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.
This press release was published by Reinier de Graaf Hospital on 12 March 2019
The role of Luscii in Reinier de Graaf Hospital:
Luscii provides hardware, software and patient support for the monitoring of the COPD patients in Reinier de Graaf Hospital. The Luscii platform is used by the care teams in the hospital to monitor their patients and get notifications in case of increased health risks. Patients who are enrolled will download the Luscii vitals and Luscii contact apps to sent in their measurements and have (video)-communication with the nurses or pulmonologists. Also, after enrollment, Luscii is responsible for all logistics (sending the measurement devices), service and (installation) support for patients within the Reinier de Graaf Telemonitoring service. Luscii implementation specialists will support Reinier de Graaf with the implementation of the new procedures, care pathway and will together evaluation research is carried out.
We are very happy to announce that this week a new Research Assistant started at Luscii! Fenna Jonker, who’s currently finishing her Bachelor’s degree in Health Policy and Management at the Erasmus University, will assist Luscii’s team with conducting different research projects.
A number of hospitals in the Netherlands have started with the Experience phase of Luscii telemonitoring. To gain insight in the feasibility of telemonitoring of patients with Heart Failure or COPD, different research projects with care professionals are being conducted. This will make it possible to learn and see whether adaptations are necessary to the current care pathway of the hospitals to prepare and scale remote patient monitoring. Fenna will help us with gathering, structuring and analyzing these data.
Fenna considers continuing a master’s degree in Healthcare management. In the meantime, she hopes to learn here more how eHealth solutions can be implemented successfully for different hospitals. “I am also very curious to learn more from a business perspective, since I don’t have any experience as a student yet”.
Good luck Fenna!
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.
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)
Even our deputy prime minister, Hugo de Jonge, is calling for more speed when it comes to e-health, for example, with home measuring. But where do you start? In this article, we provide an action plan to help you make the right choices with the current healthcare purchases for 2019.
This action plan is based on a combination of practice and science. I learned by trial and error during projects with both FocusCura and Luscii. I studied ICT implementations during my PhD at the University of Twente. This is how I discovered that successful implementations almost always follow a fixed pattern.
My most important lesson: a successful implementation is determined by the execution. The transformation of a dream into the reality of new daily care. Thomas Edison already said it best: “Vision without execution is hallucination”. So, let’s get started!
Preparation: define your dream and be specific
Start by making your dream concrete. Do you wish to give your clients more independence by staying at home with technology as an alternative to the care home? Do you, as a hospital, want to prevent unnecessary admittance for chronic patients?
You don’t have to come up with everything yourself, there are many good examples inside and outside the sector that can inspire you. Make your dream tangible for your organisation or department. Who are you doing it for and at what point will you consider it a success?
There is a big pitfall that I have often fallen into on this point. If you share your dream with care recipients and caregivers, you will notice that organisational limitations or financial restrictions will become the guiding principle. So, turn this around. Discuss your dream and find out whether they share it, but also show leadership to align the preconditions with your preferences.
Step 1: choose your partners and gain experienceNow it is time to involve others. Like the insurer. And partners that can offer competencies that you do not have. And no, in the year 2018 this is not the domain of the purchasing or IT department. It is a strategic choice. Does your partner already have agreements with insurers that you can take advantage of? Which partners can bring practical experience so you don’t have to reinvent the wheel? Choose a partner that suits your culture, as you are about to embark on a journey with one another.
Together, you begin with a proof of concept. As a first step to learn how your vision works in practice. At Luscii, we call this the experience phase. We approach the care process differently with around 25 care recipients by using our technology. That number is small enough to not have to disturb things too much. Yet it is still large enough for users to experience whether this will give them what they need. The dream comes to life and the caregivers involved become frontrunners, or idea champions, as I labelled them in my thesis.
After around four months, you can evaluate whether your idea works and create a follow-up plan to mix up the care path, which will involve financial agreements and technical integrations. If it appears in the evaluation that it does not work, then make alterations or stop. The latter sounds hard but I see many projects that remain dormant and that makes no sense. Show leadership in these cases and keep going, or stop and start again. If you continue, this also means that you choose not to keep the innovation free of obligation.
Step 2: continue and eliminate thresholds
Now that you are continuing, progress to around 150 users. This intermediate step is conscious. At this scale, it is impossible to do everything ‘on the side’, so your care path now changes completely. But with this intermediate step, you can keep the change manageable.
