Hospitals across the country are freeing up beds with the Luscii COVID-19 Home app
The English NHS health service is rapidly opening ‘virtual nursing wards’ in the fight against the UK’s Coronavirus variant. To make this possible, the NHS uses digital health apps from two companies, including the Dutch firm, Luscii. The Luscii COVID-19 Home app prevents hospital admissions and allows patients to be discharged earlier. This was stated by NHSx, the NHS’s digital unit, last weekend in The Sunday Times.
British Corona variant
The British Coronavirus is wreaking havoc across England. The Corona variant is to blame for the overcrowded hospitals, as previous images from London have shown. The NHS health service, responsible for all healthcare throughout the UK, is doing everything in its power to relieve the pressure. This includes digital care, implemented to prevent hospital visits and admissions. As a result, the available healthcare capacity can be utilised as effectively as possible.
The NHS has therefore requested English regions to set up ‘virtual wards’. Via an app, patients measure their oxygen levels, temperature and other symptoms at home. A smart algorithm in the app assesses the home measurements and alerts healthcare providers on the virtual ward, if necessary. Patients who are admitted can then use the app to be discharged earlier from hospital. The virtual ward monitors them remotely via the app so they can recover at home and the hospital bed can be used immediately for the next patient.
Luscii COVID-19 Home app
One of the two apps used by the NHS is the Dutch Luscii app. “Our app was already widely used by the NHS for patients with chronic conditions”, says Daan Dohmen, founder of Luscii and professor of Digital Transformation in Healthcare. “When the NHS heard about our program to support COVID-19 patients at home, things developed quickly”.
Example of a virtual ward in Sunderland; footage from before corona >
In Sunderland, North England, the app was first set up for the British population and since then, the Luscii team are connecting multiple regions to the app every week. Dohmen: “It’s great that we can help out. And what makes this rapid roll-out extra special is that the projects are completely virtual. After all, we are unable to travel, so our teams do all implementations entirely via Zoom”.
St. Antonius Nieuwegein
Luscii became known to the public through the launch of The Corona Check with the OLVG during the pandemic’s first wave. This digital healthcare service was used by almost 200,000 people in the Netherlands. Development for the COVID-19 Home app also started, in collaboration with the St. Antonius Hospital, Nieuwegein. Research led by pulmonologists Hans Hardeman and Renske Vorsselaars subsequently showed that patients using oxygen together with the app were discharged around 6.5 days earlier from hospital. 97% of the patients were also extremely satisfied with this form of remote care. After publication of these results in the summer, interest from other regions quickly followed. “Our team provides a ‘Zoom walk-in hour’ every week. Through this, we bring doctors and nurses from all regions together to exchange experiences. It is really special that everyone works together so openly and intensively”, says Dohmen.
Also operating in 15 Dutch hospitals
In addition to England, the app is being used in up to 6 other countries, including in Africa. In the app’s home country of the Netherlands, home measurements are rapidly scaling up. On one hand, almost 50% of hospitals are already using the app to support their regular care. On the other hand, there are now around 15 hospitals connected to the COVID-19 Home program, often in conjunction with regional GP groups. They include St. Antonius Hospital, Albert Schweitzer Hospital, UMC
Utrecht, Maasstad Hospital, Jeroen Bosch Hospital, Rode Kruis Hospital, Isala Hospital, Alrijne Hospital, Zaans Medical Centre, Groene Hart Hospital, Meander Medical Centre, Canisius Wilhelmina Hospital, and a few others that are currently getting set up.
The Sunday Times – https://bit.ly/3sLxPYa
Research St. Antonius Hospital – https://bit.ly/3okdo1i
The St. Antonius Hospital, together with e-health company Luscii, has developed home monitoring for hospitalised Covid patients. A reduction of 134 admission days was recorded in a group of 33 patients. These positive results bring a greater admission capacity for hospitals a step closer.
Home monitoring via the Luscii app
Covid-19 patients who have not yet fully recovered, but are stable, may voluntarily take early discharge. They receive home monitoring to ease the transition. Via a tailor-made program in the Luscii app, patients report their oxygen saturation levels, temperature and symptoms on a daily basis. A team of pulmonologists and co-assistants assess the data trends and make contact if necessary. In the case of deterioration, rapid adjustment of the treatment may prevent a readmission. The medical team is also available to patients by telephone for additional questions.
