Patients with a severe form of the pulmonary disease COPD have been using home monitoring since February. By completing a questionnaire twice a week via the Luscii app, they are monitored remotely and are immediately assisted in the event of deterioration. Pulmonary nurse Iris Huisman explains the benefits.
Fewer trips to the hospital
More and more people are suffering from Chronic Obstructive Pulmonary Disease (COPD), a chronic lung disease, in which the damaged lungs lead to shortness of breath, coughing and fatigue. In patients with a severe form of COPD, the symptoms are often so bad that they become less mobile or may need extra oxygen. For them, a mild cold can lead to a dramatic increase in symptoms. We call this a lung attack, resulting in hospitalisation and further damage to the lungs. Iris: “Now that we are monitoring this group of patients remotely, we are able to guide them more effectively and hope to prevent such attacks and hospital admissions. In addition, patients no longer need to come to the hospital for standard checks, which they often find tiring because of their limited mobility”.
Contact at the right time
For the home monitoring of patients, Tergooi is working together with the medical service centre, NAAST. The nurses at NAAST already have experience with this method of monitoring at Slingeland Hospital and know the procedure at Tergooi. They keep an eye on everything 24/7 and if they see a deterioration, they immediately contact the patient via a video consultation, calling through the Luscii video connection. “If NAAST are unable to respond, we become involved. Coincidentally, this afternoon I had a video consultation with a patient whose symptoms we had noticed had suddenly worsened. He admitted that he did not realise that things were going so badly and would not have called himself, but he was very pleased that there was direct contact and that action had been taken”.
Telemonitoring can also be a solution for COPD patients who need more intensive support. Iris: “Because NAAST is available 24 hours a day, a patient who is very anxious and scared at night can make contact very easily. A video consultation at such a moment is exceptionally reassuring and supportive. Patients’ voices are therefore heard if necessary and they can ask for care at any time. At the same time, they also gain more insight into their illness by completing the questionnaires twice a week”.
Since the introduction of telemonitoring for patients with chronic heart problems (in 2016), more than 500 Zilveren Kruis policyholders have been using HartWacht (translated HeartGuard, a remote monitoring service powered by Luscii, red.). 128 patients (25% of the participants) have been using HartWacht for more than a year. Comparisons have been made between their healthcare usage for the 12 months prior to telemonitoring and the 12 months following use. The results are impressive.
The first research results show a large decrease in the use of care. Olivier Gerrits, Director of Zilveren Kruis Healthcare Purchasing: “We were already convinced that telemonitoring contributes to more control and better quality of life. Now it appears that for our policyholders, there are also fewer admissions, emergency visits and ambulance trips”.
Major decrease in emergency first aid visits on A&E
Patients guided by HartWacht for a year have experienced a decrease in the number of nursing days, the number of emergency trips and the number of emergency room visits. This reduction has been compared to the year prior to the supervision of HartWacht. The number of nursing days has dropped by more than 40% and the number of emergency trips with the ambulance has been reduced by 30% in one year. The largest decrease occurred in the number of emergency room visits: In the group of patients that began with HartWacht, the number of emergency room visits (A&E) fell by 70%, compared to the year before.
VBHC Prize 2019
HartWacht is a joint initiative of Zilveren Kruis, the Netherlands’ Cardiology Centre (CCN) and the Dutch healthcare innovation company Luscii. The number of participants is growing steadily. This breakthrough in eHealth was an international first for the Netherlands in 2016. Last month, HartWacht received the VBHC Prize for its collaboration. Igor Tulevski, cardiologist and co-founder of CCN: “A wonderful reward for increasing the quality of life for patients and reducing healthcare costs on a daily basis”.
There is a growing demand across the UK for telemonitoring provided by Luscii. To steer expansion on the British side of the Channel in the right direction, Rob Brougham will be joining the team. He will begin his role as Managing Director for the United Kingdom on the 1st of May.
Impact on healthcare
Rob is a successful entrepreneur, and has also worked for large companies including British Telecom (BT) where he became CEO of the e-health division. The division built on the Whole Systems Demonstrator; a global, randomised controlled trial studying various tele-health systems. The positive impact of modern technology on the lives of patients with a chronic illness made a big impression on Rob. The number of hospital admissions (14-20%) and visits to emergency care (15%) were reduced significantly within the study population.
