Imagine no longer having to go to the hospital, but simply having a conversation at home with your lung nurse about how you feel. From February 2019, this will become a reality for 25 Treant patients with the chronic disorder COPD (lung disease). During this month, the healthcare group will begin a trial in which patients receive a tablet, on loan, through which they can transfer their medical information to the hospital. If this information requires further discussion, the lung nurse will contact the patient via ‘video calling’.
Treant, in collaboration with the healthcare innovation company Luscii, is starting this pilot to gain experience in monitoring COPD patients from a distance. Lung specialist, Steven Rutgers, is pleased with the new scheme: “For patients who already have less energy because of their illness, it is of course fantastic that they will no longer have to come to the clinic every time. This pilot also strengthens our vision to concentrate care as close to the patient as possible. It is great that we can experiment with this possibility.”
How does it work?
Every week, patients use the tablet to fill in their information, such as blood pressure, weight and physical activity. They also report how they are feeling. They then send this information to the hospital. A specialist nurse will take a look at the data and, if necessary, will contact the patient. Through the use of ‘video calling’, healthcare professionals can see how the patient is doing and, in consultation with the pulmonologist, can adjust the medication if necessary.
COPD is a lung disease in which the lungs are damaged. The lungs cannot absorb sufficient oxygen, leaving the patient with shortness of breath and less energy. COPD is characterised by lung attacks that often lead to hospitalisation. Rutgers: “As we receive information about the condition of the patient more often during this pilot, we hope to prevent such lung attacks and subsequent hospital admissions”.
The pilot was made possible by healthcare insurer Zilveren Kruis and will last for six months. The pilot reinforces the agreement that Treant holds with the healthcare insurer to develop initiatives that bring care closer to the patient. A good example of the right care in the right place. In collaboration with the healthcare innovation company Luscii, scientific research will also be conducted into the results of remote monitoring. To start with, remote monitoring will be available to just 25 COPD patients treated at Scheper in Emmen. If the pilot proves successful, in the future, more patients will be able to pass on information to the hospital via video calling.
This press release was published by Treant ziekenhuis on 4 December 2018 (https://bit.ly/2RhyywZ)
When keeping an eye on your health, you do not always have to go to the hospital. The home measurement of, for example, heart rate, blood pressure and weight, is on the rise. And that is a positive development; as it gives people more control over their health. The Jeroen Bosch Hospital is therefore starting a trial of home measuring for people with heart failure and patients with the chronic lung disease COPD. The trial will run for six months and is a collaboration between the Jeroen Bosch Hospital and Luscii, the hospital branch of FocusCura.
A total of fifty people will take part. One participant is Mrs. Liefmans*, who lives with COPD. Twice a week, she will measure her heart rate and saturation (amount of oxygen in the body) from the comfort of her easy chair. In addition, she will complete a digital questionnaire; has she had any difficulty breathing in the past few days? How much has she moved? All the information that helps indicate the status of her health.
All data is sent digitally to her lung nurse, Joke Spierings, in the Jeroen Bosch Hospital. Has something deteriorated? Then she can contact Mrs. Liefmans immediately via video calling on a tablet. “By monitoring more often, we can spot a potential lung attack earlier. This way we can take action together and prevent any hospitalisation”, says Spierings.
“Thanks to home measurement, I know exactly how I am doing”
Previously, Mrs. Liefmans did not have such a precise insight into her health. She went to her GP and visited the pulmonary doctor for a check-up once a year. She only saw her lung nurse in the hospital after a lung attack.
“If I did not feel well, I often thought: it’s not too bad, I’ll see how it goes and then visit the doctor”, says Mrs. Liefmans. “But, by that time it was too late, and before you know it, you’re in hospital”. She was still there three months ago. Thanks to home measuring, she expects that this will no longer happen so quickly. “I want to be able to take steps earlier, so that my health does not deteriorate further. Thanks to home measurement, I know exactly how I am doing. That gives me peace of mind. And because I can always consult with my nurse if things get worse, I feel that I really have control”.