Reduction in length of stay
The results from the first Corona wave show a reduction of an average of 5 admission days per patient. This is based on 33 patients who were monitored at home during April and May. A large proportion of these patients received oxygen at home. This group experienced the greatest reduction, with an average of 6.5 admission days per patient. Three patients were readmitted without emergency. They, too, eventually recovered well.
A survey showed that 97% of patients were very satisfied with home monitoring. The remote monitoring provides a safe feeling. In addition, recovering in one’s own living environment is much more pleasant, with familiar faces close at hand. All users would recommend this form of care to their loved ones.
The home monitoring of St. Antonius Hospital was set up by a collaboration between Christiaan van Swol (chair of the e-health working group for Covid-19), pulmonologists Renske Vorselaars, Hans Hardeman and Eline Mattern, and Kalle Majoor and Agnes Grutters, both fifth-year co-assistants. Thanks to the earlier collaboration with Luscii for people with COPD, a creative solution for overcrowded hospitals could be devised quickly.
‘We saw the shortage of beds increasing and therefore wanted to create a nursing ward at home’, explained Agnes Grutters. ‘In a safe way, so that the hospital retains capacity without adding an extra burden onto GPs. As a requirement, patients had to be able to manage themselves at home. This home monitoring can actually be seen as a bridge between the hospital and the GP. Fortunately, we can include an unlimited number of patients at no extra cost. This flexibility is needed now that the number of admissions continues to rise’.
Expansion to other hospitals
Now that the second wave is in full swing, the St. Antonius Hospital is using the Luscii program once again. By now, almost 20 patients are already working with the app at home. By reducing admission days, more beds are available for Covid patients and regular care is less compromised. Several hospitals have already expressed an interest in using it, too. This can be achieved relatively quickly; the Maasstad Hospital and UMC Utrecht, for example, recently started as well. Approximately half of all Dutch hospitals already work with the Luscii app for other conditions.
Since 2017, pregnant women with an increased risk of complications can be monitored at home via SAFE@Home. This e-health program was developed by UMC Utrecht in collaboration with Luscii, a supplier of apps for remote care. Results of a pilot study show that this method of home monitoring leads to fewer clinic visits, fewer ultrasounds and fewer admissions among the participants. The program is now expanding further, with the Jeroen Bosch Hospital being the first to participate in the follow-up study.
In 2016, gynaecologist Dr. Mireille Bekker took the initiative in introducing this new method of monitoring. “I wanted to modernise care for pregnant women, so they would only have to visit the hospital if it was really necessary. That’s how I came up with SAFE@Home”. In Luscii, she found a partner who had the innovative technology readily available and a successful collaboration was set in motion.
In the app, women can measure their blood pressure at home and fill in a questionnaire. This data is forwarded to the hospital. If one of the values falls outside the threshold, the healthcare provider will be notified. The gynaecologist or midwife can then get in touch via the app or telephone to give the pregnant woman the appropriate advice. The app is combined with a care path of a minimum number of hospital visits.
A recent publication in the international trade journal, Pregnancy Hypertension, documented the results of the pilot study of 103 patients. The study showed fewer clinic visits, fewer ultrasounds and fewer admissions related to hypertension in the SAFE@Home group, compared to patients who received regular care. The pregnancy outcomes remained the same.
Both the pregnant women and the professionals were very positive about working with SAFE@Home; pregnant women also indicated that they felt safer with this form of monitoring. Bekker: “Via SAFE@Home, we can monitor the well-being of patients more effectively. This enables us to take appropriate action to prevent unnecessary hospital visits, diagnostics and probably even admissions“.
