The Department of Pulmonary Diseases at the Isala Hospital started with digital homemonitoring for COPD patients via Luscii Apps in 2017. Patients in the project don’t have to come to the hospital as often and have a lower risk of hospital admissions as well. The check-ups of the patients are completed remotely, with home measurements taken twice a week using the Luscii Apps. If Luscii detects deterioration, the nurses at Isala will be informed and will reach out immediately. The project is accompanied by research carried out by Martine Breteler MSc, working together with different people at the Isala Hospital, including pulmonologist Jan Willen van den Berg MD, PhD.
The Dutch Ministry of Health made a video of this great project and showcased it as an example of the eHealth movement in the Netherlands during the eHealth Week:
Mr. Foederer suffers from heart failure, a serious condition in which the heart’s pumping function continues to decrease. As one of the first patients of the Haga Hospital’s Heart Centre and in the region in general, he is now under supervision at home via ‘Cardio@Home’. The doctor or nurse sees all measurement results and can intervene quickly if a situation changes.
In the Netherlands, about 150,000 patients are suffering from heart failure. There are many disorders that can cause heart failure: a heart attack, high blood pressure, cardiac arrhythmias, cardiomyopathy, valvular heart disease, inflammation of the heart muscle or a congenital heart defect. “Although the medication continues to improve, the condition is unfortunately as yet incurable”, explains cardiologist Ivo van der Bilt. “Half of these patients have a life expectancy of 5 years after the diagnosis, so it is a serious condition that calls for proper support of the patient and family. The Haga Heart Centre has an outpatient clinic with specialised nurses for heart failure. Here, we recently started the project Cardio@Home”.
More measurements, less hospital visits
“The patients that participate in the project Cardio@Home are now monitored more often, while they have to visit the hospital less often”, says heart failure nurse Arjan te Hoonte. “They receive an iPad, a wireless blood pressure monitor and a weighing scale for 6 months. The equipment is delivered and installed at the patient’s home by the supplier Luscii (previously ‘FocusCura’). At home, the patient measures his or her weight and blood pressure 2x a week. The results are sent to us via an app and we assess them immediately. We also ask the patient to fill in a questionnaire regularly, which contains questions about shortness of breath and fatigue during the measurements. This helps us in evaluating the measured values. In addition to the regular check-ups in the hospital, now we can also monitor and check on the patient remotely, adjust medication or give other advice, and if necessary, we can video call the patient via the iPad”.
Arjan is very enthusiastic about this development. It helps the patient to feel safer and to reduce the the hospital visits. “We also ask about the level of satisfaction, to make the quality of life visible. It provides us with a lot of information for scientific research, which helps us to adjust policies and to continue the use effectively”.
Safe and secure
Mr. Foederer feels comfortable with monitoring at home. “I do not have to go to the hospital as often, and if there is something strange, I can take action immediately. I can have a call with the nurse through the iPad. The nurse also called me once when my weight suddenly went up. He wanted to know if I was also developing fluid retention around my ankles. Now I’m being watched closely, but remotely”.
E-health has become an integral part of healthcare
Ivo van der Bilt considers this form of e-health a valuable addition to healthcare. “Innovative e-health facilities are used increasingly as part of the care process in healthcare.Thanks to Cardio@Home, these vulnerable patients can live independently at home for as long as possible. We can reassure the patient remotely, but also intervene faster if the situation worsens. With medication adjustment, for example, we can prevent a visit to the Emergency Department and maybe even a hospital admission, which is a reassuring thought for the patient”.
This article was published in Dutch on the website of Haga Hospital in December 2017.
“I can’t do it anymore. My husband has late-stage dementia and my children live far away. I just don’t know what to do anymore. Please help me”. Wow, that hit home. I looked up and saw an older woman sighing with frustration at the health-care counter. The woman at the desk was doing her best, but didn’t really know how to help. I was sitting in the waiting room, watching it all unfold. For some reason, I couldn’t stop thinking about it. Is this vulnerable group of people being left behind? Are we expecting them to be too self-sufficient? Are we doing enough to help them?
Technology back in the day
When I first started working with FocusCura in 2003 (the company which I founded and of which Luscii became a spin-out brand), the world was relatively simple. iPads and iPhones didn’t exist and technology was reserved for cool youngsters and nerds, not for senior citizens. That’s why a lot of people called me crazy when I came up with the idea of using technology to help older people maintain their independence. But I did it anyway. And the senior citizens loved it. You can see how it looked on the picture below (made in 2004).
Things are very different today. Technology plays a dominant role in the lives of young and old alike. We use computers, smartphones, and tablets for everything. In fact, our devices are the first thing we see when we wake up and the last thing we see when we go to bed.
Last year, 86% of Dutch people used a smartphone (source: Dutch Smartphone Users report by Telecompaper). The majority of this growth was found among older people, given that most young people already used smartphones. In fact, smartphone use among people in the 65-80 age bracket increased from 9% to 63% in 2016.
