Patient demand should be a central consideration in eHealth applications, says Niels Chavannes, Professor of Primary Care Medicine and holder of the strategic chair of eHealth applications in disease management at LUMC. “An eHealth app should offer ease of use, reliable content that adds value, and an attractive look and feel.” Medical Delta partners combine all the necessary skills to provide that through the eHealth Institute.
The recent collaboration between Medical Delta and the University of California at Berkeley underlines that this link starts in the field of eHealth. “Berkeley has a lot of start-up know-how as well as technological expertise, but clinical research is lacking,” says Chavannes. “That’s why we wanted a three-party collaboration with Kaiser Permanente, a California health insurance and healthcare company with 17 million members. We can add the clinically relevant questions to gain important insights from their big data.”
Delft design-thinking, Rotterdam public health know-how, and Leiden clinical expertise add up to a strong package for eHealth applications. Clinical content and strategy go hand in hand in the new virtual eHealth Institute, which fits perfectly in the Medical Delta formula.
Niels Chavannes, Professor of Primary Care Medicine and holder of the strategic chair of eHealth applications in disease management at LUMC
Build on success
This is only one approach to eHealth, a container term used for anything from getting drug recipes online to complex patient portals. “The problem with eHealth is not a lack of supply, but rather a lack of proven added value,” says Chavannes. “In the iStore you can find 440,000 health apps, but which of these are useful and which are useless? To answer this last question: most are useless.”
One of the aspects of the eHealth Institute’s approach is to add value to products that are already good and popular. An example of this is the website www.thuisarts.nl by the Nederlands Huisartsen Genootschap (NHG). It attracts more than 25 million visitors annually. “The site offers visitors solutions to grassroots health problems,” says Chavannes. “It’s easy to use, and is also very relevant with regard to the present discussion on the deductible in the Netherlands, as this website has a considerable and proven dampening effect on the use of front-line healthcare. This success can be explained by its simplicity. The simpler a solution seems, the better. ‘Under the bonnet’ an app can be highly complicated and supported by lots of clinical data, but if it can’t be used intuitively, it’s no good. Patients want their lives to become easier, not more difficult.” Medical Delta will add clinically proven content to this website.
Apart from ease of use, another key to success, says Chavannes, is the fit to patient demand. “It’s important to listen carefully to patients when they talk about the problems they patients notice and the suggestions they make. These things might enable successful eHealth applications. And, as the annual survey carried out by the Dutch national competence centre for eHealth (NICTIZ) observes, such successes are necessary or the uptake of eHealth applications will stagnate. But many patients aren’t too keen on on-screen consultation, preferring personal contact. A top-down, supply-driven approach won’t work. Large-scale introduction is therefore not a good idea.”
What patients do appreciate is reduced waiting time and better information in the waiting room. “Some chronic-disease patients like the opportunity to ask questions through an app, enabling them to skip regular consultation, but others don’t,” says Chavannes. “So let them decide for themselves. Technology offers them the opportunity of more flexibility, so why not use that?” Similarly, the front-line diabetes care in The Hague (LOS) lets patients choose between regular visits and visits in combination with an app, made with Medical Delta support.
Given the eHealth Institute’s recent launch, many activities are still in a preliminary phase. But there is already a myriad of initiatives underway. For instance, there is an app to monitor the risk of dementia as a follow-up to a Cardio Vascular Accident (CVA). Or an app that asks patients in hospital to indicate precursor elements to urinary tract infections related to catheter use, to prevent actual infections. Another great example is an app for making grant applications for a cardio-vascular research that has already passed the first selection round. The app monitors health aspects for self-management. It stimulates an active life, a healthy diet and supports quitting bad habits, such as smoking. It has been supported from the behavioural angle by psychologist Andrea Evers.
“Discounts for healthy food in supermarkets and gym subscriptions add an element of seduction,” says Chavannes. “Real-time movement tracking and coaching opportunities are among the features. One of the most remarkable ideas is an app called Health@work by EIT. The aim of this app is to improve employee health and reduce sick leave. It will be tested by thousands of Medical Delta employees. The health insurance company Achmea and the electronics company Philips are on board as partners. The idea is to promote better health, as well as a more healthy business, on the basis of clinical expertise. A lot of parties can be linked to it, from the company’s industrial medical officer to health insurance companies.”
Erasmus MC’s “Around the World” app is based partly on the same idea, but approaches it from a different angle. The element of seduction involves introducing aspects of gaming and competition. In this “serious game”, teams try to be the first to travel around the globe by adding up their steps. The app shows how far they have travelled, but also monitors medical parameters, such as blood pressure and heart rate.
Within LUMC alone, at one point there were 41 eHealth projects running simultaneously. “This could do with some streamlining,” says Chavannes. “In many cases, making the right connections creates interesting shortcuts. In this way, people who have undergone a knee operation will also be able to make use of many aspects of the urinary tract infection app. Both share the same goal: to prevent infection. After all, why re-invent the wheel?”
“To promote collaborations such as this one, we organise lectures on eHealth and ‘serious gaming’ events,” explains Chavannes. “During drinks afterwards, many ideas for new grant applications arise. These occasions also provide an opportunity to link Leiden medical experts to Delft technologists. These lectures are a considerable success, and lead to unique collaborations. There’s a shared awareness of the need to collaborate if we’re to attain the goal of value-added solutions.”
Interview by: Leendert van der Ent