Follow-up study SAFE@Home II
After an initial pilot study, the SAFE@Home II follow-up study will begin in October, and several hospitals will be able to participate in the program. Bekker: “This will give us a good insight into aspects concerning upscaling and implementation, as well as the effect on medical outcomes. Since the COVID-19 pandemic, we have also witnessed an additional need for “the right care in the right place”, and telemonitoring such as SAFE@Home contributes to this“. The Prevention Early Diagnosis and E-Health Foundation, and Health Holland, a program of the Top Sector Life Science and Health, are making a research and development subsidy available for this purpose. UMC Utrecht is coordinating the study.
Jeroen Bosch Hospital first participant
Dr. Jacques Dirken, gynaecologist at the Jeroen Bosch Hospital, explains the participation of SAFE@Home within the Jeroen Bosch Hospital. “Just like in Utrecht, we already worked with remote CTGs (heart monitors) to keep an eye on the baby in the womb, with SAFE@Home we can also monitor the mother’s blood pressure. These are two important parameters for monitoring a pregnancy, and now we can do both from home. This is a fantastic innovation, which means we can anticipate possible complications more quickly and reduce the need for pregnant women to visit the hospital”.
Gynaecologist Dirken expects approximately 50 patients from the Jeroen Bosch Hospital to participate in the study. With the implementation of this modern care, more control is also given to the patient. “As pregnant women now regularly measure their blood pressure and complete a questionnaire, they learn to assess what the values mean. Because of this insight, I expect them to be more actively involved in their pregnancy and the care that surrounds it”.
Luscii founder and CEO Daan Dohmen has been appointed as a special professor in the Faculty of Management Sciences at the Open University. In his new position, Daan will play a leading role in the development of research into the effects and implementation methods of digital care.
Of course, Daan is best known as an entrepreneur, but he also obtained his doctorate cum laude for a study on e-health implementation and has since remained active within the field. Prof. Dr. Ir. Dohmen is therefore delighted with his appointment, especially as it concerns an urgent issue that he has been working on for decades.
Dohmen: ‘Our healthcare system is under increasing pressure. Rising healthcare costs and an increasing shortage of qualified healthcare providers are ahead of us if we do not make significant changes. Digital care can help make that change, but it requires more than just the use of fun apps and smart technology. What matters is the advent of technology leading to a much more proactive role of citizens and patients in healthcare’.
The need for transition
According to Daan, a transition is needed from a production model, in which everything is focused on providing care systematically, to an ‘on demand model’, in which the patient takes more responsibility. However, there is a need to ensure that medical support is available at the right time for those who need it. This is precisely where digital technology can play a decisive role.
Research and leadership
As a consequence, existing organisational structures have to be broken down. Otherwise, digital care will just be ‘on top’ of what is currently on offer. The much-needed transition therefore requires more knowledge about the effects of digital care, plus new forms of collaboration and an adaptive culture of innovation. This can be shaped by new leadership and funding models, by both entrepreneurs and existing and new healthcare providers.
This special position has been set up by VEROZ, the knowledge centre for promoting innovation and entrepreneurship in healthcare. The foundation unites entrepreneurs in healthcare and has the ambition to contribute to healthcare innovation through research and education. In collaboration with the Open University, this ambition has now been realised by the establishment of this position and the creation of an MBA in Health Management & Entrepreneurship. The new course will begin in November 2020.
Her Majesty Queen Máxima of the Netherlands paid a working visit to see the digital transformation of hospital care in times of corona. The visit took place on Tuesday afternoon, May 26th at the OLVG hospital in Amsterdam.
Following the outbreak of COVID-19, OLVG has focused on further transforming their delivery of healthcare with digital tools in order to better provide remote support to patients and their loved ones.
One of OLVG’s initiatives is The Corona Check which was developed with Luscii, a platform originally used for non-corona related healthcare. The Corona Check enables citizens to send in their health data on a daily basis using a smartphone or tablet. The app asks for corona related symptoms and provides online support in triaging symptoms and tracking possible deterioration. A clinical team triages possible alerts and if needed a medical professional contacts the user by phone within 24 hours. The Corona Check has been made available nationwide through collaborations with partner hospitals and regional general practitioners. Over 160.000 citizens use this solution.