“Selling networks and systems to businesses is challenging”, Rob explains his decision, “but it doesn’t provide the same satisfaction that telemonitoring offers. Making a difference to people in a difficult situation is an important incentive for me”.
When BT shifted its strategic course and ventured away from tele-health, Rob decided to switch definitively to the e-health industry. First, as an advisor to various English e-health companies. Later, as UK Managing Director of Ieso Digital Health, which is one of the top 50 fastest growing e-health companies in the country. And, from the 1st of May onwards, as Managing Director for Luscii UK.
Rob sees plenty of opportunities for Luscii in the UK. “There are some players on the market, but we haven’t seen the levels of quality and accessibility of Luscii here, as yet”.
At any rate, Rob is set for a busy summer ahead. A number of British hospitals are about to start working with Luscii, while others are eager to discuss the possibilities that Luscii offers. The ambitions of Luscii are therefore perfectly in line with the “Long term plan”, presented in the past quarter by the NHS. Just like the Netherlands, the United Kingdom is struggling with increasing demand and staff shortages within the healthcare sector.
Now that Rob Brougham has been brought in to strengthen the UK division, many British patients and healthcare professionals will experience Luscii’s telemonitoring in the near future. We have faith that Rob will keep enough time free for his wife and daughters. Likewise, his five a side football team and waterskiing club won’t accept too many absences either!
Doctors and nurses are gaining valuable experience through home measurement and video calling in numerous locations across the Netherlands. They are learning something new every day; how to introduce digital care to patients, how to make video calls, when to adjust thresholds. How useful would it be to bring all those caregivers together and learn from each other’s knowledge during a Sharing Session?
“Very useful”, says a nurse from Dijklander Hospital. Pulmonologist, Erik Kapteijns, begins the afternoon with his lessons learnt from 1.5 years of telemonitoring COPD patients. For example, it was not a good idea to start during flu season due to the increased workload. But since then, the results achieved have been really impressive. One quarter fewer admissions of the research population! The upscaling is therefore in full swing.
Sharing Tables exchanges tips and tricks about inclusion, the monitoring protocol and, of course, the expansion from a few patients to larger populations. Knowledge is multiplied by sharing experiences!
On behalf of Luscii, Daan Dohmen offered a sneak peek of upcoming developments. Luscii’s vision was received with wide eyes and enthusiastic nods. We make the magic of healthcare innovation possible with a little technological help, but mainly thanks to the smart collaboration between pioneering healthcare providers.
Were you unable to attend? No worries! Later this year, we will organise yet another Sharing Session. Whether another magician will be present, we will keep under wraps…for now.
HartWacht, the innovative healthcare concept that was set up through a collaboration of Cardiology Centers the Netherlands, Luscii and insurer Zilveren Kruis, was awarded by the Professor Porter Value Based Healthcare Collaboration Award 2019. For Luscii, this means that one of its projects wins this prestigious award the second year in a row. Last year the COPDInSight-service of NAAST, insurer Menzis and Luscii was the winner of the Professor Porter Value Based Primary Care Award 2018.
HartWacht telecardiology service
HartWacht is a revolutionary telecardiology service offered by the Cardiology Centers The Netherlands to their patients in 15 centers across the Netherlands. Patients with heart failure, hypertension and atrial fibrillation don’t need to go to the clinic anymore, unless it is needed. The eHealth service was announced in 2016 and is currently available all across the Netherlands with full reimbursement from five of the biggest Dutch insurers.
HartWacht telecardiology service
Globally, the demand for cardiovascular care is rising due to the ageing populations, increased cardiovascular risk and the quest for personalized care. However, resources are limited.
The “classic” healthcare system cannot meet these requirements. Therefore, an affordable and scalable solution is needed. The aim of HartWacht is to increase population health, improve the quality of care and lower the per capita costs by making use of new health technologies such as Luscii vitals.