In this phase, you will invest more, for example, in a project leader or time for caregivers to work on new protocols, ICT integrations and/or training. Don’t be afraid to stick your neck out here, but also continue to measure whether you are achieving your goals.
At Luscii, we do this by measuring three-monthly parameters, such as satisfaction of patients and caregivers, reduction of clinic visits and admissions, and the amount of time Luscii saves for nurses. With the help of a ‘data dashboard’, you can monitor continuously and compare outcomes with data from other healthcare organisations. So that you can learn from one another.
Step 3: new service is a reality
Now you are ready to change the direction completely. If all has gone according to plan, you have now reached a critical number of care recipients and caregivers involved in shaping the new working method.
By making small interim steps, you have shifted from ‘innovator’ to ‘early majority’ in the innovation model. The ‘project’ is over and your new service has become a reality. Your idea champions, the caregivers of the first hour, are probably already eager for the next stage. In current times, innovation never stops. You will start step 1 again after step 3 is complete: constant innovation is the future for continually meeting the wishes of clients, employees and everyday reality.
The future is now
If you want more tools to make e-health a success, take a look at the Playbook that we made with Menzis or download my thesis. Do you have suggestions for improving the approach yourself? If so, I am very curious to hear your thoughts.
This blog was published earlier in Dutch on Qruxx tech: https://tech.qruxx.com/drie-stappen-voor-succesvolle-introductie-van-e-health/?_ga=2.15733042.529853116.1543238273-1213197350.1530525548
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!
The role of Luscii in Medisch Spectrum Twente Hospital:
Luscii provides hardware, software and patient support for COPD Monitoring in Medisch Spectrum Twente (MST). The Luscii platform is used by the care teams in the hospital to monitor their patients and get notifications in case of increased health risks. Patients who are enrolled can download the Luscii Vitals and Luscii Contact apps on their iPhone or iPad, send in their measurements and have (video)-communication with the nurses or cardiologists. Also, after enrolment, Luscii is responsible for all logistics (sending the measurement devices), service and (installation) support for patients within the MST-service.
The innovative project ‘COPD InSight’ won theVBHC Primary Care Award 2018 on April 26th. COPD InSight is an initiative of…
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.
The role of Luscii in Rode Kruis Hospital:
Luscii provides hardware, software and patient support for the Rode Kruis Hospital. The Luscii platform is used as a web portal. Patients download the Luscii Vitals and Luscii Contact apps on their iPhone or iPad to send in their measurements and have (video)-communication with the nurses or cardiologists. Also, after enrolment, Luscii is responsible for all logistics (sending the measurement devices), service and (installation) support for patients within the service.
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.
The Martini Hospital starts, in collaboration with Luscii (previously ‘FocusCura’), two innovative projects to monitor patients with a chronic disease remotely and thereby prevent hospitalisation. Patients with COPD or heart failure receive a tablet at home, on which they transmit medical information about their condition to the hospital on a daily or weekly basis. If a patient exceeds their specific threshold value, the hospital will contact the patient via video calling. For example, medication can be adjusted at an early stage to ultimately prevent hospitalisation. In addition, it increases the degree of self-management, the feeling of safety and the quality of life of patients.
Hans Feenstra, the Martini Hospital’s chairman of the board: “These projects are a good example of ‘The right care in the right place’. We believe that, in principle, care should be organised as close to the patient as possible and we are therefore actively engaged in this”.
Patients who are already being treated by the hospital can participate in these projects. It is not the aim to relocate care to the general practitioner (substitution). This effective care is not only adding value for patients, it also reduces the costs of healthcare. Emergency admissions can be prevented and fewer outpatient visits are necessary. Feenstra: “The projects give substance to the long-term agreements that we have with healthcare insurers Menzis and Zilveren Kruis. We have committed to develop initiatives for care close to the patient.” Both projects start with a small group of patients in order to gain experience with this new way of working. Also, in collaboration with Luscii, scientific research into the results of telemonitoring is being conducted.