Her Majesty Queen Máxima of the Netherlands spoke to professionals on the team in the medical response centre. Clinicians and nurses explained more about their work during the corona crisis. Users of The Corona Check were also available to share their experience of the service. Medical and technical experts described how the service managed to achieve nationwide coverage in collaboration with partner hospitals and general practitioners in such a short period of time. The team elaborated on plans for extending the application to regular, non-corona related healthcare.
In that context, Her Majesty Queen Máxima also received a demonstration of ‘DigiPoli’ for cardiology. The Luscii DigiPoli app enables patients to track their heart problems and request contact with their healthcare professionals. If necessary the app connects directly into the medical team at OLVG and an appointment for an additional examination at the outpatient clinic can be made. The DigiPoli app supports clinicians, nurses and patients at the OLVG Heart center to restart regular, non-COVID care.
His Majesty King Willem-Alexander and Her Majesty Queen Máxima organise (video-)calls and working visits if possible, to learn more about the consequences of the corona outbreak and to express their support and appreciation for the efforts of so many in the fight against the pandemic. Appropriate measures are taken in alignment with the host organisations to allow working visits to take place.
As a partner of the OLVG, Luscii is proud that Her Majesty Queen Máxima saw the Luscii app during the working visit. Luscii founders Dr. Daan Dohmen and Ronald Scheffer together with Luscii colleagues Ruben de Neef (responsible for projects) and Rik van den Brule (tech-lead) were present together with medical experts from OLVG to give the explanation and to answer questions from Her Majesty.
Ghana currently has over 5000 confirmed cases of the Coronavirus. To keep the situation manageable, the African country is using the Luscii app to guide people with symptoms remotely.
Dr. Maxwell Antwi is a gynecologist and, since 2012, member of staff at PharmAccess, a foundation that aims to make good health care widely accessible across Africa. At the time of the interview, twenty Covid-19 patients were admitted to the University of Ghana Medical Centre, a hospital in Accra, where PharmAccess has partnered to use Luscii app against corona. Some patients are on a ventilator. The hospital has been designated as the treatment center of expertise for Covid -19 by the government.
‘Ghana was initially under lockdown’, says Antwi, ‘which has since been lifted. Gatherings of large groups of people are still prohibited. This means that schools, churches and restaurants are still closed. There is a lot of testing taking place and the mortality rate among the infected lies below 1%. In that sense, we are doing well compared with other countries.
Antwi is a coordinator of Covid Connect, the Ghanaian version of The Corona Check that has proved so successful in the Netherlands. The app allows people to submit health information on a daily basis. A medical team at the university hospital in Accra assesses the information and contacts patients if necessary. Users then receive health advice or are either referred to a testing location or the hospital.
Dutchman Kees van Lede took the initiative to bring the Luscii app to Africa. He works for CarePay, a PharmAccess partner that allows African citizens to save money through their phones to finance healthcare. He knows better than anyone how widespread mobile phones are in Africa. When he read about The Corona Check in the Netherlands, he immediately saw an opportunity.
Two weeks after the first contact with Luscii, Covid Connect was active in Ghana. A remarkable achievement, considering there was so much to organize: setting up a medical service center, training medical staff in remote guidance and translating all protocols to the Ghanaian situation. Even the program in the app itself had to be adjusted. For example, not everyone in Ghana has a thermometer, so the app was altered to allow users to estimate their body temperature.
Maxwell Antwi views the quick start as a team effort. ‘I had an easy role as coordinator between PharmAccess, the hospital and the Ministry of Health. Enthusiasm was high among all parties. And every doctor wanted to participate. We even had to make a selection! Five doctors are always present at the service center. In total, forty doctors have been trained to guide people remotely’.
SMS also in the pipeline
Covid Connect is currently available to two million Ghanaians. At the moment, the app only works with modern Android and Apple software, but the aim is to expand the service to be available via SMS, too. ‘Almost everyone has access to a mobile phone in Ghana’, Antwi explains, ‘but modern smartphones are less widespread. If we can offer our service via SMS as well, then we are able to assist many more people. And after the Corona epidemic, we can use the Luscii platform for other illnesses. We are learning a lot right now’.
