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.
ASSEN – In February, the Wilhelmina Hospital Assen will begin home telemonitoring for patients with chronic heart failure. They will initially start with a group of twenty-five people. At the moment, these patients have to go regularly to the hospital to have their blood pressure and weight measured. With the help of a blood pressure monitor, a weighing scale, and a tablet or computer, this is now possible at home.
“We do not want patients to have to come to the hospital if it is not really necessary”, says project manager Tineke Ottens. “Most people can easily measure their blood pressure and weight, and fill out a questionnaire. This data is sent to a department with specially trained employees. If there are any uncertainties or questions, they then contact the patient via videocall. Subsequently, the heart failure nurses of the WZA have a central role to play.” In order to make telemonitoring a possibility, the WZA has teamed up with Luscii, the Dutch market leader in the field of home measurement. Luscii patient apps work on Apple, Android and Windows, and the company offers a helpdesk for the predominantly older patients, and even provides installation and explanation at home if necessary.
The benefits are great: the patient does not have to go repeatedly to the hospital and can organise his or her own agenda with much more freedom. The patient also has more insight into his or her own data: they can see their blood pressure level or weight for themselves. The fact that direct contact is available also gives a feeling of safety.
The patients taking part will first receive extensive instructions on how to use the equipment. “Even someone without experience of using a tablet or a computer can get started. Older people also often discover that they can do a lot more with the iPad. Sometimes a world opens up for them”, says Tineke Ottens.
Telemonitoring is a fantastic step in the development of eHealth: care via the internet. “We show that people can stay at home more safely and with total self-control through the use of remote expert care. Ultimately, that is what everyone prefers.” In addition to chronic heart failure, this form of telemonitoring can also be offered to people with COPD or sleep apnea in the future.
How a company can become a forerunner through focus and a new method of organisation: Luscii.
June 2018. The Luscii team separates from parent company FocusCura, in which it started. The goal is to give the Luscii team plenty of space to develop their ideas and attract talent from all over the world.
Luscii is a digital healthcare platform that enables healthcare providers to supervise patients with a chronic condition from a distance. In this way, they can intervene earlier and prevent hospital visits and admissions. This is necessary as, in the Netherlands, we will soon have a shortage of hands and a large group of elderly people to look after. With the right care in the right place, we can still offer the same ‘warm’ care to an ever-growing number of patients.
Establishing a company without managers
After gaining independence, the Luscii team used maximum focus and space to organise things in their own way. Joris Janssen was given the freedom to take the digital team to the next level. He opted for self-organisation, having already tasted it at a start-up, and by learning how he didn’t want to lead a team at larger companies. Through opting for self-organisation, he did not become a manager. “What a relief! You no longer have to worry whether everyone has the opportunity to do what he or she has to do. Self-organisation is scary if you are not good at letting go. And that I can do well”, says Joris.
Structure is still a necessity
“When a structure was needed to stand on our own two feet and to give self-organisation some shape, Holacracy was the logical step. Above all, we simply had to have something. And we wanted to implement a structure that others were already using. A big organisation like Zappos had already adopted Holacracy and Ruben Timmerman of Springest came here to share his insights.
Especially when everything is new, there is a need for structure. Some employees were already used to self-organisation, but there were also ten people that came from the old branch. It was precisely for these people that Holacracy was the perfect bridge to make the structure of self-organisation clear”.
Koen Bunders guided Luscii in their first steps towards structured self-organisation. “The implementation in the circles that I was involved in went very smoothly. I think that Joris and Daan’s clear choice for this tool helped a lot. They show that they also take on board the new rules themselves. They give others the space to take full ownership of their roles, and also remain approachable within their own position(s). This form of leadership helps tremendously”.
“For others, however, it was as if they had taken a step back; as if there was too much structure. The emphasis at the start is on meetings, which are often regarded as ‘overhead’.
Those in question may not have realised that they could solve the problem themselves. They experienced the agreements as something imposing, while, in reality, the agreements are liberating. Free rein is given within the agreements, and a process is available through which you can resolve any minor or major dissatisfaction”.
