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.’
Patients with a severe form of the pulmonary disease COPD have been using home monitoring since February. By completing a questionnaire twice a week via the Luscii app, they are monitored remotely and are immediately assisted in the event of deterioration. Pulmonary nurse Iris Huisman explains the benefits.
Fewer trips to the hospital
More and more people are suffering from Chronic Obstructive Pulmonary Disease (COPD), a chronic lung disease, in which the damaged lungs lead to shortness of breath, coughing and fatigue. In patients with a severe form of COPD, the symptoms are often so bad that they become less mobile or may need extra oxygen. For them, a mild cold can lead to a dramatic increase in symptoms. We call this a lung attack, resulting in hospitalisation and further damage to the lungs. Iris: “Now that we are monitoring this group of patients remotely, we are able to guide them more effectively and hope to prevent such attacks and hospital admissions. In addition, patients no longer need to come to the hospital for standard checks, which they often find tiring because of their limited mobility”.
Contact at the right time
For the home monitoring of patients, Tergooi is working together with the medical service centre, NAAST. The nurses at NAAST already have experience with this method of monitoring at Slingeland Hospital and know the procedure at Tergooi. They keep an eye on everything 24/7 and if they see a deterioration, they immediately contact the patient via a video consultation, calling through the Luscii video connection. “If NAAST are unable to respond, we become involved. Coincidentally, this afternoon I had a video consultation with a patient whose symptoms we had noticed had suddenly worsened. He admitted that he did not realise that things were going so badly and would not have called himself, but he was very pleased that there was direct contact and that action had been taken”.
Telemonitoring can also be a solution for COPD patients who need more intensive support. Iris: “Because NAAST is available 24 hours a day, a patient who is very anxious and scared at night can make contact very easily. A video consultation at such a moment is exceptionally reassuring and supportive. Patients’ voices are therefore heard if necessary and they can ask for care at any time. At the same time, they also gain more insight into their illness by completing the questionnaires twice a week”.
Since the introduction of telemonitoring for patients with chronic heart problems (in 2016), more than 500 Zilveren Kruis policyholders have been using HartWacht (translated HeartGuard, a remote monitoring service powered by Luscii, red.). 128 patients (25% of the participants) have been using HartWacht for more than a year. Comparisons have been made between their healthcare usage for the 12 months prior to telemonitoring and the 12 months following use. The results are impressive.
The first research results show a large decrease in the use of care. Olivier Gerrits, Director of Zilveren Kruis Healthcare Purchasing: “We were already convinced that telemonitoring contributes to more control and better quality of life. Now it appears that for our policyholders, there are also fewer admissions, emergency visits and ambulance trips”.
Major decrease in emergency first aid visits on A&E
Patients guided by HartWacht for a year have experienced a decrease in the number of nursing days, the number of emergency trips and the number of emergency room visits. This reduction has been compared to the year prior to the supervision of HartWacht. The number of nursing days has dropped by more than 40% and the number of emergency trips with the ambulance has been reduced by 30% in one year. The largest decrease occurred in the number of emergency room visits: In the group of patients that began with HartWacht, the number of emergency room visits (A&E) fell by 70%, compared to the year before.
VBHC Prize 2019
HartWacht is a joint initiative of Zilveren Kruis, the Netherlands’ Cardiology Centre (CCN) and the Dutch healthcare innovation company Luscii. The number of participants is growing steadily. This breakthrough in eHealth was an international first for the Netherlands in 2016. Last month, HartWacht received the VBHC Prize for its collaboration. Igor Tulevski, cardiologist and co-founder of CCN: “A wonderful reward for increasing the quality of life for patients and reducing healthcare costs on a daily basis”.
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!
HartWacht, the innovative healthcare concept that was set up through a collaboration of Cardiology Centers the Netherlands, Luscii and insurer Zilveren Kruis, was awarded by the Professor Porter Value Based Healthcare Collaboration Award 2019. For Luscii, this means that one of its projects wins this prestigious award the second year in a row. Last year the COPDInSight-service of NAAST, insurer Menzis and Luscii was the winner of the Professor Porter Value Based Primary Care Award 2018.
HartWacht telecardiology service
HartWacht is a revolutionary telecardiology service offered by the Cardiology Centers The Netherlands to their patients in 15 centers across the Netherlands. Patients with heart failure, hypertension and atrial fibrillation don’t need to go to the clinic anymore, unless it is needed. The eHealth service was announced in 2016 and is currently available all across the Netherlands with full reimbursement from five of the biggest Dutch insurers.
HartWacht telecardiology service
Globally, the demand for cardiovascular care is rising due to the ageing populations, increased cardiovascular risk and the quest for personalized care. However, resources are limited.
