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THINK - eHealth@LU | eHealth@LU · Measure longitudinal trends in eHealth uptake, barriers and...

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Page 1: THINK - eHealth@LU | eHealth@LU · Measure longitudinal trends in eHealth uptake, barriers and facilitators . annual eHealth monitor. Improve digital integration and harmonized national
Page 3: THINK - eHealth@LU | eHealth@LU · Measure longitudinal trends in eHealth uptake, barriers and facilitators . annual eHealth monitor. Improve digital integration and harmonized national

Outline

• eHealth – some framing• eHealth innovation in the Netherlands• regional innovation ecoystem eHealth

Utrecht• THINC. - The Healthcare Innovation Center • My own research – example projects

Page 5: THINK - eHealth@LU | eHealth@LU · Measure longitudinal trends in eHealth uptake, barriers and facilitators . annual eHealth monitor. Improve digital integration and harmonized national

Different (& less strict) regulatory evaluation process• To market after CE approval (if required)• The focus is on ‘safety and techical feasibility’ i.s.o. clinical effectiveness• Different market – shorter life cycle• Lower budgets – less time

Increasingly data driven + autonomousEmerging technologies: AI, precision medicine, genomics, blockchain etc.

Increasingly disruptiveDigital transformation, substitution, citizen-centric,

Democratized, digital innovation is increasingly a non-academic activityGlobal market: 2017 - USD 47.60 billion, 2023 - USD 132.35 billion

They come with many + highly diverse i.e. > 335.000 mobile health apps

Page 6: THINK - eHealth@LU | eHealth@LU · Measure longitudinal trends in eHealth uptake, barriers and facilitators . annual eHealth monitor. Improve digital integration and harmonized national

Outline

• eHealth – some framing• eHealth innovation in the Netherlands• regional innovation ecoystem eHealth

Utrecht• The Healthcare Innovation Center • My own research – example projects

Page 7: THINK - eHealth@LU | eHealth@LU · Measure longitudinal trends in eHealth uptake, barriers and facilitators . annual eHealth monitor. Improve digital integration and harmonized national

Drivers eHealth innovation in NL

• Because we need it• Policy (top down)• Knowledge economy / innovation

(bottom up)

Page 8: THINK - eHealth@LU | eHealth@LU · Measure longitudinal trends in eHealth uptake, barriers and facilitators . annual eHealth monitor. Improve digital integration and harmonized national

Because we need it

Healthcare expenditureAnnual increase of 2.9%

By 2040 174 billion Euro (9.6 K / person)

By 2022, a shortage of 100 to 125 thousand healthcare employees is

expected

Page 9: THINK - eHealth@LU | eHealth@LU · Measure longitudinal trends in eHealth uptake, barriers and facilitators . annual eHealth monitor. Improve digital integration and harmonized national

Active policy • Set SMART goals

– >80% of chronically ill access to their medical records– 75% of chronically ill able to monitor certain aspects of their own health and share the data with their health

provider– People receiving care at home should be able to communicate with their care provider 24 hours a day via a

screen, if they wish.

• Measure longitudinal trends in eHealth uptake / barriers / facilitators (annualeHealth monitor)

• Sharing knowhow (i.e. annual eHealth week)• Improve digital integration and harmonized national data standards (i.e. Legal

framework for mandatory exchange of data, legal certification for a digital ledger solution blockchain)• Stimulate innovation (i.e. Research Grants, public private partnership matching,

ZorgInnovatie.nl : community for innovation in healthcare and wellbeing, providing a platform and database for more than 3300 communities and 700 innovations.

Set SMART goals • >80% of chronically ill access to their medical records• 75% of chronically ill able to monitor certain aspects of

their own health and share the data with their health provider

• People receiving care at home should be able tocommunicate with their care provider 24 hours a day via a screen, if they wish

Measure longitudinal trends in eHealth uptake, barriersand facilitators annual eHealth monitor

Improve digital integration and harmonized national data standards i.e. Legal framework for mandatory exchange of data, legal certification for a digital ledger solution incl. blockchain

Stimulate innovation i.e. Research Grants, public private partnership matching, ZorgInnovatie.nl : community for innovation in healthcare and wellbeing, providing a platform and database for more than 3300 communities and 700 innovations.