Learning self-organisation under professional guidance
“Koen Bunders from Energized.org led us through two larger circles. In addition, there is also a sub-circle, which began by itself. I am very happy with what Koen did. The added value of guidance is that you really get the hang of it. You can read how it works and understand it too, but at some point, you just have to try it. Someone with experience – such as a Holacracy coach – keeps you on your toes and can see potential pitfalls. I think that if we had received no guidance, we would have got stuck in those pitfalls. Maybe we would have even stopped.
You cannot acquire everything from the constitution. That only deals with the work that has to be organised. Therefore, everyone must be aware of the distinction between person and role. Writing good policies or suggesting the possibility of a new circle at the right time, are some of the things we really needed Koen for”.
The transition from traditional structure to self-organisation
“The people in the office in Driebergen, where Luscii was created, sometimes say that they find it quite strange. Some even laugh about it. I think there may even be those who consider us crazy. It does take time. People in more traditionally structured organisations naturally feel the need to place it in their mental model of a traditional hierarchy. For example, we are asked who the HR manager is. But we split all those operational tasks and we make a role, for instance, for issuing invoices. As we are continuously adapting our organisation to what is required, it may happen that a person changes role. I think that through these roles, everyone can develop exactly as he or she wants, and they can do what they are good at. If the administration aspect of the stand-in changes, this can be confusing for someone outside a holocratic organisation.
When I look from my current perspective, I realise how tiring a traditional way of working is. I can never go back. I would never again be able to work in a structure that does not clearly offer as much as Holacracy. Why would you want that?”
Koen also sees that the organisation is well developed. “Now that the members of the organisation have mastered the use of the new tools of self-organisation, I am curious to see how they will use them. Recently, a member of the Luscii team came to me with worries about how the organisation had been shaped historically and how that brought tension to today. As a coach, I offered her various options through which she could individually alleviate some of the tension in her role or even resolve it by making a proposal. It was wonderful to see the boost it gave her to realise that this problem could finally be resolved. To my great joy, I heard that she recently submitted her proposal and that it was accepted! Holacracy makes it very easy to solve problems quickly, safely and reliably. Even if the proposal has a big impact. If no reason can be found during the decision-making process that the proposal could cause damage, then it is adopted. Practice will then show whether it works effectively, and adjustments can always be made”.
You have to give yourself, as an organisation, the space to be able to change. Which is certainly important for a company like us. We have so much to discover. It is great that different people from different perspectives can explore how best to serve the market. Then you basically have much more brainpower to work on the organisation.
Joining forces supports hospitals in moving care towards the home
Luscii, the e-health application for remote monitoring once developed as part of FocusCura, continues as an independent company. Healthcare entrepreneur and FocusCura founder Daan Dohmen, has acquired the majority of the shares and formed a strategic partnership with Omron Healthcare, known among other things, as the largest manufacturer of blood pressure monitors in the world. Part of this cooperation includes an investment, with which Luscii can accelerate its development further in the coming years. Omron will also support launches in more European countries, as the two companies announced today.
In European countries, efforts have been made for some time to make e-health available for chronic patients in order to prevent hospital visits and admissions. Despite that, a breakthrough is yet to be achieved. However, Luscii is one of the first digital healthcare concepts capable of bridging the important barriers in implementation. For example, Luscii successfully managed to integrate with large electronic patient records and secured reimbursement from insurers for their concept. Scientific research showed that using Luscii for specific target groups, such as patients with COPD, heart failure and resistant hypertension, can reduce hospital costs significantly and make patients feel safer.
FocusCura will continu its activities in home care under CEO Raoul Zaal. Dohmen handed over the CEO’s baton to the former Booking.com and Essent director a year ago. Under Zaal’s management, the number of users of FocusCura innovations continued to grow and 2018 ended with a strong operating result. Dohmen remains involved as a consultant and shareholder of FocusCura. Just like Medux, known for it’s brands Medipoint and Harting-bank.