Spierings is also enthusiastic: “This program supports self-management of people. Thanks to the information provided by home measurements, and advice from our side, patients are able to make the right choices. Taking control of your health despite being ill; that is our goal.”.
* Mrs. Liefmans is a fictitious name.
This press release was published by Jeroen Bosch Hospital in Dutch on 29 November 2018 (https://bit.ly/2RhyywZ)
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
Healthcare organisations join forces for people with COPD
Starting today, residents of the Kennermerland region with the pulmonary disease COPD can now use the network ‘COPD in the neighbourhood’. Thanks to the dedicated App, they can monitor the course of their illness and contact healthcare professionals remotely via video calling. The advantages for people with COPD include reducing the need for hospital visits, gaining more control over their lives and improving that feeling of safety, as specialised nurses are available for contact day and night. COPD in the neighbourhood is made unique through the intensive cooperation between healthcare providers in the neighbourhood, the hospital and innovative partners that make remote care possible.
“COPD in the neighbourhood”
‘COPD in the neighbourhood’ is a collaboration between healthcare organisations that want to improve care for people with COPD. One of the initiators is Peter Paardekooper, from Huisartsen Centrum Zandvoort. “For people with COPD, hospital visits are strenuous because of their limited lung capacity. In addition, the checks are arranged at fixed times, meaning we are not always there when the care is really needed. Thanks to our new remote monitoring service, that is now possible; patients can securely exchange information with doctors and nurses, and make video calls on a tablet via the dedicated Luscii app. In this way, patients gain insight into their lifestyle and its influence upon their health. Then, we only need to make appointments in the hospital if it is necessary”.
What makes the project special is that all parties involved in the care for people with COPD have joined forces: general practitioners cooperative Zuid-Kennemerland, network of physiotherapists FysiQ, healthcare organisations Kennemerhart and Zorgbalans, the Spaarne Gasthuis, health insurer Zilveren Kruis and innovative partners that make ‘remote care’ a reality. In an initial pilot scheme, the idea of ‘COPD in the neighbourhood’ proved to be successful: now the time has come for the next step. Paardekooper: “What’s new is that we can now offer 24/7 care through video calling and use of the Compaan, a user-friendly tablet. With remote monitoring, we bring second-line care to the ‘zero-line’, at home with the patient. That gives him or her much more freedom”.
The 24/7 remote care is carried out by the nurses of Medisch Service Centrum NAAST. If necessary, they can call in one of the other healthcare professionals, for example, for a home visit. René Baljon, director of NAAST: “Our years of experience with remote care for hospitals can now benefit general practitioners. We stand beside the healthcare professional and the patient, and that gives them a safe feeling. With remote care, the actual care becomes a less prominent part of your life and that makes it incredibly valuable”.Fast information exchangeAll healthcare providers, such as the district nurse, practice assistant, lung nurse and the physiotherapist, remain informed over the course of the disease via the communication platform OZOverbindzorg.
Paardekooper: “Together, we give the patient control, he or she determines which care providers receive access. They can exchange information as quickly as possible and take action when necessary”. COPD in the neighbourhood will begin, in this new set-up, with 50 patients. Paardekooper: “In 2019, we wish to expand this further and make remote monitoring possible for all people with COPD in the Kennemerland region”.
Baljon supports that ambition. “It has recently been agreed in Parliament that remote care is to be made available for everyone with COPD and heart failure, across the Netherlands, within the next three years. That is where the collaboration in Kennemerland fits in seamlessly. We are ready to scale up together”.
Made possible by
The project “COPD in the neighbourhood” is made possible by the uniting parties: GPs Cooperative Zuid Kennemerland, Spaarne Gasthuis, FysiQ network, Luscii, Kennemerhart, Medisch Service Centrum NAAST, Compaan, Zorgbalans, OZOverbindzorg and Zilveren Kruis.
