduction in emergency consultations”.
The Future of Care
Gerrits explains, “By offering eHealth, we are providing the healthcare of the future, today, for our clients. With other insurers also following our example, we’re pleased to see how this kind of telemonitoring is becoming more accessible”. HeartGuard is only available for CCN patients at the moment. “All that’s left now is for other insurance companies to embrace eHealth in the coming years, so that everyone who wishes to use it is able to do so”.
HeartGuard is a joint initiative by Zilveren Kruis, Cardiologie Centra Nederland, and the Dutch healthcare innovation company Luscii (a brand of FocusCura). Since last year, Zilveren Kruis has covered the cost of HeartGuard for its policyholders, if medically prescribed. This eHealth breakthrough in the Netherlands made international headlines in 2016.
This press release was published by our partner Zilveren Kruis.
Good news for more than 600,000 COPD patients in the Netherlands: more hospitals across the country are introducing the measurement of vital COPD values at home. This means that COPD patients no longer have to go to the hospital to get these values measured. “It also prevents hospitalisations, which is a great development”, says Emiel Rolink, director of Long Alliantie Nederland (LAN, the Dutch Lung Alliance).
Fewer hospital visits, with continuous supervision
A visit to the hospital is not only taxing on COPD patients who already have reduced energy because of their disease, but because the nature of the disease also causes stress. Patients can feel insecure and worry about ‘lung attacks’. Mr. Bremer, a COPD patient, explains: “I no longer have to go to the hospital as often as I used to, which really was an intense exertion for me. Now I have my values measured twice a week, which really gives me and my family peace of mind”.
Health measurements at home
Measuring the values of COPD patients at home is made possible by Luscii Vitals (formerly cVitals), an eHealth solution designed by the Dutch health care innovation company Luscii, a spin-out brand of FocusCura. Patients submit their measurements twice a week, which are then monitored at a distance. If the system detects an increased risk or if the patient has questions of their own regarding certain measurements, they can contact a healthcare professional immediately by video chat. In doing so, the care provider can give instant medical attention and prevent hospitalisations.
“We need to reduce hospitalisations by 25%”
In the Netherlands, COPD attacks equate to 30,000 hospitalisations every year, half of which are re-admissions. Rolink notes that, “The LAN wants to reduce the number of hospitalisations by 25% across the Netherlands in the context of the Nationaal Actieprogramma Chronische Longziekten (National action programme for chronic lung disease patients), while maintaining or improving the quality of life of patients. Finland and pilot areas in the Netherlands have shown that it is possible, provided you use a systematic approach that monitors the patient closely”.
Hospitals across the Netherlands
“We are working with Luscii to make this kind of modern COPD care available to patients across the Netherlands”, states Joris van Eijck, director of Health Care for Menzis. “This follows multiple successful projects in Slingeland Hospital, Isala, and MC Slotervaart”. To help hospitals achieve this ambition, they will be receiving a book from Erik Gerritsen, the Secretary-General of the Ministry of Health, Welfare and Sport, during the national e-health week. This book contains lessons learned, experiences, and a plan of action to make digital COPD care available.
This press release was published by Menzis during the Dutch eHealth week in 2018.
Slingeland Ziekenhuis (Slingeland Hospital), Sensire, and Menzis have optimised how they work together, so that they can provide even better remote care to people suffering from heart failure. Patients can now send information about their heart rate, blood pressure, and weight every two weeks using an iPad, improving how their health is monitored and reducing the frequency of in-hospital check-ups. Health insurer Menzis now fully covers the cost of this new style of digital care.
The hospital, healthcare provider, and health insurer teamed up some time ago as part of the project ‘InBeeld’ (‘bringing into vision’), to provide remote care to people with Chronic Obstructive Pulmonary Disease (COPD). This enables patients, nursing staff, and doctors to use the ‘Vitals’ app (formerly cVitals) – a product designed by the Dutch company Luscii – on their iPad and other digital devices in order to exchange information and video-call via a secure connection. If required, patients can contact the nurse directly or schedule an appointment at the hospital.
This application seamlessly brings together the cardiologist’s specialist knowledge at Slingeland Hospital, Sensire’s nursing expertise, and Menzis’ financial support. This has boosted the quality of life of patients living in more rural areas of the Netherlands: The control they have over their health means they no longer need to go to the hospital as often. It’s a step towards a healthier life.
John Diederik from Hengelo is one of the enthusiastic users of this remote care. The time that John and his girlfriend would have spent at the hospital can now be used for their hobbies and leisure. He tells us about his experiences: “Today’s technology really has no limits. I stay in contact with friends and family via Facebook, and I also use Maps. It’s great to see how many solutions we now have for day-to-day things. Now we can add health care to that list”.
This press release was published by our partners Sensire, Slingeland and NAAST Medical Center.