Sharing knowhow i.e. annual eHealth week

Government policy

Page 10: THINK - eHealth@LU | eHealth@LU · Measure longitudinal trends in eHealth uptake, barriers and facilitators . annual eHealth monitor. Improve digital integration and harmonized national

(1) Are we doingwell ? (online access)

88%

50%Any form of online contact with HC provider

E-consultation 55%

22%

Video consultation2% 26%

Make an online appoinment 53%

23%

Primary care Secondary care

eHealth monitor 2019, RIVM, NICTIZ

Page 11: THINK - eHealth@LU | eHealth@LU · Measure longitudinal trends in eHealth uptake, barriers and facilitators . annual eHealth monitor. Improve digital integration and harmonized national

(2) Are we doingwell ? (self-management / personal health environments)

64%Seeks information on internet

Uses internet to decide to consult a GP 37%

Tracking of physical activity

Yes14%

Tracking health (general)

34%

Any user

eHealth monitor 2019, RIVM, NICTIZ

Chronic disease

Yes10%

Page 12: THINK - eHealth@LU | eHealth@LU · Measure longitudinal trends in eHealth uptake, barriers and facilitators . annual eHealth monitor. Improve digital integration and harmonized national

(3) Are we doingwell ? (remote support)

47%37%Telemonitoring

Personal alarm

Movement sensors

GPS trackers / door sensors

Primary care Secondary care

eHealth monitor 2019, RIVM, NICTIZ

14%

87%

66%

23%

Nursinghome / elderly care

Care robots10%

Page 13: THINK - eHealth@LU | eHealth@LU · Measure longitudinal trends in eHealth uptake, barriers and facilitators . annual eHealth monitor. Improve digital integration and harmonized national

Dutch Innovation ecosystem

Page 14: THINK - eHealth@LU | eHealth@LU · Measure longitudinal trends in eHealth uptake, barriers and facilitators . annual eHealth monitor. Improve digital integration and harmonized national

Worlds most concentrated Life Sciences & Health cluster• Worldwide #1 for number of medical technology patents • #1 EuroHealth Consumer Index 2014, 2015, 2016, 2017• 3rd for number of biotechnology patents• 7th for number of pharmaceutical patents• Areas and diseases of focus include:

• Biopharmaceuticals • Biotech• Molecular imaging• Medical technology• e-Health• One Health

• Biomaterials and regenerative medicine• Biobanking• Vaccines• Oncology• Cardiovascular diseases• Health systems and research infrastructure

Page 15: THINK - eHealth@LU | eHealth@LU · Measure longitudinal trends in eHealth uptake, barriers and facilitators . annual eHealth monitor. Improve digital integration and harmonized national

Life Sciences & Health cluster

Page 16: THINK - eHealth@LU | eHealth@LU · Measure longitudinal trends in eHealth uptake, barriers and facilitators . annual eHealth monitor. Improve digital integration and harmonized national

Regional Health Innovation hubs

Page 17: THINK - eHealth@LU | eHealth@LU · Measure longitudinal trends in eHealth uptake, barriers and facilitators . annual eHealth monitor. Improve digital integration and harmonized national

Health Hub Utrecht – Healthy Urban Living

Page 18: THINK - eHealth@LU | eHealth@LU · Measure longitudinal trends in eHealth uptake, barriers and facilitators . annual eHealth monitor. Improve digital integration and harmonized national

Utrecht region

• Most highly educated workforcein the Netherlands: 46% of working population has a university degree

• 8 million skilled employees within an hour’s travel of Utrecht.

• Life science and health community: 1,700 researchersand 1,750 PhD candidates

The Utrecht region has been ranked the most competitive place on the European

mainland by the European Commission since 2010

Page 19: THINK - eHealth@LU | eHealth@LU · Measure longitudinal trends in eHealth uptake, barriers and facilitators . annual eHealth monitor. Improve digital integration and harmonized national

Health Hub Utrecht

• Most highly educated workforcein the Netherlands: 46% of working population has a university degree

• 8 million skilled employees within an hour’s travel of Utrecht.

• Life science and health community: 1,700 researchersand 1,750 PhD candidates

27,200 jobs108 companies51.500 students

Page 20: THINK - eHealth@LU | eHealth@LU · Measure longitudinal trends in eHealth uptake, barriers and facilitators . annual eHealth monitor. Improve digital integration and harmonized national

Health Hub Utrecht

Community-focusedprevention

(lifestyle, health literacyetc.)

A dynamic regio-alliance that aims at highlighting ‘the sense of urgency’ (increasing costsand lack of personnel) and ‘the sense of opportunity’ (unique regional proposition)

Digital transformation

(eHealth, personal health environments, serious

games)

Attractive job market

(professional development,

leadership)

Page 21: THINK - eHealth@LU | eHealth@LU · Measure longitudinal trends in eHealth uptake, barriers and facilitators . annual eHealth monitor. Improve digital integration and harmonized national

Innovation journey – an iterative multi-stakeholder proces

Idea Research | Development | Validation CommercialisationOr implementation

Scaling up

Science-based & user centered development

Page 22: THINK - eHealth@LU | eHealth@LU · Measure longitudinal trends in eHealth uptake, barriers and facilitators . annual eHealth monitor. Improve digital integration and harmonized national

Innovation journey - a bumpy road

EFFECTIVE

USED

REACH

???

Health benefitsCost-effectiveness

Many innovation are not effective, are not used or do not reach limited value for patientsprofessionals and society

Systematic flaws, fragmentation and limitedstreamlining of the innovation process

Researcher Professional User Designer Techno-logical/ ICT

Entre-preneurial

Page 23: THINK - eHealth@LU | eHealth@LU · Measure longitudinal trends in eHealth uptake, barriers and facilitators . annual eHealth monitor. Improve digital integration and harmonized national

There’s an urgent need for

• Faster and better available science• Flexible methodology & tailored

scientific services• …that are offered agile through

public-private partnerships

Page 24: THINK - eHealth@LU | eHealth@LU · Measure longitudinal trends in eHealth uptake, barriers and facilitators . annual eHealth monitor. Improve digital integration and harmonized national

The Healthcare Innovation Center

Page 25: THINK - eHealth@LU | eHealth@LU · Measure longitudinal trends in eHealth uptake, barriers and facilitators . annual eHealth monitor. Improve digital integration and harmonized national

Access topatients

Network of experts

Experienceand cases

Innovativemethodology

Innovation processes

Data & data science

Page 26: THINK - eHealth@LU | eHealth@LU · Measure longitudinal trends in eHealth uptake, barriers and facilitators . annual eHealth monitor. Improve digital integration and harmonized national

Scienceas a Service

Page 27: THINK - eHealth@LU | eHealth@LU · Measure longitudinal trends in eHealth uptake, barriers and facilitators . annual eHealth monitor. Improve digital integration and harmonized national

Appl@b user-centered roadmap(+ scientific engineering services)

Page 28: THINK - eHealth@LU | eHealth@LU · Measure longitudinal trends in eHealth uptake, barriers and facilitators . annual eHealth monitor. Improve digital integration and harmonized national

Background, context & content analysis Participatory eHealth development(User-centered, persuasive & data driven)

Theoryidentifi-cation

Problem / target

analysis

Needsanalysis

Currentpractice / contextual

analysis

Value specifi-cation

Logic modeling

IdeationScenario-

basedtesting

Paper / mock-up

prototyping

Alphausabilitytesting

LiteratureReview (scoping / systematic)

Iterativesoftware develop-

ment

Require-ments

definition

Fieldusabilitytesting

Evaluation

Full scaleevaluation

Feasibility / pilot

testing

Focus groupsQualitative interviewsSurveys

Desk researchStakeholder analysis

Delphi studies Focus groups / qualitative interviews with patients/experts/ professionalsBehavioral analysis (BCT / COM-B)

Background, context & content analysis

Value drivers(Early) HTABusiness modeling

Modeling Workingmechanismof change

Identify quality indicators:Set safety / technicalsecurity / privacy / legal / ethical thresholds

Pressure cooker sessionsFocus groupsNominal Group Techniques

User-storiesQualitative interviewsFocus groups

High / low fidelityPrototyping Qualitative research

Task-analysis HeuristicsCognitive walkthroughsQualitative interviews

Observational feasibility studies(acceptablity, integration, demand, practicality, adaptation, implemenation, expansion, limited efficacy)Diagnostic / prognosic accuracystudies

Full/quasi experimental studiesObservational (data-driven) studies

eHealthsolutions that:

are EFFECTIVE✓(health benefits, access,

efficiency etc.)

are USED✓(maximum fit with end-users

needs)

REACH end-users✓(survive the competitive eHealth

ecoystem)

Proof of mechanism Proof of concept Proof of principle

Page 29: THINK - eHealth@LU | eHealth@LU · Measure longitudinal trends in eHealth uptake, barriers and facilitators . annual eHealth monitor. Improve digital integration and harmonized national

Background, context & content analysis Participatory eHealth development(User-centered, persuasive & data driven)

Theoryidentifi-cation

Problem / target

analysis

Needsanalysis

Currentpractice / contextual

analysis

Value specifi-cation

Logic modeling

IdeationScenario-

basedtesting

Paper / mock-up

prototyping

Alphausabilitytesting

Iterativesoftware develop-

ment

Require-ments

definition

Fieldusabilitytesting

Evaluation

Full scaleevaluation

Feasibility / pilot

testing

Background, context & content analysis

eHealthsolutions that:

are EFFECTIVE✓(health benefits, access,

efficiency etc.)

are USED✓(maximum fit with end-users

needs)

REACH end-users✓(survive the competitive eHealth

ecoystem)

Page 31: THINK - eHealth@LU | eHealth@LU · Measure longitudinal trends in eHealth uptake, barriers and facilitators . annual eHealth monitor. Improve digital integration and harmonized national

Usability

ObjectiveTo evaluate the usability (system, user, en medical) of serious game Wind Tales in children with Cystic Fibrosis

MethodsN=5-10, mixed-methods triangulation of video observations, semi-structured interviews and think aloud data

Page 32: THINK - eHealth@LU | eHealth@LU · Measure longitudinal trends in eHealth uptake, barriers and facilitators . annual eHealth monitor. Improve digital integration and harmonized national

Feasibility

ObjectiveEvaluation of the real-world feasiblity (acceptation, demand, implementation, integrationand preliminary efficacy) behoefte, implementatie, integratie en voorlopige werkzaamheid) of NightWatch during 4 months follow-up in patients with epilepsy (>12 years) their parents / loved-ones, and professionals in home care and in patient care..

MethodN=50, longitudinal mixed-methods triangulation study

Page 33: THINK - eHealth@LU | eHealth@LU · Measure longitudinal trends in eHealth uptake, barriers and facilitators . annual eHealth monitor. Improve digital integration and harmonized national
Page 34: THINK - eHealth@LU | eHealth@LU · Measure longitudinal trends in eHealth uptake, barriers and facilitators . annual eHealth monitor. Improve digital integration and harmonized national

Impact of COPD exacerbations

Lung functionQuality of life

29.000 admissions / year25% dies within 1 year

> € 500 Mil / jaar

Page 35: THINK - eHealth@LU | eHealth@LU · Measure longitudinal trends in eHealth uptake, barriers and facilitators . annual eHealth monitor. Improve digital integration and harmonized national

Prior

During

After

Exacerbations & self-management

Page 36: THINK - eHealth@LU | eHealth@LU · Measure longitudinal trends in eHealth uptake, barriers and facilitators . annual eHealth monitor. Improve digital integration and harmonized national

OBJECTIVE

To develop a tailored mHealth intervention to decrease the impact of exacerbations by enhancing exacerbation-related self-management in

COPD patients.

More specifically a mHealth intervention that is;• Meeting patient’s needs, perceptions and preferences.• Able to manage heterogeneity of exacerbations in and between patients.• Focusing on target behaviors identified by scientific evidence.• Safe, literacy sensitive and patient friendly.• Feasible in current Dutch COPD care.

Page 37: THINK - eHealth@LU | eHealth@LU · Measure longitudinal trends in eHealth uptake, barriers and facilitators . annual eHealth monitor. Improve digital integration and harmonized national

Learning by doing

Page 38: THINK - eHealth@LU | eHealth@LU · Measure longitudinal trends in eHealth uptake, barriers and facilitators . annual eHealth monitor. Improve digital integration and harmonized national

USER-CENTERED DEVELOPMENT

(based on: Johnston, 2009; Van Meijel, 2004; Graig, 2008)

Page 39: THINK - eHealth@LU | eHealth@LU · Measure longitudinal trends in eHealth uptake, barriers and facilitators . annual eHealth monitor. Improve digital integration and harmonized national

4 YEARS OF RESEARCH (2014-2018)

DeliverableConsensus on relevant and feasible self-management behaviors prior, during and after an exacerbation

Deliverablesomst• potential barrieres

and limitations of mHealth use in exacebation-related SM

• needs regarding intervention components and mode of delivery

DeliverablesConceptueel model ‘factors that influenceexacerbation-relatedself-management behavior’

DeliverableOverview of determinants of self-management capacity in COPD patients

Page 40: THINK - eHealth@LU | eHealth@LU · Measure longitudinal trends in eHealth uptake, barriers and facilitators . annual eHealth monitor. Improve digital integration and harmonized national

CONCEPTUAL MODEL

Page 41: THINK - eHealth@LU | eHealth@LU · Measure longitudinal trends in eHealth uptake, barriers and facilitators . annual eHealth monitor. Improve digital integration and harmonized national
Page 42: THINK - eHealth@LU | eHealth@LU · Measure longitudinal trends in eHealth uptake, barriers and facilitators . annual eHealth monitor. Improve digital integration and harmonized national

Contact:[email protected]+31-(0)6-48060052http://www.thinc.healthcare/


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