Imagine no longer having to go to the hospital, but simply having a conversation at home with your lung nurse about how you feel. From February 2019, this will become a reality for 25 Treant patients with the chronic disorder COPD (lung disease). During this month, the healthcare group will begin a trial in which patients receive a tablet, on loan, through which they can transfer their medical information to the hospital. If this information requires further discussion, the lung nurse will contact the patient via ‘video calling’.
Treant, in collaboration with the healthcare innovation company Luscii, is starting this pilot to gain experience in monitoring COPD patients from a distance. Lung specialist, Steven Rutgers, is pleased with the new scheme: “For patients who already have less energy because of their illness, it is of course fantastic that they will no longer have to come to the clinic every time. This pilot also strengthens our vision to concentrate care as close to the patient as possible. It is great that we can experiment with this possibility.”
How does it work?
Every week, patients use the tablet to fill in their information, such as blood pressure, weight and physical activity. They also report how they are feeling. They then send this information to the hospital. A specialist nurse will take a look at the data and, if necessary, will contact the patient. Through the use of ‘video calling’, healthcare professionals can see how the patient is doing and, in consultation with the pulmonologist, can adjust the medication if necessary.
COPD is a lung disease in which the lungs are damaged. The lungs cannot absorb sufficient oxygen, leaving the patient with shortness of breath and less energy. COPD is characterised by lung attacks that often lead to hospitalisation. Rutgers: “As we receive information about the condition of the patient more often during this pilot, we hope to prevent such lung attacks and subsequent hospital admissions”.
The pilot was made possible by healthcare insurer Zilveren Kruis and will last for six months. The pilot reinforces the agreement that Treant holds with the healthcare insurer to develop initiatives that bring care closer to the patient. A good example of the right care in the right place. In collaboration with the healthcare innovation company Luscii, scientific research will also be conducted into the results of remote monitoring. To start with, remote monitoring will be available to just 25 COPD patients treated at Scheper in Emmen. If the pilot proves successful, in the future, more patients will be able to pass on information to the hospital via video calling.
This press release was published by Treant ziekenhuis on 4 December 2018 (https://bit.ly/2RhyywZ)
When keeping an eye on your health, you do not always have to go to the hospital. The home measurement of, for example, heart rate, blood pressure and weight, is on the rise. And that is a positive development; as it gives people more control over their health. The Jeroen Bosch Hospital is therefore starting a trial of home measuring for people with heart failure and patients with the chronic lung disease COPD. The trial will run for six months and is a collaboration between the Jeroen Bosch Hospital and Luscii, the hospital branch of FocusCura.
A total of fifty people will take part. One participant is Mrs. Liefmans*, who lives with COPD. Twice a week, she will measure her heart rate and saturation (amount of oxygen in the body) from the comfort of her easy chair. In addition, she will complete a digital questionnaire; has she had any difficulty breathing in the past few days? How much has she moved? All the information that helps indicate the status of her health.
All data is sent digitally to her lung nurse, Joke Spierings, in the Jeroen Bosch Hospital. Has something deteriorated? Then she can contact Mrs. Liefmans immediately via video calling on a tablet. “By monitoring more often, we can spot a potential lung attack earlier. This way we can take action together and prevent any hospitalisation”, says Spierings.
“Thanks to home measurement, I know exactly how I am doing”
Previously, Mrs. Liefmans did not have such a precise insight into her health. She went to her GP and visited the pulmonary doctor for a check-up once a year. She only saw her lung nurse in the hospital after a lung attack.
“If I did not feel well, I often thought: it’s not too bad, I’ll see how it goes and then visit the doctor”, says Mrs. Liefmans. “But, by that time it was too late, and before you know it, you’re in hospital”. She was still there three months ago. Thanks to home measuring, she expects that this will no longer happen so quickly. “I want to be able to take steps earlier, so that my health does not deteriorate further. Thanks to home measurement, I know exactly how I am doing. That gives me peace of mind. And because I can always consult with my nurse if things get worse, I feel that I really have control”.
Spierings is also enthusiastic: “This program supports self-management of people. Thanks to the information provided by home measurements, and advice from our side, patients are able to make the right choices. Taking control of your health despite being ill; that is our goal.”.
* Mrs. Liefmans is a fictitious name.
