Laurens Touwen

Donderdag 25 november 2010

Care within reach

Can we change behaviour

through e-health??

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• Not a joint venture, but

• A new entity:

a not-for profit

Foundation- project plan

- money

• I saw idealism

A Foundation

Insurance company

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Improving access to health care and quality of life

of chronically ill patients and the acquisition of trust

in medical professionals, government and other

authorities and patients by providing and promoting

‘’Care at a distance’’

and

the development and implementation of proven

concepts for remote solutions for

chronically ill patients

Mission statement

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Increase the coming 15 - 20 years:

• Diabetes 70%

• COPD 35%

• CHF 40% (bron RIVM)

Shortage of 500.000 workers in

2025… in the Netherlands?

Trend in Chronic care

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New solutions for:

CHF

COPD

Diabetes

With:

e-health

M-healthEngineering

Change management

What is our focus?

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Concept-ontwikkelingwerkgroepen

Grootschaligtesten

Financiering basis-

verzekeringDe markt

3 year

20121,5 year

1 year

2010

Generating

concepts testingPart of health

care insurance

Free for

market

Our process

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Behavior change examples

• Banking – everyone a bankcard

from visiting a bank towards internet

• Direct life – movement program

monitoring and coaching your movement

• Example Stockholm http://www.youtube.com/watch?v=2lXh2n0aPyw

Challenging your imagination

Not technology is leading, but the appreciation of Patient and caregiver

So: We did a ‘patient journey’

and a ‘caregiver journey’

Through the patients eyes

Celebrating Jan’s birthday

Insights:• smoking is part of the

fun in life and it’s a strong part of your social life: you smoke together, it’s a form of ‘social cohesion’

Journey of COPD

At the GP’s practice

Insights:• Sometimes, the GP doesn’t

recognize and acknowledge the fact that you have COPD, but deep down, you know something’s wrong.

• You need to feel that youcan tell your story to the GP, that he really listens and that he is direct and honest to you.

At the lung specialist’s office

Emotions:• Shocked• Anger• Self blame

Insights:• You already had an idea deep down

that something’s wrong. The shock comes from the fact that you now become conscious of the fact that you will never heal, which is in big contrast with the idea of a ‘bad condition’.

• You don’t really realize what thedoctors tell you about the need tostop smoking.

• You also tend to forget many of the things the specialist has said.

• When you are proven right, you are angry, but eventually this turns into self blame for not acting more assertively to the GP.

Conflict of interests

Emotions:• (un)safe• Not taken account of• Dependent , angry ,low

self esteem

Insights:• It’s important that family and

friends understand what you have. I.e. they know what to do when it’s clear that the illness causes complaints (during short term wheezyness for example). This makes you feel safe.

• You also expect family and friends to take account of you.

• The feeling that you’re dependent on others is a terrible feeling, it emphasizes that you cannot do things on your own.

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• Smoking• Bad eating habits• Little exercise• Etc.

Illness:• COPD

• Disrupted relationships with your environment

• Freedom is taken away

• Life doesn’t make sense anymore

• ...

Shortcomings:• Tiredness• Bad physical condition• Short of breath• Etc.

Causes/EffectsCauses Effects

Experience of doctors Experience of patients

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Heal thyself

Two completely different points of views :

1. Doctors conclude you have an illness, whereas patients conclude you have

shortcomings

2. Doctors clearly point to the causes (and dangers) of the illness, while a

patient focuses on the effects of the shortcomings

3. NB: After a longer period of complaints, patients do begin to realize that

there is a connection between smoking and their shortcomings

COPD

3

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Concerns

• Strengthen the relation Patient- Caregiver

• Caregivers less work, more role as coach- more partner than authority

• Psychology is the key in self management- find short-cycle feedback

• Focus is mainly on change of lifestyle

• Web portal- with specific and practical applications- Personal Health Record

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Lessons learned for web portals

Develop solutions close to patient in 0-and first line:

• The measurement of vital and relevant values at

home or close to home - monitoring

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Lessons learned for web portals

Personal health record with education and action:

• Combines all patient information in one platform

with self-learning algorithms:

guide disease management

selecting appropriate education

brings peers together

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• Behavioral Science to ensure compliance

Both compliance to medicine as lifestyle

Work with goal setting and diary

Lessons learned for web portals

movingeating

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• Lead to optimization of the "work flow"

• Managing multiple chronic conditions

• Insight in the quality of care (pi's)

• Supporting treatment at home

• Focus on ‘’Mantelzorger’’

Technology is an "enabler" and not the distinctive

Lessons learned for web portals

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Can e-health change us?

• There is evidence in many trials that the patient

can profit from e-health:

- patient experiences more freedom

- patient improves his well-being

- patient is taking the lead

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Can e-health change us?

• Can the caregiver profit??

- only when the care process has been changed

- the workload has to lower

- web tools must be integrated in his system

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Perspective

We believe e-health will change the future

And behavior will be changed through e-health!