Antwi does not know what the future will bring. ‘It is a new virus, so how it spreads continues to be a guess. I expect about 6,000 infections during the peak around June. I don’t think it will get as bad as in the US, Europe or China. We have a young population and the Ministry of Health is a tremendous help to doctors and nurses’.
‘Two weeks after the call, the first patients were connected’
The United Kingdom is under lockdown as a result of the Corona crisis. Vulnerable people, such as patients with COPD, have to isolate themselves even more stringently. That puts them in a tricky situation. How can they stay connected with their regular care providers when isolated in their own homes? Home health monitoring provides a solution and Luscii has sprung into action to help hospitals in need.
Rob Brougham is Managing Director of Luscii in England. Since his appointment in 2019, he has been talking to healthcare organisations across the NHS about the possibilities of Luscii. Sunderland was the first district to actually start with home health monitoring. A process that took months. But Corona has changed everything.
“We can act much faster now”, said Rob. “We already showed that in the Netherlands with the Corona Check – an app that the Amsterdam OLVG City Hospital developed together with Luscii within a week, which is already in use by more than 100,000 people at home and abroad. With the lessons learned, we can now accelerate the implementation of existing programs, especially in hospitals that see the necessity for such services”.
The Worcestershire Royal Hospital
Rob uses the Royal Hospital in Worcester as an example, which is part of the NHS region of Herefordshire and Worcestershire, close to the Welsh border. “We had been discussing the possibilities of home measurement for some time, but the Corona crisis resulted in an urgent call. How soon could we get started? Within two weeks of that call, the first COPD patients were connected to the Luscii app.”
The hospital treats around 1,300 COPD patients. The intention is to connect the majority to the Luscii app. Through the app, patients can monitor their own well-being. If their condition deteriorates, Luscii automatically alerts the hospital’s COPD team. The option of direct contact is also available through a video connection. In this way nurses can keep an eye on their patients despite the lockdown.
Helping one another
Given the needs of a lot of vulnerable people, Rob is keen to encourage more Trusts to contact him. “We have reliable technology that has already processed millions of home measurements and we can get things moving really quickly. And hospitals don’t have to worry about a sky-high bill. We have a simplified contract and affordable pricing ready. In times of crisis, you just have to be ready to help one another out”.
Check the video to see how Luscii works in daily practice:
The whole of the Netherlands is concerned about the Coronavirus. GPs and hospitals are being flooded with questions. In response, Amsterdam’s OLVG City Hospital, together with Luscii, has developed a virtual guidance tool in a matter of days. No contract, no profit, simply on the basis of trust.
Over 33,000 daily users
With the OLVG corona check, people can easily submit health data via a modified version of the Luscii app. For example, if they have a cough, are short of breath and have a fever. If a measurement gives cause for concern, the app warns the experts at the OLVG’s control centre. If necessary, experts can then make contact via messaging or telephone. More than 41,000 people have already downloaded the app and over 33,000 are actively using the service every day.
OLVG corona check will become more widely available
The OLVG Corona check is primarily intended for adult residents of Greater Amsterdam with health problems that may be aggravated by the Coronavirus. Because of the succes the service will become more widely available in the coming days. Certainly, in the Netherlands, but very likely abroad too.
For registration and more information, please visit: https://luscii.com/olvg-corona-check/
‘The time for pilots is over. Now it’s all about impact. ’
The Jeroen Bosch Hospital (JBZ) and health care innovator Luscii, have made home health monitoring available for every patient that might benefit from it. Alerts triggered by Luscii are pushed directly into the workflow of the EMR of their doctors and nurses.
Health checks at home
Patients are now able to receive digital coaching and perform their own health checks such as taking their own blood pressure and weight measurements. Additionally, patients regularly complete a questionnaire about their physical and mental condition. The Luscii App makes it possible for the hospital to receive these readings in a safe and secure manner. In case of a deterioration, the health care provider is alerted through their EMR and the patient can be contacted using a video call.