The “classic” healthcare system cannot meet these requirements. Therefore, an affordable and scalable solution is needed. The aim of HartWacht is to increase population health, improve the quality of care and lower the per capita costs by making use of new health technologies such as Luscii vitals.
Heart failure, hypertension and atrial fibrillation
Patients are selected for HartWacht by their cardiologist based on their diagnosis and protocolized inclusion and exclusion criteria. Patients can then share their data with their healthcare provider using the app and the results will be integrated in their electronic patient file. By making both the home measurements and the other relevant medical data online available to the patients, they are encouraged to participate actively in their healthcare processes. In addition, therapy and policy are focused around patient data and adapted continuously if needed. Interventions include lifestyle advice if appropriate, change in medication, education about disease and/or additional diagnostics, thereby forming an IPU.
Patients with severe hypertension and heart failure are guided by the Luscii app to do home measurements with connected measurement devices for blood pressure, heart rate and weight. Also patients with atrial fibrillation are enrolled using Kardia with EKG-monitor. All the data of patients is analyzed and securely transmitted to the the electronic patient file and is interpreted by a dedicated team supported by smart algorithms and a nationwide network of outpatient clinics which can be visited by the patients if needed. The concept is financed through bundled payment schemes. Patient value is measured through standardized questionnaires.
To continuously monitor quality and safety and patient outcome, research projects have been initiated. First results are published in scientific peer reviewed journals and demonstrate a positive effect on safety of the program and patient experience and outcome. Research shows that HartWacht results in less visits to outpatient clinics and emergency departments, thereby adding value to our healthcare system by improved health outcome with less costs. Also patients and treating physicians are satisfied: with less effort they experience faster results of success of their therapy.
Tergooi Hospital (Gooi and Vechtstreek), in partnership with health insurer Zilveren Kruis, are set to bring 20 percent of their current hospital care closer to home. Both organisations have signed a declaration of intent for the new proposal. In doing so, they hope to respond to patients’ needs to receive the right care in the right place.
Subsequently, optimal use must be made of innovative technological options, such as telemonitoring for COPD and heart patients. The Zorg Dichterbij program aims to realise this possibility. In addition, Tergooi and Zilveren Kruis are starting projects focused on prevention. The goal is to avoid repeat trips to the hospital for treatment and/or admittance for patients with a specific condition.
Accelerated relocation of care to the home, an appropriate IT infrastructure and the prevention of care are central to the transition plan that Tergooi and Zilveren Kruis have agreed upon. As is now common knowledge, this is desperately needed to combat challenges such as cost increases, an aging society and the associated growth in the number of chronic disorders, but it is also necessary to help alleviate increasing pressures on the shrinking number of healthcare professionals.
Tergooi has a main location in Hilversum and two regional medical centres. By offering safe care at home, the hospital will organise its healthcare in a different way. Acute, intensive and complex care will remain within the hospital. Good cooperation between healthcare institutions and caregivers within the region is also essential to achieve the desired care in the right place.
Compact New Build
The new construction of Tergooi, which will begin at the end of this year, will be smaller. With the use of online consultations, closer cooperation with care partners, and standardised nursing departments and outpatient clinics, the hospital expects to be able to cope with a more compact building.
Hans den Hollander, Chairman of the Tergooi Executive Board, explains: “As we are starting our new building this year, this is the perfect time for us to implement the change to deliver care in the right place. In doing so, we can continue to improve the quality of our care and respond to the needs of patients, whilst keeping hospital care affordable”.
Care Close By
Tergooi and Zilveren Kruis have already begun with the Zorg Dichterbij program. Part of this includes telemonitoring for chronic heart failure and chronic lung diseases (COPD). More and more doctors from the hospital are also providing consultations via video. Furthermore, treatments are being moved towards the home, for example, with kidney dialysis.
The precondition remains that home treatment is only an option if it is medically justified, says Olivier Gerrits, Director of Healthcare Purchasing at Zilveren Kruis: “Our policyholders prefer to have healthcare as near as possible. We attach great importance to stimulating the movement of care to the home, together with caregivers. So that illness has as little impact as possible on the lives of our policyholders. For us, Tergooi is an example of how we can implement that vision in a sustainable and modern way”.
Right Care, Right Place
In September 2018, the health insurance company announced that it would be investing more in applications that could move healthcare from the hospital to the home environment. In October, Zilveren Kruis announced that it would link its healthcare procurement policy and its focus on “the right care in the right place” to the Medical Specialist Care Outline Agreement 2019-2022.