Self-sufficiency and technology
Technology is playing an increasingly important role in our lives and is therefore becoming a determining factor in our ability to remain self-sufficient. However, there are a lot of vulnerable people who don’t understand these advancements – like the woman in the story above – and are afraid to ask for help. They are limited in their ability to take care of themselves and manage their lives. In many cases, the children live far away or have no interest in caring for their parents. It’s important that we don’t forget these people. And we aren’t: ten thousand nurses, caregivers, and volunteers are committed to helping this vulnerable group every day.
At home with dementia
I recently had the opportunity to shadow a dementia nurse at a healthcare organisation we work with. Dementia nurses help old people with dementia and their relatives, such as husbands, wives, and close family members, the entire time that person lives at home. During my work, I try to have this kind of ‘days in the life of’ with the users of our products once in a while (see also our way of working in the keynote below).
Together, we biked around visiting several clients. One of those clients was a couple and the wife had severe dementia. The husband was faced with a tough decision: put her in a nursing home or keep her at home. Their daughter was there too and I had so much respect for how they handled the situation. They explored all of the possibilities and thought long and hard about ways to avoid this difficult decision. “The last thing you want is to have your own wife committed”, he explained to me. The case manager and community care services were extremely supportive.
We visited another older gentleman that day who lived alone. He was vulnerable but very happy. He was eager to share his stories with us, with no real connection between them. He didn’t know a thing about technology. He was still coming to terms with the passing of his wife. As we were walking out the door, he explained that his children were worried about him. They all live far away and don’t really know how to help.
Technology to alleviate concerns
I was very impressed that morning and it really got me thinking. All of these people have their own challenges and problems, but were extremely happy with the support of the community care services and the case managers. To them, self-sufficiency was about as abstract a concept as technology. Although, that’s not entirely true with respect to the latter. Lots of people asked me to explain what FocusCura does. So I told them about partnering with healthcare institutions to help vulnerable people live at home safely and independently.
These people in particular, who didn’t really understand technology at all, were the ones who encouraged me to continue. While the sensors may be too late for them, they would have certainly made life easier. It also would have been nice to stay in the comfort of their own home for dementia check-ups, instead of having to take their partner with them to the hospital.
Plenty of work to do
This day made me realise all the more how important technology is. While it may not help dementia patients directly, it does give them the opportunity to enjoy the personal attention of their own warm, loving, and dedicated caregivers.
I don’t want to be a doomsayer, but the statistics don’t lie. With the number of healthcare users on the rise and a shortage of healthcare workers, our problem won’t be a lack of budget in the future. The real problem is a lack of qualified nurses, caregivers, and case managers.
The clever use of technology can provide support to these caregivers in helping their clients. In this way, we can help them maximise their limited time so they can also focus on offering personal and warm care. After all, they’re the ones who know the type of care someone needs and when they need it.
How great would it be if they could use wearables to check on their clients and take immediate action when something goes wrong? And how comforting would it be for the client’s children to be able to hop by using Luscii videocare, to join a visit of the nurse?
We still have a long way to go and there’s still plenty to do and develop in terms of healthcare technology. As great as the commercials are, it’s extremely challenging to develop technologies that perfectly address the needs of users, be they healthcare providers or clients.
We also have to reform our healthcare budget system if we want to achieve this. We don’t even have to replace the current rules and regulations with new ones; in fact, I believe that almost everything we want is possible in our current healthcare system. We just have to do it, which requires courage on all sides: healthcare providers, insurance companies, and businesses. If they create the room for healthcare providers to determine their own care methods, we can make good on our promise!
It all comes down to one thing: the people.
Of course, the gadgets, robots, and new technologies are super exciting, but they really play a minor role. It’s all about the people who use these technologies: the case managers who trust that these devices will be their eyes and ears; the caregivers who know that the smart sensors will alert them if something goes wrong.
Of course, this extends beyond the technology used in dementia care. The same applies to telemonitoring for COPD and heart failure, whereby patients send their measurements to their healthcare providers. Technology plays an important and welcome role for this group as well. It does, however, have to be extremely user-friendly and often also requires a detailed explanation from our technicians. But when I hear how happy patients and caregivers are and how much calmer they feel, I know we’re on the right path.
Extra help for an extremely vulnerable group
Is eHealth only suitable for independent, trendy, and healthy people? Or for people with a strong social network? Absolutely not! We can’t forget the extremely vulnerable group of people, like the older woman at the healthcare counter. They deserve special attention and help. After all, they’re the ones who will benefit most from the support of modern technology.
Not necessarily from the technology itself, but from the warm and personal attention of caregivers who are always at hand. This personal care can continue to exist for all those who need it in the future!
*The situations were modified slightly for privacy reasons, without sacrificing the essence of the story.
THE HAGUE – Collaboration in the healthcare sector is becoming increasingly important. It is therefore vital that patient data can be shared easily between healthcare providers and with patients themselves. Unfortunately, the multitude of different systems in the healthcare sector has always complicated matters. But that’s about to change. The Reinier Haga Group is the first organisation to put Zorgplatform (the Care Platform) into use, which enables simple, structured and secure exchange of patient data.
The Reinier Haga Group (consisting of Reinier de Graaf Hospital in Delft, Haga Hospital in The Hague and LangeLand Hospital in Zoetermeer) has become the first to put Zorgplatform into action. Using this platform, patient data in the electronic patient file can be shared in a simple, secure and structured manner between healthcare institutions and eHealth solutions, such as the Luscii Vitals (formerly cVitals) app. The introduction of Zorgplatform is a welcome boost to the cabinet’s ambition to promote collaboration in the healthcare sector by actively developing ICT standards and making them compulsory. Today, Secretary General Erik Gerritsen talked about this development during a working visit.
“The Reinier Haga Group strives to offer its patients the right care in the right place at the right time. To achieve this ambition, it is essential that healthcare is tailored to suit individual patients as much as possible, increasingly making patients the directors of their own care processes. The introduction of a home-measurement app to measure vital statistics, such as blood pressure, weight and pulse rate, will facilitate this greatly. In addition, the availability of a patient file to our doctors and nurses is vitally important”, explains ICT manager Marcel Slingerland. “An increasing amount of the patient data we use is now obtained from other healthcare organisations and innovative apps used by patients at home. Zorgplatform has allowed us to tap in to these rich wells of data”.
Standard data exchange
A long-held desire among doctors and nurses is to have a total picture of each individual patient’s health. This is often impossible as the data required is locked away in a maze of separate systems. “We specially developed Zorgplatform to solve this problem simply and securely”, explains ChipSoft’s Remko Nienhuis. “Zorgplatform allows data to be shared with the hospital’s electronic patient file in a standard manner with the aid of the Healthcare Information Building Blocks (Zorg Informatie Bouwstenen or ZIBs) developed by the government. In this way, hospital EPFs can connect to other patient files and even to other innovative healthcare technologies”.
Luscii is the first to have its Vitals app (formerly cVitals) connected to Zorgplatform. This allows medical specialists to prescribe ‘Vitals home measurements’ directly via the electronic medical record (EMR), to access these home measurements and to receive alerts if any deviations are identified. They can then respond to these alerts, for example, via a video call using Luscii Contact (formerly cContact). Cardiologist Jan Willem Borleffs, who works at the Haga Heart Centre at Haga Hospital, is very impressed with the new possibilities. “Last year, we saw exactly how Luscii’s home measurements and video calls can provide vital assistance to patients with heart problems. Patients feel safer and we can take action earlier, which means hospital admission is often prevented”.
The right care in the right place
Mr. van der Hoeven, a heart patient, agrees. “This new form of care means better check-ups for me and that works really well”.
To connect more patients to this system, it is vital that these home measurements are integrated into ChipSoft’s EMR HiX, as this will prevent a whole separate system from being required simultaneously. “I am very happy that Zorgplatform has made all data available in our EMR”, says Borleffs. “This is a key step in gaining acceptance of eHealth”.
The connection of the home-measurement functionality in Zorgplatform means other healthcare institutions who connect to Zorgplatform can also access this data. The Netherlands has therefore made an important medical breakthrough in the field of sharing patient data.
The integration of Luscii into EMR Chipsoft:
A team of Luscii and Chipsoft HiX (the biggest EMR vendor in the Netherlands) integrated Luscii deeply into Chipsoft using ‘Zorgplatform.’ The integration has three features: 1) sign up of patients for telemonitoring directly from the EMR, 2) alarm handling of Luscii alarms in the EMR workflow and 3) all data measured with Luscii delivered directly into the EMR. The first hospital system to use the integration is Haga Group (three hospitals in The Hague, Delft and Zoetermeer).
This press release was published by Luscii and Chipsoft at the beginning of 2018.
Slingeland Ziekenhuis (Slingeland Hospital), Sensire, and Menzis have optimised how they work together, so that they can provide even better remote care to people suffering from heart failure. Patients can now send information about their heart rate, blood pressure, and weight every two weeks using an iPad, improving how their health is monitored and reducing the frequency of in-hospital check-ups. Health insurer Menzis now fully covers the cost of this new style of digital care.
The hospital, healthcare provider, and health insurer teamed up some time ago as part of the project ‘InBeeld’ (‘bringing into vision’), to provide remote care to people with Chronic Obstructive Pulmonary Disease (COPD). This enables patients, nursing staff, and doctors to use the ‘Vitals’ app (formerly cVitals) – a product designed by the Dutch company Luscii – on their iPad and other digital devices in order to exchange information and video-call via a secure connection. If required, patients can contact the nurse directly or schedule an appointment at the hospital.
This application seamlessly brings together the cardiologist’s specialist knowledge at Slingeland Hospital, Sensire’s nursing expertise, and Menzis’ financial support. This has boosted the quality of life of patients living in more rural areas of the Netherlands: The control they have over their health means they no longer need to go to the hospital as often. It’s a step towards a healthier life.
John Diederik from Hengelo is one of the enthusiastic users of this remote care. The time that John and his girlfriend would have spent at the hospital can now be used for their hobbies and leisure. He tells us about his experiences: “Today’s technology really has no limits. I stay in contact with friends and family via Facebook, and I also use Maps. It’s great to see how many solutions we now have for day-to-day things. Now we can add health care to that list”.
This press release was published by our partners Sensire, Slingeland and NAAST Medical Center.