This press release was published by Jeroen Bosch Hospital in Dutch on 29 November 2018 (https://bit.ly/2RhyywZ)
Healthcare organisations join forces for people with COPD
Starting today, residents of the Kennermerland region with the pulmonary disease COPD can now use the network ‘COPD in the neighbourhood’. Thanks to the dedicated App, they can monitor the course of their illness and contact healthcare professionals remotely via video calling. The advantages for people with COPD include reducing the need for hospital visits, gaining more control over their lives and improving that feeling of safety, as specialised nurses are available for contact day and night. COPD in the neighbourhood is made unique through the intensive cooperation between healthcare providers in the neighbourhood, the hospital and innovative partners that make remote care possible.
“COPD in the neighbourhood”
‘COPD in the neighbourhood’ is a collaboration between healthcare organisations that want to improve care for people with COPD. One of the initiators is Peter Paardekooper, from Huisartsen Centrum Zandvoort. “For people with COPD, hospital visits are strenuous because of their limited lung capacity. In addition, the checks are arranged at fixed times, meaning we are not always there when the care is really needed. Thanks to our new remote monitoring service, that is now possible; patients can securely exchange information with doctors and nurses, and make video calls on a tablet via the dedicated Luscii app. In this way, patients gain insight into their lifestyle and its influence upon their health. Then, we only need to make appointments in the hospital if it is necessary”.
What makes the project special is that all parties involved in the care for people with COPD have joined forces: general practitioners cooperative Zuid-Kennemerland, network of physiotherapists FysiQ, healthcare organisations Kennemerhart and Zorgbalans, the Spaarne Gasthuis, health insurer Zilveren Kruis and innovative partners that make ‘remote care’ a reality. In an initial pilot scheme, the idea of ‘COPD in the neighbourhood’ proved to be successful: now the time has come for the next step. Paardekooper: “What’s new is that we can now offer 24/7 care through video calling and use of the Compaan, a user-friendly tablet. With remote monitoring, we bring second-line care to the ‘zero-line’, at home with the patient. That gives him or her much more freedom”.
The 24/7 remote care is carried out by the nurses of Medisch Service Centrum NAAST. If necessary, they can call in one of the other healthcare professionals, for example, for a home visit. René Baljon, director of NAAST: “Our years of experience with remote care for hospitals can now benefit general practitioners. We stand beside the healthcare professional and the patient, and that gives them a safe feeling. With remote care, the actual care becomes a less prominent part of your life and that makes it incredibly valuable”.Fast information exchangeAll healthcare providers, such as the district nurse, practice assistant, lung nurse and the physiotherapist, remain informed over the course of the disease via the communication platform OZOverbindzorg.
Paardekooper: “Together, we give the patient control, he or she determines which care providers receive access. They can exchange information as quickly as possible and take action when necessary”. COPD in the neighbourhood will begin, in this new set-up, with 50 patients. Paardekooper: “In 2019, we wish to expand this further and make remote monitoring possible for all people with COPD in the Kennemerland region”.
Baljon supports that ambition. “It has recently been agreed in Parliament that remote care is to be made available for everyone with COPD and heart failure, across the Netherlands, within the next three years. That is where the collaboration in Kennemerland fits in seamlessly. We are ready to scale up together”.
Made possible by
The project “COPD in the neighbourhood” is made possible by the uniting parties: GPs Cooperative Zuid Kennemerland, Spaarne Gasthuis, FysiQ network, Luscii, Kennemerhart, Medisch Service Centrum NAAST, Compaan, Zorgbalans, OZOverbindzorg and Zilveren Kruis.
This press release was published by NAAST on 11 November 2018 in Dutch (https://www.icthealth.nl/nieuws/zorgorganisaties-bundelen-krachten-voor-mensen-met-copd/)
Noordwest Ziekenhuisgroep and Luscii start pilot
The Heart-Lung Centre of the Noordwest Ziekenhuisgroep (Northwest Hospital Group) starts its Telemonitoring pilot with Luscii. With Telemonitoring, patients are followed remotely by a medical specialist and/or nurse specialist while carrying out medical check-ups from home. This means they won’t have to visit the outpatient clinic every time.