The Outline Agreement for the hospital sector states that the growth in hospital expenditure must be reduced (via digital care applications, amongst others) in order to reach 0 by 2022. Purchasing Director Gerrits stated at the time that relocation of care to the home (the right care in the right place is also a spearhead of the NVZ and a cabinet ambition) will result in the greatest savings. Even more than just moving care from the second to the first line.
At the beginning of August, the health insurer reported that following a successful pilot with Hartwacht at the Dutch Cardiology Centre, they would also make agreements with hospitals across the Netherlands for telemonitoring heart patients. In accordance, Zilveren Kruis offers hospitals three-year contracts.
In February 2019, Zilveren Kruis signed a multi-year agreement with the Isala Hospital in Zwolle, to further improve the content of healthcare and meet the rising demand for care through the use of e-health, such as telemonitoring. Gelre Hospital followed in March. In addition, just like CZ, the insurer encourages the use of online treatments in mental health care to reduce waiting lists.
Patients with the lung disease COPD are now able to send measurements from home directly to the outpatient clinic of pulmonary medicine. Pulmonologist Pathman Pasupathy explains the procedure: “Every week, patients fill out a questionnaire on their tablet and send in their saturation values. If their situation deteriorates, we will be notified and, if necessary, we will contact the patient via video calling (iPad)”.
Zuyderland is using Luscii for the project. The pilot is intended to gain experience in the remote monitoring of COPD patients. Monique van de Kragt, a physician assistant at the clinic, says that she is happy with the trial: “For patients who already have less energy due to their illness, it is of course fantastic that they do not have to come to the clinic every time. This pilot also strengthens our vision that we wish to manage healthcare as close to the patient as possible. It’s great that we are able to experiment with this”.
COPD is characterised by lung attacks that often lead to hospitalisation. Pasupathy: “As we have more insight into the condition of the patient through this pilot, we hope to prevent such lung attacks and, subsequently, hospital admissions”.
The pilot is being carried out in collaboration with health insurer CZ and will run for the coming six months.
Providing senior patients with quality care is becoming increasingly difficult. The growing elderly population is putting a strain on healthcare systems, as doctors and nurses no longer have the time or resources to meet demands. Bjørn Moesgaard Lou Kristensen, an employee of Eldercare in Kokkedal, Denmark, knows this predicament all too well.
A year and a half ago, Kristensen sought out a solution for senior citizens in the Fredensborg area, stating “We just knew that we had to do something”. Replacing home visits with remote contact appeared to be the perfect answer to the problem. Using Luscii’s videocare software, the team in Kokkedal have successfully integrated the project into their daily routine.
Benefiting daily life
Kristensen works with senior citizens suffering from a range of illnesses, including Alzheimer’s and dementia. Such patients are typically visited in the morning, allowing caregivers to prepare food for the day ahead. By then giving the patients a videocall around lunchtime, the carers can ensure they have eaten, drank enough fluids and have remembered to take their medication.
One patient in particular, an elderly lady with dementia and psychiatric issues, looks forward to Kristensen’s calls every day. Her physical visits have been reduced to just once a week, during which caregivers are able to clean and administer medication. The rest of the week, she is contacted via a screen three times a day. This allows Kristensen to not only make sure she is taking her tablets, but also enables him to visually check her appearance. He even requests that she walks around the dining table a couple of times while they chat, to show she is physically active. Something which he simply wouldn’t have the time for during a home visit.
And that quality of contact has been the driving force throughout the project. Kristensen explains, “I have been in this line of work now for 22 years, and I know what it takes to visit a patient. But the difference here is the eye contact. During a videocall, you are with that person 100%”.
Persuading some seniors to get on board with the technology required has been tough at times, according to the Eldercare team. Additionally, figuring out the right way of how to proceed has cost the most time and effort. Several organisations in neighbouring towns and cities are looking to Kokkedal for direction, having also adopted video monitoring, in seeking an effective and successful approach to delivering this new type of care. The target is to have set up at least 100 citizens with video calling by the end of this year, with a total of 20 patients in every town or city across the area.
Despite initial difficulties, once fully up and running, the reactions from both caregivers and patients have been very encouraging. Aside from providing more direct contact, remote monitoring also saves precious time for healthcare professionals. Kristensen values this new wave of e-health development, citing “This is the future. It is here to stay”. Having recognised the positive effects such modern advances can have, he hopes to expand his vision even further by ensuring the best quality care for everyone who needs it.
In the coming six months, the Reinier de Graaf hospital, together with the e-health company Luscii, will conduct a pilot of home measurement for patients with the chronic lung disease COPD. With the help of these measurements, caregivers can provide medical advice remotely. Therefore, COPD patients will need to visit the hospital less often.