Prevent an exacerbation
COPD is a lung disease in which the lungs are damaged. The lungs fail to provide adequate breathing and the patient has less energy. COPD is characterised by lung attacks, in which the patient experiences more stuffiness, coughing and production of mucus, which often results in hospitalisation. We want to prevent these exacerbations by means of more frequent monitoring. Patients suffering from severe COPD fill in a validated questionnaire every week, containing questions about how the patient feels. A specialised nurse monitors the outcomes in the hospital. If these outcomes exceed certain threshold values, the nurse will contact the patient via a video consult. This way she can literally see how the patient is doing and can, for example, adjust the medication. This may possibly prevent an exacerbation. For patients with COPD, the trip to the hospital is very exhausting, as it often requires a great physical effort. Therefore this type of remote care is very suitable for them.
Titration of medication
Heart failure is a condition in which the pumping function of the heart decreases slowly or abruptly. As a result, patients get tired faster, develop fluid retention and experience shortness of breath in daily activities. Patients with heart failure transmit measurements of their weight, blood pressure and heart rate to the hospital daily, using the iPad. Therefore, these patients do not only receive an iPad, but also a weighing scale and a blood pressure meter at their disposal. Telemonitoring for heart failure is highly suitable for patients who have just been diagnosed with heart failure and for patients who are in an unstable phase of their condition. In both groups, the medication must be properly set or reset. And where that normally happens over a period of eight weeks through a series of visits to the outpatient clinic, it is expected that this can now be done in just a few visits and in just a few weeks. Adjusting the medication and explaining the condition and lifestyle will now take place via video contact, so that the patient does not have to visit the hospital. It is also expected that emergency admissions will be prevented. In addition, the patient is actively involved in his or her care process through this form of telemonitoring. Research shows that more control and self-management increases the patient’s quality of life.
The role of Luscii in the Martine Hospital:
Luscii provides hardware, software and patient support for the Martini Hospital. Luscii also helps the Hospital to implement Luscii the right way and to create the business case for insurers. Furthermore, when a patient is enrolled in telemonitoring, he/she will receive the Luscii Vitals and Luscii Contact apps to send in their measurements and have (video)-communication with the nurses or doctors. Also, after enrolment, Luscii is responsible for all logistics (sending the measurement devices), service and (installation) support for patients within the region of the Martini Hospital (Groningen). The PhD of Luscii (Martine Breteler) will be helping with the validation research.
This article was published in Dutch on the website of Martini Hospital in July 2018.
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:
The role of Luscii at Isala Hospital:
Luscii provides hardware, software and patient support for the COPD project at the Isala Hospital. Luscii helped the hospital to introduce telemonitoring into the outpatient clinic visit. Luscii worked together with the pulmonologists and specialised nurses in setting up the project. Furthermore, when a patient is enrolled into telemonitoring, they will receive the Luscii Vitals and Luscii Contact apps to send in their measurements and have (video)-communication with the nurses or pulmonologists. Also, after enrolment, Luscii is responsible for all logistics (sending the measurement devices), service and (installation) support for patients within the service.
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”.
The role of Luscii in Cardio@Home at Haga Hospital:
Luscii provides hardware, software and patient support for the Cardio@Home project at the Haga Hospital. Luscii helped Haga Hospital to introduce telemonitoring into the outpatient clinic visit. Luscii’s implementation specialists guided the cardiologists and specialised cardio nurses in setting up the project. Furthermore, when a patient is enrolled in telemonitoring, he/she willl receive the Luscii Vitals and Luscii Contact apps to send in measurements and have (video)-communication with the nurses or cardiologists. Also, after enrolment, Luscii is responsible for all logistics (sending the measurement devices), service and (installation) support for patients within Cardio@Home.
This article was published in Dutch on the website of Haga Hospital in December 2017.
People often question the proof of innovation in healthcare, for example, in projects such as COPD InSight or HeartGuard. Which is no small thing, considering so many innovations are implemented ‘on top of’ current healthcare, making it unnecessarily expensive. Just what do we mean by ‘proven’? What evidence already exists?
In this blog, Martine Breteler and Daan Dohmen will guide you through these questions. We can define the success of digital care as consisting of three categories of ‘evidence’, otherwise referred to as the Triple Aim principle. While it may be a slightly informal term, it actually just means ‘a healthy population’, ‘a better qualitative experience of healthcare’ for ‘relatively lower costs’. What evidence already exists?
Telemonitoring makes people healthier
For the first type of evidence, we will look at the effects of digital care, specifically that of telemonitoring in the population. In short, do patients experience fewer symptoms? Has there been a reduction in patients with worsening symptoms? Has there been an improvement in patients’ blood pressure?
A brief look at scientific articles indicates that there is a growing body of evidence worldwide showing this to be the case. Cardiologist Dr. Milani convincingly proved that virtual care for hypertension using connected devices has delivered a huge improvement (Milani et al. Am. J. Med. 2016). No less than 71% of patients diagnosed with high blood pressure achieved their goal to manage their blood pressure (with an average improvement of 14/5 mmHg) after three months, compared to 31% of patients who received regular care.
In addition to the hypertension patient group, other patient groups saw significant improvements to their health. One of the largest telemonitoring experiments in the world, the famed ‘Whole System Demonstrator’ programme, showed promising results based on its test group of 3,230 patients who had been diagnosed with either diabetes, COPD, or heart failure. This cluster randomised controlled trial showed a significant reduction in the number of fatalities and the number of visits to the emergency room among patients who used telemonitoring, compared to the control group.
Our own project reviews also show promising results. One review of 77 patients suffering from heart failure or COPD showed that among patients suffering from heart failure, 42% experienced fewer symptoms, and 69% felt more independent. Among COPD patients, this was 28% and 52% respectively. However, it is important to remember that these results were reported in specific patient groups whose doctor or healthcare specialist had ‘prescribed’ for measurements to be performed at home. So the question remains, in spite of these great results, whether this change is only temporary in nature. To achieve this result in the long term, it is even more important that patients themselves actually want to keep using telemonitoring.
Patients want it!
The second type of evidence is possibly the most important – improvements to a patient’s perception or experience. This may seem like a ‘softer’ type of evidence compared to the efficacy of studies of effectiveness. Then again, Uber and booking.com didn’t need to scientifically verify that their way of doing things was better than the way it used to be, did they? It’s the consumers who appreciate their services more, and therefore choose to keep using them.
In the healthcare industry, the number of options to choose from is limited. Patients are dependent on the suppliers, yet there are hardly any major differences between those suppliers. Meanwhile, we have already deployed telemonitoring in hospitals and are seeing impressive results among patients. A review among 23 patients of the St. Anna Hospital, Zuidzorg, and SGE show that 92% have experienced improved healthcare. Our test group of patients suffering from COPD and heart failure showed that 81% of patients with heart failure and 68% of patients with COPD experienced better healthcare.
Looking at HeartGuard, the first effect measurement among patients with resistant hypertension, who had been referred to second-line care and now receive remote support, improved these patients’ quality of life (measured using EQ-5D-5L) and increased their level of self-management (measured using PAM-13).
We shouldn’t really suggest that there is a link between the results shown in our test groups, which are still limited, and the existing body of scientific literature, yet we see similar results among patients who use telemonitoring as well. A large study was conducted among 851 vulnerable elderly patients suffering from COPD, heart failure, diabetes, or hypertension who had just been discharged from the hospital to investigate the effects of telemonitoring (Cardozo and Steinberg, Telemed J E Health 2010). This study showed that telemonitoring, defined as the daily measurement of vital signs combined with regular nurse visits, increased beneficial outcomes for elderly patients as well. 66% of patients thought that the quality of healthcare provided had improved, with customer satisfaction easily reaching 90%.
Again, the way in which measurements at home are performed – which specific patient group, which technology, and which type of intervention – is clearly a determining factor in the results. Behavioural scientists still have a lot to explore in this area. There is also a great deal left to research about the long-term effects, as many studies run over a limited time frame. Whatever happens, it’s going to be interesting!
Of course, although there’s no doubting the huge role played by scientific research in this area, we think it’s just as important to simply talk to patients and keep listening to their experiences. It really gives you a boost when patients themselves tell you what this service means to them.
Lower cost of care when using telemonitoring
It’s no simple matter to measure whether the cost of care provided decreases when using telemonitoring, mainly due to the way that care is ‘calculated’. However, scientific research concluded that the use of telemonitoring led to a reduction in the number of COPD patients with worsening symptoms, a reduction in hospital admissions, and a reduction in overall costs.
Seto’s systematic review of nine studies (Telemed J E Health. 2008) shows when comparing the cost of use of telemonitoring to the costs of regular healthcare, the total costs decreased in all studies as a result of telemonitoring, varying between 1.6% and 68.3%. This can be primarily attributed to the decrease in re-admissions. The figures may vary slightly due to differences in the telemonitoring system used, the variety of protocols, and the number of hospitals studied. However, this is still a promising piece of evidence that telemonitoring has a positive financial impact.
The aforementioned decrease in the use of healthcare has an even more significant effect. If we can treat the same number of patients with less labour but for equal or reduced costs, this will give a boost to the ever increasing shortage of staff in the healthcare sector.
So far, the initial results of research on these three types of ‘evidence’ reveal very promising outcomes as far as the use of telemonitoring is concerned. We realise that the body of scientific evidence is still scarce, so there’s still lots of work to be done!
Dilemmas when researching eHealth
For quite some time now, we’ve been trying to establish a generic experiment, intended to test the effectiveness of telemonitoring for COPD patients on a large scale, bridging multiple healthcare organisations. Establishing the correct research design has already proven to be problematic. Although the ‘randomised controlled trial’ (RCT) provides the most credible evidence available, there are various reasons why it’s an unsuitable method for researching the effects of telemonitoring.
A telemonitoring app is in a constant state of development, for example. Our developers regularly publish an updated version of the Luscii Vitals telemonitoring app with improvements for the patient or care provider. This makes a reliable comparison between the test and control group on the impacts of it impossible.
We consider it to be bordering on unethical to exclude patients who wish to participate because we know what it can mean for them (even though we probably shouldn’t be saying this out loud as scientists). Randomising who does and who does not receive telemonitoring is therefore not an option.
No “one size fits all”
How should we do it, then? To avoid reinventing the wheel, we have to take a really close look at scientific literature when establishing a research design.
In concrete terms, this means that telemonitoring is a medical intervention that needs to be implemented in a targeted way – it’s not suitable for every patient. We absolutely must listen to doctors who have ‘prescribed’ telemonitoring and assess how telemonitoring has been embedded in the healthcare process.
Literature increasingly supports this line of thinking. For instance, this month’s edition of Nature featured a meta-analysis of sixteen reliable randomised controlled trials. This showed that telemonitoring as a generic tool for ‘every patient’ has almost no significant benefit, while the proper use of telemonitoring for specific patient groups is very promising (Noah et. al, 2018).
How should we design our multi-centre research?
Unfortunately, there is no such thing as a “one size fits all” research design. After consulting different healthcare professionals, we have come to the conclusion that we need a control group if we want to report useable results. We have chosen a research design, together with Dr. Joris Jansen and in collaboration with professor of Data Science & Health Maurits Kaptein, that uses a matched control group consisting of patients who do not use telemonitoring.
Learning, doing, and researching at the same time
A single experiment won’t be enough to address all the research questions that require more ‘evidence’. Besides, we’re not aiming to conduct only one big experiment, live in a bunker, and await the results before continuing our work. Far from it. You really can’t put a price on the valuable information we obtain from studying continuous results. This targeted approach helps us provide practical applications of the ‘lessons learned’ about implementing an eHealth service. It’s all about learning, doing, and researching at the same time.
Meaning even more to patients
Of course, we want telemonitoring to be part of regular healthcare for patients who could benefit from it, including the funding that comes with it. Because, however complex it is to perform research, simply listening to patients’ experiences in our projects has shown us how we can mean so much more to these people. Given the expected rise in the number of patients, this will be more crucial than ever!
- Milani, R. V., Lavie, C. J., Bober, R. et al. (2017). Improving Hypertension Control and Patient Engagement Using Digital Tools. The American Journal of Medicine, 130(1), 14-20.
- Dransfield, M., Wells, M., & Bhatt, S. (2013). Effect of telehealth on use of secondary care and mortality: findings from the Whole System Demonstrator cluster randomised trial.
- Cardozo, L., & Steinberg, J. (2010). Telemedicine for Recently Discharged Older Patients. Telemedicine and e- Health, 16(1), 49-55.
- Seto, E. (2008). Cost Comparison Between Telemonitoring and Usual Care of Heart Failure: A Systematic Review. Telemedicine and e- Health,14(7), 679-686
- Noah, B., Keller, M.S., Mosadeghi, S., et al. (2018). Impact of remote patient monitoring on clinical outcomes: an updated meta-analysis of randomized controlled trials. Nature partner journals Digital Medicine 1, Article number:2