During the pilot phase, Noordwest Ziekenhuisgroep will ask 25 heart failure patients and 25 COPD patients to participate for a period of 6 months. The project is a collaboration between Noordwest Ziekenhuisgroep and Luscii.
Today Floor Haak, member of the Board of Directors of the Noordwest Ziekenhuisgroep and Daan Dohmen, founder of Luscii, signed the collaboration agreement for Telemonitoring using Luscii. “This project is great because it is a way to deliver care in a very patient centred and future proof manner. Care of high quality, delivered at the right place”, said Floor Haak.
The signing itself was also completed in an innovative way, using the video communication to practice what we preach. On the photo (from left to right): Jan van Ramshorts (cardiologist), Victor Umans (cardiologist), Daan Dohmen (on the screen), Floor Haak (member of the Board of Directors) and Wendy Burgersdijk (pulmonologist).
Photo by Noordwest Ziekenhuisgroep/Pierre Mettes
This press release was published by Noordwest Ziekenhuisgroep on 6 November 2018 (https://www.nwz.nl/Nieuws-NWZ/ArtMID/6077/ArticleID/865/Noordwest-en-Luscii-starten-pilot-Telemonitoring)
Patients with COPD of the Medisch Spectrum Twente Hospital will now have the opportunity to receive Luscii telemonitoring to support their at-home care and reduce the risk of hospital readmissions. I was at the kick-off meeting with patients and talked to them and their doctors and nurses.
Last week, on Tuesday 11th September, the official Kick Off with COPD patients, their relatives and care professionals took place in Enschede. Patients were shown how to use the iPad with Luscii monitoring and Luscii videocare at home and are now familiar with the term ‘telemonitoring’.
MST – one of the biggest hospitals in the eastern part of the Netherlands – starts with an Experience phase first, where patients with a history of frequent hospitalisations will be monitored at home. To gain insight into the feasibility of telemonitoring for these patients, I will lead a study together with the care professionals in the hospital. Since this new way of providing care to patients is quite exciting to both patients and care providers, we expect to retrieve some initial answers on the added value of telemonitoring from this research.
Chantal van der Linde, pulmonary care nurse, explains that she “hopes to be able to intervene in case of deterioration much earlier”. And to “offer a better safety net to patients”.
Patients are looking forward to starting with home monitoring. When asked what they expect from telemonitoring, one patient explained that they hope for “less hospital admissions, I already had two in a row recently”. Another patient added: “I believe that this makes contact with the nurse much easier and quicker, now I often call when it’s already too late”.
“It is difficult to address the effect of telemonitoring within the first 25 patients we start with”, explains Dr. Hekelaar, pulmonologist. “But I’m curious to see to what extent we can keep patients out of the hospital”.
We are all very excited to start and are looking forward to experiencing the use of telemonitoring in practice!
At the start of the Dutch e-Health Week, RKZ-patients will receive their tablets with the Luscii Vitals (formerly cVitals) and Luscii Contact (formerly cContact) applications. They will use them to monitor their vital signs directly from home.
The Luscii Vitals app on the tablet will provide the patients with information about their disease, self-management tips and support when having health problems related to their COPD. Over the following months, they will fill out a questionnaire weekly and whenever Luscii detects deterioration of their health situation, Luscii will inform the pulmonary nurse of VIVA Homecare directly. The nurse will then visit the patients at home or use Luscii videocare for a virtual consultation. If needed, they can refer to the pulmonologist or pulmonary nurse directly at the Rode Kruis Hospital.
Pulmonologist Erik Kapteijns: “We are going to treat these patients much more intensively without them needing to visit the outpatient clinic. By acting earlier, patients will have less exacerbations and a more stable development of their disease”.
Luscii will provide its digital health platform with apps for the patients and hospital users. Through this digital health platform, data will be managed and sent securely. The first step is to test and optimise the care pathway with a smaller group of patients. When successful, it will be scaled further.
Part of this article was published in Dutch on the website of RKZ in January 2017. A follow up article was published in print in May 2018.