Prevent hospitalisations due to lung attacks
COPD is a disease in which the lungs are damaged. This makes it more difficult for patients to breathe and reduces their energy levels. Patients with COPD often suffer from lung attacks, in which they experience shortness of breath, coughing or excess mucus production. As a result, they often need to be hospitalised.
25 COPD patients are taking part in the pilot. The participants will receive a tablet, through which they use an app to complete a weekly questionnaire concerning their quality of life. They will also measure the oxygen content of their blood through a device known as a saturation meter, which is connected to the tablet.
A specialist lung nurse then examines the results in the hospital. If these exceed certain threshold values, the nurse will contact the patient via videocall. In this way, the nurse can literally see how the patient is doing and he or she can, for example, adjust the medication in consultation with the treating specialist. Therefore, the patient doesn’t need to come to the hospital as often for a check-up or treatment. This journey is a major undertaking, especially for patients with COPD. Remote care is subsequently perfectly suited for this group of patients.
Bring healthcare close to the patient
“With this pilot, we want to bring healthcare as close to the patient as possible”, says project leader René de Brouwer. “In addition, we can ensure that COPD patients gain more control over their own health. This project is a great example of how we, at Reinier de Graaf, want to provide the right care in the right place”.
Evaluation will take place during and after the pilot. The experiences of patients and caregivers are the central concern. Scientific research into the results of remote monitoring is also being carried out in collaboration with Luscii. If the pilot is successful, the Lung Diseases department wish to monitor more COPD patients remotely.
We thought it was time for a present. We invited a few healthcare providers who are using Luscii for an interactive workshop in which we learned how to share our story in the best way. It would be wonderful if people who are using Luscii in their working environment share their stories and inspire others to use our health platform.
When everyone arrived, we had the time to get to know each other and had some lunch. The group was very divers. Nurses, doctors, department heads and we from Luscii. After we ate lunch together, we started with the workshop on the second floor of the building. In the area there was a podium with a few lights focused on it. Some participants are regularly on stage, but it is always exciting to speak for an audience. We learned to share stories through story telling.
It was an inspiring and fun afternoon and we learned a lot from each other
It was an interactive workshop in which we learned how to apply the most important laws of communication to our own story. We’ve heard some impactful but also funny stories this day. For example, there was a nurse who told us she had a patient that needed to be monitored once a week. Because of her condition this hospital visit makes her very tired and took her three days to recover. This condition was taking over her life. When she started using Luscii this all changed, because she is monitored at home and we can contact her when needed. At the moment she is less tired, and she can spend more time with her grandchildren. It is very nice to hear this kind of stories, because this is why Luscii exists.
We ended the workshop with a drink at the restaurant downstairs. We would like to hear more, so please share your story about Luscii.
Healthcare insurer Zilveren Kruis and Isala Hospital are joining forces to further improve care quality and meet the rising demand for healthcare. To achieve this, they have once again entered into a multi-year contract. Isala and Zilveren Kruis share the vision that part of the care should be organised differently for this purpose.
Quality and safety
Rob Dillmann, Chairman of the Board of Directors at Isala: “We have a large number of challenges in the region that we can only solve together. Our vision is fully in line with that of Zilveren Kruis. We have agreed to move 10% of healthcare to the home in the coming years, whilst guaranteeing both its quality and safety”.
Dillmann continues: “By moving a part of healthcare to the home, the patient is better served. Research shows that patients are happy to receive care at home. E-health and connected care play a crucial role in this. Even from a distance, personal contact can be maintained between the patient and the healthcare professional via, for example, video calling. Above all, the patient benefits from more control over his or her own health. This in turn contributes to earlier recognition of problems, so that more hospital admissions can be prevented. And that is also a relief for the patient and his or her relatives”.
1,000 COPD patients will be telemonitored
Up until 2022, around 1,000 COPD patients will be telemonitored, so they only have to go to the hospital if they really need treating. People who are eligible for cardiac rehabilitation or who have cancer can also receive part of their treatment safely at home.
Olivier Gerrits, Director of Purchasing at Zilveren Kruis, adds: “By bringing more care to the home together, we can prevent unnecessary hospital visits and admissions. This also relieves the doctors and nurses. In the case of telemonitoring of chronic heart failure, it has now become clear that quality of life is improving, the number of hospital admissions is falling, and we are spending less on premiums. That reversal is also badly needed. A win-win situation for everyone”.
Together with patients(associations), hospitals and other partners in healthcare, Zilveren Kruis wants to have succeeded in bringing 10% of care to the home by 2021. This urgency comes from the growing patient flow and rising healthcare costs.
The Dutch Ministry of Health made a video on the first phase of this unique project:
2018 – COPD monitoring and videocare at Isala hospital using Luscii from Luscii on Vimeo.