This press release was published by NAAST on 11 November 2018 in Dutch (https://www.icthealth.nl/nieuws/zorgorganisaties-bundelen-krachten-voor-mensen-met-copd/)
Noordwest Ziekenhuisgroep and Luscii start pilot
The Heart-Lung Centre of the Noordwest Ziekenhuisgroep (Northwest Hospital Group) starts its Telemonitoring pilot with Luscii. With Telemonitoring, patients are followed remotely by a medical specialist and/or nurse specialist while carrying out medical check-ups from home. This means they won’t have to visit the outpatient clinic every time.
During the pilot phase, Noordwest Ziekenhuisgroep will ask 25 heart failure patients and 25 COPD patients to participate for a period of 6 months. The project is a collaboration between Noordwest Ziekenhuisgroep and Luscii.
Today Floor Haak, member of the Board of Directors of the Noordwest Ziekenhuisgroep and Daan Dohmen, founder of Luscii, signed the collaboration agreement for Telemonitoring using Luscii. “This project is great because it is a way to deliver care in a very patient centred and future proof manner. Care of high quality, delivered at the right place”, said Floor Haak.
The signing itself was also completed in an innovative way, using the video communication to practice what we preach. On the photo (from left to right): Jan van Ramshorts (cardiologist), Victor Umans (cardiologist), Daan Dohmen (on the screen), Floor Haak (member of the Board of Directors) and Wendy Burgersdijk (pulmonologist).
Photo by Noordwest Ziekenhuisgroep/Pierre Mettes
This press release was published by Noordwest Ziekenhuisgroep on 6 November 2018 (https://www.nwz.nl/Nieuws-NWZ/ArtMID/6077/ArticleID/865/Noordwest-en-Luscii-starten-pilot-Telemonitoring)
Patients with COPD of the Medisch Spectrum Twente Hospital will now have the opportunity to receive Luscii telemonitoring to support their at-home care and reduce the risk of hospital readmissions. I was at the kick-off meeting with patients and talked to them and their doctors and nurses.
Last week, on Tuesday 11th September, the official Kick Off with COPD patients, their relatives and care professionals took place in Enschede. Patients were shown how to use the iPad with Luscii monitoring and Luscii videocare at home and are now familiar with the term ‘telemonitoring’.
MST – one of the biggest hospitals in the eastern part of the Netherlands – starts with an Experience phase first, where patients with a history of frequent hospitalisations will be monitored at home. To gain insight into the feasibility of telemonitoring for these patients, I will lead a study together with the care professionals in the hospital. Since this new way of providing care to patients is quite exciting to both patients and care providers, we expect to retrieve some initial answers on the added value of telemonitoring from this research.
Chantal van der Linde, pulmonary care nurse, explains that she “hopes to be able to intervene in case of deterioration much earlier”. And to “offer a better safety net to patients”.
Patients are looking forward to starting with home monitoring. When asked what they expect from telemonitoring, one patient explained that they hope for “less hospital admissions, I already had two in a row recently”. Another patient added: “I believe that this makes contact with the nurse much easier and quicker, now I often call when it’s already too late”.
“It is difficult to address the effect of telemonitoring within the first 25 patients we start with”, explains Dr. Hekelaar, pulmonologist. “But I’m curious to see to what extent we can keep patients out of the hospital”.
We are all very excited to start and are looking forward to experiencing the use of telemonitoring in practice!
Today there is good news for thousands of Dutch heart patients. After the largest insurer Zilveren Kruis announced to fully reimburse the e-health service HeartGuard, four other major healthcare insurers (VGZ, DSW, ONVZ, De Friesland) will also follow and reimburse HeartGuard in 2017. Cardiology Centers The Netherlands (CCN), together with Luscii, founding partner of HeartGuard, announced this news today.
HeartGuard enables continuous monitoring of cardiovascular patients suffering from heart failure, hypertension or atrial fibrillation. Patients can measure their vital signs at home with the Vitals App (formerly cVitals), developed by the Dutch healthcare innovation company Luscii.