Heart failure, hypertension and atrial fibrillation
Patients are selected for HartWacht by their cardiologist based on their diagnosis and protocolized inclusion and exclusion criteria. Patients can then share their data with their healthcare provider using the app and the results will be integrated in their electronic patient file. By making both the home measurements and the other relevant medical data online available to the patients, they are encouraged to participate actively in their healthcare processes. In addition, therapy and policy are focused around patient data and adapted continuously if needed. Interventions include lifestyle advice if appropriate, change in medication, education about disease and/or additional diagnostics, thereby forming an IPU.
Patients with severe hypertension and heart failure are guided by the Luscii app to do home measurements with connected measurement devices for blood pressure, heart rate and weight. Also patients with atrial fibrillation are enrolled using Kardia with EKG-monitor. All the data of patients is analyzed and securely transmitted to the the electronic patient file and is interpreted by a dedicated team supported by smart algorithms and a nationwide network of outpatient clinics which can be visited by the patients if needed. The concept is financed through bundled payment schemes. Patient value is measured through standardized questionnaires.
To continuously monitor quality and safety and patient outcome, research projects have been initiated. First results are published in scientific peer reviewed journals and demonstrate a positive effect on safety of the program and patient experience and outcome. Research shows that HartWacht results in less visits to outpatient clinics and emergency departments, thereby adding value to our healthcare system by improved health outcome with less costs. Also patients and treating physicians are satisfied: with less effort they experience faster results of success of their therapy.
For every patient that is registered for home measurement in the coming Heart Week, we will donate to the Hartstichting
It is collection week at the Hartstichting! More than 50,000 collectors are raising money for solutions to keep everyone’s heart as healthy as possible. Luscii wants to contribute too. And our professional users help us during this Heart Week!
They determine the Luscii donation
We have decided to donate a fee to the Hartstichting for every new patient that is registered for home measurement this week. In doing so, we can combine the start of modern care for patients with a contribution to a good cause.
At Luscii, we like to keep things simple. Therefore doctors and patients can just register patients in the same way as usual. In the upcoming Heart Week (15th to the 19th of April), we will keep a record of how many patients have been registered. We will not distinguish between different groups (for example, we will also count patients in other Luscii programs, such as COPD). Once the week is over, we will transfer our contribution to the Hartstichting. There is no limit, so the amount raised lies entirely in the hands of our users.
The collection is of vital importance
Living with a heart disease is tough, for the patient and their surroundings. The number of patients is growing rapidly. Therefore, the proceeds from the Hartstichting’s collection will be used to create solutions for keeping every heart as healthy as possible. The Hartstichting is working towards 3 goals:
- The prevention of developing heart problems
- Faster assistance in an emergency situation
- Better treatments, so that patients suffer less
All help is welcome, so that the Hartstichting can find solutions earlier. At Luscii, we think this is important. That is why we are happy to support this goal.
The next charity?
At Luscii, we believe that companies have a responsibility to add something positive to society. And that is something we are very conscious of. This time, we chose the Hartstichting. And with success, we will gladly support another goal next time.
We welcome any ideas for that!
Tergooi Hospital (Gooi and Vechtstreek), in partnership with health insurer Zilveren Kruis, are set to bring 20 percent of their current hospital care closer to home. Both organisations have signed a declaration of intent for the new proposal. In doing so, they hope to respond to patients’ needs to receive the right care in the right place.
Subsequently, optimal use must be made of innovative technological options, such as telemonitoring for COPD and heart patients. The Zorg Dichterbij program aims to realise this possibility. In addition, Tergooi and Zilveren Kruis are starting projects focused on prevention. The goal is to avoid repeat trips to the hospital for treatment and/or admittance for patients with a specific condition.
Accelerated relocation of care to the home, an appropriate IT infrastructure and the prevention of care are central to the transition plan that Tergooi and Zilveren Kruis have agreed upon. As is now common knowledge, this is desperately needed to combat challenges such as cost increases, an aging society and the associated growth in the number of chronic disorders, but it is also necessary to help alleviate increasing pressures on the shrinking number of healthcare professionals.
Tergooi has a main location in Hilversum and two regional medical centres. By offering safe care at home, the hospital will organise its healthcare in a different way. Acute, intensive and complex care will remain within the hospital. Good cooperation between healthcare institutions and caregivers within the region is also essential to achieve the desired care in the right place.
Compact New Build
The new construction of Tergooi, which will begin at the end of this year, will be smaller. With the use of online consultations, closer cooperation with care partners, and standardised nursing departments and outpatient clinics, the hospital expects to be able to cope with a more compact building.
Hans den Hollander, Chairman of the Tergooi Executive Board, explains: “As we are starting our new building this year, this is the perfect time for us to implement the change to deliver care in the right place. In doing so, we can continue to improve the quality of our care and respond to the needs of patients, whilst keeping hospital care affordable”.
Care Close By
Tergooi and Zilveren Kruis have already begun with the Zorg Dichterbij program. Part of this includes telemonitoring for chronic heart failure and chronic lung diseases (COPD). More and more doctors from the hospital are also providing consultations via video. Furthermore, treatments are being moved towards the home, for example, with kidney dialysis.
The precondition remains that home treatment is only an option if it is medically justified, says Olivier Gerrits, Director of Healthcare Purchasing at Zilveren Kruis: “Our policyholders prefer to have healthcare as near as possible. We attach great importance to stimulating the movement of care to the home, together with caregivers. So that illness has as little impact as possible on the lives of our policyholders. For us, Tergooi is an example of how we can implement that vision in a sustainable and modern way”.
Right Care, Right Place
In September 2018, the health insurance company announced that it would be investing more in applications that could move healthcare from the hospital to the home environment. In October, Zilveren Kruis announced that it would link its healthcare procurement policy and its focus on “the right care in the right place” to the Medical Specialist Care Outline Agreement 2019-2022.
The Outline Agreement for the hospital sector states that the growth in hospital expenditure must be reduced (via digital care applications, amongst others) in order to reach 0 by 2022. Purchasing Director Gerrits stated at the time that relocation of care to the home (the right care in the right place is also a spearhead of the NVZ and a cabinet ambition) will result in the greatest savings. Even more than just moving care from the second to the first line.
At the beginning of August, the health insurer reported that following a successful pilot with Hartwacht at the Dutch Cardiology Centre, they would also make agreements with hospitals across the Netherlands for telemonitoring heart patients. In accordance, Zilveren Kruis offers hospitals three-year contracts.
In February 2019, Zilveren Kruis signed a multi-year agreement with the Isala Hospital in Zwolle, to further improve the content of healthcare and meet the rising demand for care through the use of e-health, such as telemonitoring. Gelre Hospital followed in March. In addition, just like CZ, the insurer encourages the use of online treatments in mental health care to reduce waiting lists.
Press Release – Queen Maxima Visits Sensire and NAAST
VARSSEVELD – Clients and employees of Sensire and NAAST were surprised this morning with a visit from Queen Maxima. She visited the organisation to get acquainted with Remote Care, a unique collaboration of digital healthcare in the Achterhoek.
“Thanks to the iPad, I have my freedom back!” This surprising admission was shared with Queen Maxima by 72-year-old Mrs. Mijnten-Schoolderman, during an informal work visit to healthcare organisations Sensire and NAAST. Sensire provides remote care via digital healthcare organisation NAAST to patients with, for example, the lung disease COPD or heart failure. “At first, I didn’t want anything to do with the iPad, but that soon changed”, she says. “I can now decide for myself how my life should be”. Thanks to remote care, patients can decide for themselves when to have contact with care workers. Patients are given an iPad with special software from Luscii, a start-up that develops smart software for remote care. Via video calling, they can make contact with nurses and other specialists who provide care from a distance. “Do you know what the real beauty of it is? The people at NAAST know me and my situation. So I don’t have to tell my story over and over again”.
“The visit of Queen Maxima demonstrates that something really special is happening with healthcare in the Achterhoek”, says Maarten van Rixtel, Director of Sensire. Digital resources and techniques are being implemented into healthcare in more places across the Netherlands. “What makes our commitment special is the scope and the fact that we, as different organisations, work together”, says Van Rixtel. An intensive collaboration exists between Slingeland Hospital and health insurer Menzis in the area of remote care.
Sensire has been a pioneer of digital care since 2009 and has remained closely involved with Luscii since 2014, who specialise in healthcare innovation. “Giving people an iPad is not that difficult”, says Daan Dohmen of Luscii. “The point is to build and deploy the technology in such a way that customers regain control”.
