Portrait and video Douwe Atsma: "I feel like I'm in a toy store with all those other disciplines"

The current healthcare system faces an uncertain future. Rising costs, increasing pressure on personnel, and a surge in patients with complex diseases are driving the need for innovative solutions. Prof. Dr. Douwe Atsma is at the forefront, seeking answers beyond the traditional boundaries of hospitals and healthcare institutions. "With remote care, you can be much more present in someone's life."

Douwe Atsma, professor of cardiology at LUMC. Additionally, he serves as one of the Principal Investigators at the Healthy Society Hub. Since this month he has been appointed as Medical Delta professor with a dual appointment at TU Delft. "This presents a fantastic opportunity for me to collaborate with various disciplines and expand my research focus on virtual care."

Can you tell us about your research?

"In my research, I develop ways to provide healthcare in patients' home environments. We do this by providing the patient with a box, 'The Box,' a kit equipped with instruments allowing patients to conduct self-measurements. The contents, including a scale, ECG meter, thermometer, and sleep analysis device, are tailored to each patient's unique situation.

Through a dedicated app, patients perform measurements, and the data is relayed back to the healthcare team. This real-time feedback empowers patients to comprehend their health dynamics. Patients can learn about the relationship between weight and high blood pressure or understand the influence of food and sleep on glucose levels. The real-time feedback allows the patient to comprehend how their body works and what they can do to improve."

The innovation extends to digital support for patients, a substantial departure from the limited interactions in the current healthcare system. Doctors and nurses generally see patients very little throughout the year. Douwe Atsma envisions, "With remote care, you can be much more present in someone's life," echoing the sentiments shared by patients in focus groups who feel more supported."

This doesn't sound like classical cardiology. How did you come to this topic?

"After high school, I was torn between studying medicine or technical education at Delft University of Technology. Ultimately, I chose medicine, but my interest in technology was always there. Cardiology is also a technical field. You work with ECG, X-rays, and echo and have a lot to do with IT.

Our traditional way of providing healthcare is unsustainable. Too many people come to the hospital, healthcare is too expensive, and there is too little personnel. With my interest in IT, I started looking for solutions. Within LUMC, I have a lot of room for this. Innovation is also part of an academic center. Often, it takes the form of a new treatment, but in my case, it's a bit different."

What does collaborating with other disciplines bring to your work?

"A tremendous amount! Take, for instance, industrial designers like Maaike Kleinsmann from TU Delft. Their expertise lies in seamlessly navigating processes, mapping out care paths, and envisioning patient flows at a strategic level. They prompt essential questions about transforming the entire healthcare system to impact not only traditional spaces like general practitioners and hospitals but also the societal environment. Maaike has been instrumental in broadening my perspective, teaching me to view the ecosystem more comprehensively and holistically. As doctors, our focus tends to be narrower. Processes and involving industry in these initiatives are not instinctively considered from the medical side, but Industrial Design brings that essential viewpoint. This is critical because we require industry solutions that are sustainable in the long term and come with acceptable costs.

Our collaboration extends to psychologists like Veronica Janssen and Andrea Evers from Leiden University. They guide us in employing the most effective strategies for behavior change. What coaching and guidance techniques can motivate individuals to adopt healthier lifestyles? Measurement proves invaluable. Witnessing improvements in blood pressure, weight, or sleep acts as a powerful motivator. Positive feedback from a supporter, be it a doctor, nurse, or a trained professional, further fuels this motivation. The more dialogue and interaction, the more favorable the outcomes."

The more dialogue and interaction, the more favorable the outcomes.

"The app that participants use with The Box is a crucial component. 'Industrial Design has assisted us in this aspect as well. Alongside Valentijn Visch from TU Delft, we incorporated elements from the gaming world to keep people engaged. Within the app, users can observe their data and progress. A subsequent step we aim to take is to employ Artificial Intelligence to identify users who, at that moment, may need some extra attention. This attention doesn't always have to come from a doctor; it could be an automated bot sending a reminder or encouragement.

It's incredibly exciting to collaborate in this way. I feel like I'm in a toy store with all those other disciplines. It's also beautiful to notice the abundance of enthusiasm, creativity, and energy from everyone. Working with other disciplines is truly a valuable addition to what we already do here at LUMC."

How much does transdisciplinary collaboration strengthen your research?

"I am a staunch advocate for it. In our realm of research, influencing healthier behaviors encounters numerous elements beyond our immediate control. Consider the environment, for instance. Is the infrastructure conducive to cycling instead of using a car? Is there an ample supply of healthy food? Why hasn't tobacco been banned yet?

The pursuit of a healthy lifestyle involves myriad societal stakeholders. Neither doctors nor industrial designers can tackle this alone.The pursuit of a healthy lifestyle involves myriad societal stakeholders. Neither doctors nor industrial designers can tackle this alone. It necessitates conversations with the government, municipalities, and provinces, working collaboratively. The potential gains are substantial. For instance, 80% of cardiac patients suffer complaints due to an unhealthy lifestyle; the solution lies in addressing these lifestyle factors."

How do you involve partners from practice in your research?

"Take the Stevenshof Vitaal project as an example. Stevenshof is one of the ten districts in Leiden, ranking second in terms of patients for LUMC. Together with residents, cure and care entities, municipalities, and health insurers, we collectively explore possibilities. It becomes evident that the involvement of all parties is indispensable in arriving at comprehensive solutions. Our focus extends beyond those already sick to those at risk, such as individuals with high blood pressure or overweight concerns. The Box, a key element in our research, proves invaluable in such cases."

What is it like to start working with someone from a completely different discipline?

"For me, it wasn't challenging but rather immensely enjoyable. There's a recognition of each other's thought processes. In my experience, we swiftly delved into the crux of matters and established a connection. Perhaps it's the people I've collaborated with, but I haven't sensed being on a different planet.

Certainly, there's the need to explain and be explained to. Yet, I view it as an investment, one I'm genuinely pleased to make. It's a delightful journey discovering where commonalities lie and where differences emerge. It becomes even clearer when you receive feedback from someone with a distinct perspective. This is a common occurrence within Medical Delta, with individuals from diverse backgrounds contributing to constructive feedback and reflection."

You will probably meet more scientists from other disciplines and institutions now. Whose work has surprised you and why?

"While not necessarily surprised, I'm truly delighted with Maaike Kleinsmann's decisiveness and enthusiasm. She possesses a broad vision, always striving to understand things in a larger context. Her holistic approach, blending the theoretical with the practical, is truly commendable."

Prof. dr. Douwe Atsma is one of the distinguished Medical Delta professors and lecturers inaugurated on November 14 during the Medical Delta Conference. As part of a portrait series, Medical Delta spotlights one lecturer or professor each week. Explore previous profiles here.