The vital signs, like blood pressure or weight, are sent in remotely through the Vitals App on the patient’s iPhone or iPad to the cardiology centres and are automatically added to the Electronic Medical Record of the patient. Doctors and nurses will be alerted in case of detection of an increased health risk. Following that alarm, the staff will reach out to the patient and/or general practitioner. Hospital admissions and outpatient clinic visits are reduced by the HeartGuard service.
Fast scale up possible because of reimbursement
”Contracting with any of these four insurances companies makes it possible to offer the service to thousands of patients”, according to Cecile Goldman, VP of Operations at CCN. ”Now we can offer the service to patients insured at these insurers as well. This number can grow even further, when insurers CZ and Menzis will start reimbursing HeartGuard too. ”We are in dialogue with them to offer HeartGuard as well”.
CCN: “Dutch insurers are setting an example”
By reimbursing HeartGuard, Dutch insurers are setting an example. They are showing that they are not only retaining traditional care delivery, but are willing to support innovation. ”HeartGuard is at the forefront of further evolution in healthcare and by opening up the service to these new patients, we can increase our insights into the effects of this innovative healthcare service on an even larger scale”, says Cecile Goldman.
Insurer ONVZ: “enthusiastic about possibilities of eHealth”
Chairman of the Board of insurer ONVZ Jean-Paul van Haarlem is enthusiastic about the possibilities of HeartGuard for its clients: ”This is an innovation that provides patients with personalised care. HeartGuard will have a positive impact on quality of care and on efficient use of resources. Because it monitors the patient’s health remotely, HeartGuard will lead to a reduced number of hospital visits. This is a major improvement for the patient. Reimbursing HeartGuard is an important step for heart patients insured at ONVZ.
Insurer Zilveren Kruis: “good that others are following”
“We are very happy with the fact that we have realised this breakthrough last summer with Luscii and CCN to bring chronic cardiovascular care close to our clients. The fact that others follow this example towards innovative care, making it available to more patients is great”, says Erik-Jan Wilhelm, VP of Strategy and Innovation of Zilveren Kruis.
Dutch Patients Federation: “positive development”
The Dutch Patient Federation is happy that more and more insurers reimburse eHealth. ”We are glad that other insurers are following the example of Zilveren Kruis”, says Director Dianda Veldman. ”I hope more of these eHealth initiatives will be developed so all patients can enjoy this modern form of healthcare.”
Collaboration with hospitals and GPs
At this moment, only patients of Cardiology Centers the Netherlands are eligible to use HeartGuard, but, according to Cecile Goldman, this will change soon: ”We are already having conversations with GPs and hospitals to offer HeartGuard from their own locations to their own patients. We will monitor the patients in that case in commission of their own doctor. Scale is an important factor to eHealth, sharing our resources and expertise reduces the need for every hospital to reinvent the wheel“.
This press release was published by Cardiology Centers The Netherlands and Luscii (previously FocusCura) on 6th March 2017.
In the midst of the summer holidays, healthcare insurer Zilveren Kruis introduced a unique financing model for hospitals who want to offer telemonitoring at home for their patients. The news is a breakthrough for thousands of citizens that suffer from heart disease. Together with Menzis – who previously introduced unique funding for COPD monitoring – the insurers show that this innovation is not just a whim for them. Now, what does this mean for hospitals and patients?
Financial paradox for eHealth
Despite all the promises, eHealth is not widely available for every patient. A major cause being the current funding system. Though VBHC (Value Based HealthCare) sounds inspirational, nowadays reimbursements for specialist medical care are based on the number of actions that have been carried out. In short; a hospital gets paid when patients visit the doctor or the outpatient clinic, or are admitted. In contradiction, many eHealth solutions – including home measurement – aim to prevent care. And that’s a catch 22; Costs to the hospital increase when introducing home measurement tools, while turnover decreases because fewer interventions or admittances are needed. From an insurer or payer or citizen perspective this is a win (we all pay taxes and fees for insurance). But this does not work for the hospital and the doctor… What now?