Slingeland Hospital sees remote digital care as an important means of getting closer to the patient. “As a hospital, you are actually always too late”, says Erwin Bomers, Director of Healthcare Policy at Santiz Hospitals. “With remote care, you get very close to your patients: in their own home environment. As a result, you have a better picture of the situation, and our people are able to ask other questions”.
For Menzis, collaboration with healthcare organisations, such as Sensire and Slingeland Hospital, is a special step. Olivier van Noort, Senior Healthcare Purchaser at Menzis: “The exceptional thing is that we really entered into this together: we share the risks and the benefits”. Remote digital care not only gives customers more control, it also offers an important means to continue to make healthcare possible in the future.
Healthcare organisation Omring, Dijklander Hospital, Northwest Hospital Group, GGZ North-Holland North and GP organisations are joining forces with VGZ, part of which includes Univé Zorg. Together, they are working on “sensible care”. This relates to better quality healthcare for the patient that remains accessible and affordable.
These institutions can no longer accept the shortage of nurses; the decline in this region caused by the increasing aging of the population. After all, growth requires new, different and creative solutions, and these organisations, and their doctors and nurses, are working on this collectively with VGZ. The basis for the special regional cooperation comes from the office floor itself: doctors, (district) nurses and psychologists are working together with VGZ on over 100 ideas, all contributing to better care for patients. As most residents in North Holland are insured with Univé, they will certainly notice new forms of healthcare arising in the long term.
The healthcare providers involved have signed long-term agreements (or an intention thereto) with VGZ. In doing so, the organisations won’t have to renegotiate their contract with the health insurer every year, and can instead focus on improving care for the client at lower costs. After all, they have certainty for the coming years and a basis of trust. This has already produced good results in various places across the country.
Omring: Together the best care, close to home
In collaboration with VGZ, Omring is working on a new and faster method of compression therapy (support stockings), fall prevention for vulnerable seniors, more efficient supra-regional triage via an app, amongst other things, and oncological treatment at home, which patients greatly appreciate.
Northwest Hospital Group and Dijklander Hospital: Medicines, primary care and wound management
The Northwest Hospital Group has already enjoyed success in its approach to expensive medicines, in improving first-line care so that patients no longer need to visit a specialist, and with its coordinating function for complex wound management, together with nine general practices. Experts from the Dijklander Hospital are working on better wound care through video calling, together with Omring nurses. This saves the patient a lot of appointments and travelling. At the same time, district nurses will be trained accordingly.
GGZ North-Holland North: Mobile care
GGZ North-Holland North has drastically shortened waiting times thanks to its approach to personal and recovery-orientated diagnosis. The direction for the treatment is expressly placed with the client. The organisation has also successfully integrated e-Health, in anticipation of specialised healthcare providers.
GPs pilot: More time for the patient
In West Friesland, seven GPs are participating in a “more time for the patient” pilot. In other regions, this approach has already led to better quality care, an increase in patient satisfaction, a rise in work satisfaction for the GPs, and a decrease in the number of referrals to the hospital.
Patients with the lung disease COPD are now able to send measurements from home directly to the outpatient clinic of pulmonary medicine. Pulmonologist Pathman Pasupathy explains the procedure: “Every week, patients fill out a questionnaire on their tablet and send in their saturation values. If their situation deteriorates, we will be notified and, if necessary, we will contact the patient via video calling (iPad)”.
Zuyderland is using Luscii for the project. The pilot is intended to gain experience in the remote monitoring of COPD patients. Monique van de Kragt, a physician assistant at the clinic, says that she is happy with the trial: “For patients who already have less energy due to their illness, it is of course fantastic that they do not have to come to the clinic every time. This pilot also strengthens our vision that we wish to manage healthcare as close to the patient as possible. It’s great that we are able to experiment with this”.
COPD is characterised by lung attacks that often lead to hospitalisation. Pasupathy: “As we have more insight into the condition of the patient through this pilot, we hope to prevent such lung attacks and, subsequently, hospital admissions”.
The pilot is being carried out in collaboration with health insurer CZ and will run for the coming six months.
The Netherlands scores well internationally in the field of healthcare. But unfortunately, spending on healthcare is rising faster than the rest of the economy. This is simply not tenable for the future. Furthermore, differences in the quality of care are often not clear. Through sound healthcare procurement, CZ hopes to contribute to future-proof healthcare in 2020.
Responsible and Close by
The common thread throughout our 2020 healthcare purchasing policy is ‘Responsible and Close By’.
- ‘Responsible’ ensures that CZ group will only contract healthcare that is both affordable and in line with our quality vision. In accordance, we apply appropriate yet ambitious standards.‘
- Close by’ is the starting point of the healthcare provision: either at home or close to home if possible. And further away if it guarantees better quality care. By ‘close by’, we also mean: in keeping with the wishes and choices of the insured in regard to their treatment. For example, through joint decision-making processes and the deployment of new (distribution) forms of diagnostics and digital support. In this way, we make treatment less stressful and much more person-orientated.
Vision of quality
CZ attaches great importance to high-quality care for its policyholders. This vision is reflected in our healthcare procurement policy and documents of value.
Vision of healthcare purchasing
Healthcare must be of good quality, affordable and accessible. Now and in the future. That is why CZ makes agreements with healthcare providers to ensure high-quality care that meets the needs of patients, is delivered in the right place, and maintains a reasonable price.
Purchasing in consultation with the healthcare field
Healthcare purchasing is not a stand-alone activity, in which we single-handedly decide what is right. Instead, we are involving and collaborating more and more with the healthcare field: patients, healthcare providers, municipalities and other stakeholders. By innovating, collaborating and continuing to work on structural progress, we can improve healthcare in the Netherlands and give substance to “Healthcare that goes further”.
Providing senior patients with quality care is becoming increasingly difficult. The growing elderly population is putting a strain on healthcare systems, as doctors and nurses no longer have the time or resources to meet demands. Bjørn Moesgaard Lou Kristensen, an employee of Eldercare in Kokkedal, Denmark, knows this predicament all too well.
A year and a half ago, Kristensen sought out a solution for senior citizens in the Fredensborg area, stating “We just knew that we had to do something”. Replacing home visits with remote contact appeared to be the perfect answer to the problem. Using Luscii’s videocare software, the team in Kokkedal have successfully integrated the project into their daily routine.
Benefiting daily life
Kristensen works with senior citizens suffering from a range of illnesses, including Alzheimer’s and dementia. Such patients are typically visited in the morning, allowing caregivers to prepare food for the day ahead. By then giving the patients a videocall around lunchtime, the carers can ensure they have eaten, drank enough fluids and have remembered to take their medication.
One patient in particular, an elderly lady with dementia and psychiatric issues, looks forward to Kristensen’s calls every day. Her physical visits have been reduced to just once a week, during which caregivers are able to clean and administer medication. The rest of the week, she is contacted via a screen three times a day. This allows Kristensen to not only make sure she is taking her tablets, but also enables him to visually check her appearance. He even requests that she walks around the dining table a couple of times while they chat, to show she is physically active. Something which he simply wouldn’t have the time for during a home visit.
And that quality of contact has been the driving force throughout the project. Kristensen explains, “I have been in this line of work now for 22 years, and I know what it takes to visit a patient. But the difference here is the eye contact. During a videocall, you are with that person 100%”.
Persuading some seniors to get on board with the technology required has been tough at times, according to the Eldercare team. Additionally, figuring out the right way of how to proceed has cost the most time and effort. Several organisations in neighbouring towns and cities are looking to Kokkedal for direction, having also adopted video monitoring, in seeking an effective and successful approach to delivering this new type of care. The target is to have set up at least 100 citizens with video calling by the end of this year, with a total of 20 patients in every town or city across the area.
Despite initial difficulties, once fully up and running, the reactions from both caregivers and patients have been very encouraging. Aside from providing more direct contact, remote monitoring also saves precious time for healthcare professionals. Kristensen values this new wave of e-health development, citing “This is the future. It is here to stay”. Having recognised the positive effects such modern advances can have, he hopes to expand his vision even further by ensuring the best quality care for everyone who needs it.