Keeping a virtual finger on the pulse
The JBZ hospital started a trial period in the end of 2018, focusing on patients with COPD and heart failure. The patients who participated were positive about this new way of delivering care and felt safe at home whilst developing more insight into their sickness. Building on these results, JBZ hospital is scaling up home health monitoring. Janet van Kuilenburg, cardiologist at JBZ: “Home health monitoring provides many opportunities for various patient groups. Health care providers can keep a virtual finger on the pulse, regardless of where the patient might be. More freedom when things are going well, but extra attention and care when necessary. This is precisely what we want for everyone in our area…the right health care at the right time.”
Initially, the scaling up will start with COPD and heart failure patients. Other departments (such as Haematology and Gynaecology) are already making plans to follow suit. Patients and health care providers have both been closely involved in these developments.
Assembling your own program
Daan Dohmen, CEO and founder of Luscii has seen a dream fulfilled: “As a team, we have worked relentlessly to develop Luscii as a simple and self-assembling health kit, and now we’ve done it. Health care professionals can now compose their own home health monitoring program. Relevant measurements, e-learning and even the algorithm that creates notifications in the electronic health file, are simple to adjust according to the needs of the user. The time for pilots is over. Now it’s all about impact. It’s really great that JBZ is the first hospital to start using it.”
Wilhelmina Hospital Assen (WZA) now has more than half a year of experience with the Luscii app, and enthusiasm levels are high. Evaluations show that patients feel safer, the cooperation between professionals is running smoothly and Luscii is easy to use. Therefore, the hospital has decided to expand. Initially, within the heart failure department, but with ambitions to extend even further.
It was back in April 2019 that the first patients at WZA’s heart failure clinic were introduced to the Luscii app. Since then, patients measure their own pulse, blood pressure and weight at home, which means they no longer need to visit the hospital for check-ups. The measurement data is then sent via the Luscii app to the Medical Service Centre NAAST. Is there a rise in weight or blood pressure? If so, NAAST informs the heart failure nurse in the WZA immediately. With a razor-sharp video connection, the nurse can make direct contact with the patient to assess the situation.
Nurse takes the lead
Stoer, a heart failure nurse in training, is one of the initiators. ‘At the outpatient clinic, I often see people returning for check-ups. And yet, agendas are bulging. I asked myself: could we not do something differently? We already had a vision document on remote guidance in the WZA, so I started to look for suitable systems. Then I came across Luscii. Coincidentally, our board was already in contact with Luscii’. A meeting was then arranged between cardiologist Richard de Jong, WZA director Suzanne Kruizinga and Daan Dohmen, the founder of Luscii. And Erica Stoer? She joined too. ‘We are a relatively small hospital with more direct lines. Everybody knows each other. The fact that I was a part of such a conversation as a nurse fits in with that philosophy. Ultimately, I’m the one who has to work with the system’.
About thirty patients with heart failure are now connected to the Luscii app, and enthusiasm levels are high. Evaluations show that patients feel safer. The collaboration between professionals is also going well and the Luscii technology is easy to use. That’s why the decision was made to continue to expand. Initially to fifty patients, but the ambitions of the hospital extend even further.
Step by step
‘The growth from thirty to fifty patients is an intermediate step’, according to cardiologist Richard de Jong. ‘We need to gain experience and adjust the organisation where necessary. Of course, I would prefer to supervise all my heart failure patients remotely. It is still too early for foregone conclusions, but several studies have since shown that remote guidance stimulates a patient’s insight into their own illness and encourages self-management. We even expect that the number of acute admissions will decrease in the long term because we can spot deterioration earlier. Growth in the number of patients does mean a shift in outpatient work. Nurses are now in charge of remote guidance. They are doing a great job, but they must be facilitated in that responsibility. For them, I am merely a supervisor and a back-up’.
The right care in the right place
Director Suzanne Kruizinga, formerly a doctor in emergency care, thinks it is a wonderful development. ‘We are eager to scale up extensively with Luscii. I would prefer to include all patients who need care for a longer period of time in the home measurement program today. The aging population is increasing the number of patients while specialist nurses are becoming scarcer. The right care in the right place offers a solution and Luscii’s technology helps to implement it safely. In addition, we desperately need to involve patients more in their treatment. Research shows that telemonitoring offers a starting point to achieve this goal’.
Sometimes, Kruizinga experiences some opposition within the organisation. ‘Healthcare professionals have to let go of their patients and that is not always easy. But’, she puts the resistance into perspective, ‘it is, above all, a challenge to steer the enthusiasm about remote guidance in the right direction. Every week, I have a medical specialist at my desk who has big plans for home measurement. And we had to stop recruiting patients because we couldn’t handle the influx. I want to scale up as quickly as possible, but carefully, too. Remote guidance means adjusting processes. I prefer to do that without overhauling the entire organisation. Learn, grow and consolidate, that is the goal. There must be room to try new things and make mistakes. And the revenue model must also be right. But I am confident that, together, we can make the transition a success’.
Health care insurer happy with safe care at home
Many people like being treated at home’, says Rutger de Vries, senior buyer at health care insurer Zilveren Kruis. ‘They feel that this type of care gives them more control over their lives, flexibility and comfort. So, we are happy with the upscaling within the WZA. The hospital puts innovation to the fore. Periodic check-ups for chronically ill seniors have long been the rule, but home measurement offers many benefits. It leads to customisation and prevents patients and their loved ones from having to travel unnecessarily. Hospitals see that. However, it requires a change in organisation and different ways of working. For example, nurses need support in their new role. We continue to actively look for options to organise healthcare in a smarter manner and are subsequently following developments in the WZA with more interest than usual’.
De Vries agrees with Suzanne Kruizinga that the revenue model of the WZA needs attention. ‘When hospitals are successful with telemonitoring, this leads to fewer visits to the outpatient clinic and emergency department. That is good for the patient and healthcare costs, but not for the income of the hospital. We are currently in discussions with the WZA about compensating for such a loss of income. After all, money cannot put the brakes on this great development. We will look together at which type of contract offers the best solution’.
In the meantime, the WZA has not been idle. With the publication of this article, the upscaling to fifty patients has long been achieved and there are concrete plans to use the Luscii app in other specialties, including oncology and surgery.
In the view of many doctors and nurses, remote guidance is still seen as a thing of the future. However, the Dutch Slingeland Hospital, which is a part of Santiz, has been guiding chronically ill patients from a distance for years. Luscii spoke with Malou Peppelman, a program manager of innovation at Santiz. Who is Malou? What is her role? And why has her hospital soared so far forward in terms of experience?
Some children dream of becoming a firefighter. Yet, you thought: ‘When I grow up, I’m going to be an innovation manager’?
‘Ha ha, no. After my pre-university education, I had various interests. Healthcare appealed to me a lot, but I also liked maths and technology. That’s why I opted for technical medicine. After graduating, I obtained my PhD in Nijmegen on non-invasive techniques for skin disorders. As a postdoc, I then worked for a while at the Radboud Hospital. Working closely with healthcare practice, collaborating with companies, and implementing innovative technology; it was useful, fascinating and educational. Afterwards, I wanted to broaden my horizons. I had management ambitions, but I also longed to be involved with innovation in healthcare. I got talking with Santiz hospitals. They were in the process of setting up an innovation structure in Doetinchem (Slingeland Hospital) and Winterswijk (Queen Beatrix Regional Hospital), and saw a great role for me to play in the process. That’s how I became an innovation manager’.
And what exactly are you doing now?
‘I have a connecting and a facilitating role. Whenever doctors or nurses are faced with obstacles, I put them in contact with the right person to arrange a solution. That can be internal, but also external. For example, the medical service centre NAAST undertakes the first triage of the patients we guide remotely. And Luscii provides the digital technology. In the region, we are working with a pilot for a personal health environment (PHE). That is a website or an app, through which you can actively get started with your health and well-being. You can manage medical data, but can also share the information with, for example, the doctor or district nurse. As far as that is concerned, it is important for me to have a good network. In addition, I have a more strategic role. I initiate and lead various projects and am chairwoman of the innovation steering committee within Santiz’.
You are quite far ahead when it comes to digital innovations. Is it difficult to keep healthcare professionals connected?
‘A technical innovation is never implemented just like that. There is an idea behind it. It has to be the solution to a bottleneck. For example, we don’t use telemonitoring for the fun of it: it is there to benefit the well-being of the patient. The complications do not lie in the technology, but in the alteration of work processes. That is often the biggest challenge. It begins with explaining effectively why change is needed and then facilitating in helping others take the first step. Initially, we try to get the enthusiasts involved. They are then in the best position to get their colleagues on board. Here, a vast network is important, too. After all, I have to know who the enthusiasts are’.
How do we keep healthcare future-proof?
‘We are struggling with an aging population in the Achterhoek. This causes pressure on the system from two sides. Together with our partners, we are looking for local solutions. But for that, decompartmentalisation is necessary. Administration wise, we are now on the right track with the PHE. But at a financial level, every organisation still has to stand on its own two feet. Here too, solutions are sought based on solid regional cooperation. Steps are also needed at capacity level. If an alarm from a patient arrives at the service centre, the nearest district nurse must be able to get there. Whether he or she is from organisation A or organisation B should not really matter. After all, together we have to organise healthcare in the region as efficiently as possible’.
That pressure on the region, with the aging population: does that explain your head start when it comes to innovation?
‘Santiz has anticipated the challenges of the future at an early stage. And the fact that the pressure has rapidly increased has certainly helped. We have the ambition to make healthcare more sustainable and bring it closer to home. We achieve this by making healthcare proactive instead of reactive, and we use various digital and technological solutions in order to fulfil our goal. The right care, in the right place, from the right caregiver is subsequently an important principle. Those who really need to be in the hospital are very welcome. If it is not a necessity, then we organise care outside the hospital, for example, with telemonitoring. We invest in self-control for patients and look closely at the qualities of our employees. The direction for remote guidance, for example, lies with nursing specialists. They are well equipped for this and thus create space for cardiologists and pulmonologists to dive deeper into their own medical specialisms. Everyone should be able to be at their very best’.
Since working at Luscii, I often think about the World Exhibition in Paris in 1900. Electric street lamps, escalators, moving images on a screen. The people couldn’t believe what they were seeing. Was this really possible? All those new inventions brought enormous energy into society. What progress! The beauty is that this wonder and energy was captured in various works of art. The painting Bal Tabarin by Jan Sluijters (1907) is one such striking example. People dancing euphorically under ultramodern artificial lighting.
That wonder of new possibilities that Parisians felt during the fin de siècle; I experience that almost daily at Luscii. As a nurse, I am confronted with developments in healthcare that I had never thought possible. The future, I am learning quickly, is now.
People with heart failure measure their own blood pressure and weight at home. The easy-to-use measuring equipment is connected wirelessly to the Luscii app. Values are immediately available in the EPD of the correct healthcare provider. And if there is a risk that things are heading in the wrong direction, nurses make direct contact via a razor-sharp video connection to assess the situation, long before a crisis situation arises. How wonderful and safe would it be for patients if they no longer have to go to the hospital with wailing sirens?
I have seen with my own eyes that new possibilities are transforming healthcare. Nurses have more control. Patients feel more involved in their own treatment. The collaboration between doctors and nurses is improving. New energy is being nurtured in organisations to meet the future challenges of the sector.
Because, let’s face it: those challenges are great. With fewer professionals, we will have to provide more care in the coming years. At the same time, I realise that many doctors and nurses are not even aware of the new possibilities. Until recently I was the same, even though I am naturally quite curious and read a lot about the developments in my field.
That’s why I am making a series of interviews for Luscii. Nurses, doctors, physician assistants, innovation managers, researchers and administrators. I let them all have their say. They can talk about their daily work, how they view the challenges of the sector from their position, and what it is like in practice to monitor and guide patients remotely.
In addition, I offer people a platform that contributes to future-proofing healthcare in other ways. As that is what we need now in the healthcare sector: energy and inspiration. Are you, as a doctor or nurse, working on something special at the moment that is helping to keep healthcare accessible? Then please contact me!
Hugo van der Wedden is a nurse and medical sociologist. He visited bedsides across different hospitals in the most diverse specialisms. He has written a regular column in a Dutch Nursing Magazine for years and published in several news papers. As the “voice of Luscii”, it is his job to make the voice of people within the field resonate in everything that Luscii does.