The start of new financial models for home monitoring
In 2016, Zilveren Kruis, Cardiology Centers the Netherlands (CCN) and FocusCura entered into a long-term partnership to bring as much hospital care as possible to the homes of patients. They launched the “HeartGuard” concept, watching over patients with heart failure, hypertension and atrial fibrillation. Part of this concept would also include a completely new way of funding, and that was easier said than done…
Over the course of nine months, an innovation team representing all three parties worked on the concept. They shared the vision that care should be delivered tailor-made to the patient’s needs, and while monitored safely at home with technology, a hospital visit would only be necessary in case of urgency. This approach improved the patients’ service-experience tremendously, while at the same time, the cost of care was reduced: Admissions are prevented and outpatient care is partially substituted. The calculation model of the innovation team was tested at CCN, and after testing the ‘Hartwacht fee’, would be made widely available by Zilveren Kruis. And that moment is now.
The concept is based on the principle of ‘bundled payments’. An insurer pays the hospital a bundled price per care pathway. The price being determined upon the historical price of the mix of healthcare products in the concerned care pathway. Though this seems complicated, basically it comes down to the hospital always receiving a guaranteed rate per pathway. Regardless of whether the patients visit the outpatient clinic, are hospitalised or are monitored remotely through home monitoring and videocare. Caregivers can thus determine, without financial consequences, in consultation with their patients, what is best for them. And if they decide to use the home monitoring, there are no additional costs for the patient, since they are paid for in the bundle price.
Does it work for the patients?
From my own experience, I can tell what this means for patients. Kor: “Someone in my immediate family has heart problems. He had to go to the hospital very regularly. Sometimes for a routine check-up, even though he had no complaints. Another time in panic to the emergency room. Fortunately, he has a modern cardiologist who prescribed ‘HeartGuard’”.
Kor received measuring equipment at home and the Vitals app was installed on his phone. During the first ‘setting week’, a personal measurement protocol was set up. Now he sends in his measurements weekly and he no longer has to visit the clinic. “I remember how ‘happily surprised’ he was after being ‘videocalled’ by the HeartGuard Centre, when it appeared that there were strange values in his measurements. His medication was adjusted and altogether this gave him such peace of mind. Not only for him, but also for us, as his direct family”.
More time for cardiologists
And besides, his own cardiologist was extremely satisfied. He now has insight into all home measurement data in the EMR and remains Kor’s regular point of contact for those moments when something is really off. According to a jointly agreed protocol, home measurements are treated in the HeartGuard Centre in Dokkum. The HeartGuard data shows that less than one in ten measurements have to be forwarded to the cardiologist. The rest of the home measurements are handled by the Vitals app itself or the HeartGuard team in Dokkum.
For Kor’s cardiologist, this means that many urgent questions popping up in his busy schedule, now belong in the past, while patients immediately have clarity about their condition and possible risks. He can thus have more patients under his supervision. And his own work is more pleasant, he said, because he can do his job even better by intervening proactively and by using the data for the benefit of his patients.
2019: Extra financial incentive
To make this widely available, Zilveren Kruis goes a step further; they commit to a fixed bundle price for three years. So hospitals will receive the same bundle price over the next three years, regardless of how their operational costs of the outpatient clinic decrease or the number of admissions decreases. Hospitals are allowed to keep the margins themselves and are given the time to adjust to the new way of care. A huge incentive!
Sharing knowledge to better care
It is very cool to be able to contribute to this movement with our team. We are happy to share our knowledge gained through various channels, such as in this blog. Because I hope that other hospitals will now also take the step. Since not only my Kor, but all heart patients, deserve the best care that fits their needs. VBHC then becomes a practice.
Or like my inspiration Florence Nightingale stated:
“Were there none who were discontented with what they had, the world would never reach anything better.”
This blog was published in Dutch on the website of Qruxx about Value Based Healthcare in August 2018.
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.
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.
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: