![Page 1: Re-designing Health Care NeLL · 2018-10-16 · •Redesign: •Correct care at the correct site •24x7 accessible •Together with patients and patient groups •Clinically-driven,](https://reader034.vdocuments.us/reader034/viewer/2022042923/5f71f557911cd215926a7fd7/html5/thumbnails/1.jpg)
Re-designingHealth Care
NeLL
Douwe E. Atsma
Niels H. Chavannes
![Page 2: Re-designing Health Care NeLL · 2018-10-16 · •Redesign: •Correct care at the correct site •24x7 accessible •Together with patients and patient groups •Clinically-driven,](https://reader034.vdocuments.us/reader034/viewer/2022042923/5f71f557911cd215926a7fd7/html5/thumbnails/2.jpg)
Cardiovasculair care 1970-2014Acute Myocardial Infarction Care
care
cure1970
Admission: 6 wks
Mortality 50%
2014Admission: 2-3 days
Mortality 1-2%
![Page 3: Re-designing Health Care NeLL · 2018-10-16 · •Redesign: •Correct care at the correct site •24x7 accessible •Together with patients and patient groups •Clinically-driven,](https://reader034.vdocuments.us/reader034/viewer/2022042923/5f71f557911cd215926a7fd7/html5/thumbnails/3.jpg)
Treatment of Heart Failure 1980
Digoxin=> 0.05 Euro
![Page 4: Re-designing Health Care NeLL · 2018-10-16 · •Redesign: •Correct care at the correct site •24x7 accessible •Together with patients and patient groups •Clinically-driven,](https://reader034.vdocuments.us/reader034/viewer/2022042923/5f71f557911cd215926a7fd7/html5/thumbnails/4.jpg)
INTERVENTION
RESTORE
REPAIR
RESYNCHRONIZE
REGENERATE
REPLACE
RESHAPE
RESCUE
RESTORE
REPAIR
RESYNCHRONIZE
REGENERATE
REPLACE
RESHAPE
RESCUE
Confidential Information. Do not duplicate. 4
BV pacemakerBV pacemaker
Treatment of Heartfailure 2018
![Page 5: Re-designing Health Care NeLL · 2018-10-16 · •Redesign: •Correct care at the correct site •24x7 accessible •Together with patients and patient groups •Clinically-driven,](https://reader034.vdocuments.us/reader034/viewer/2022042923/5f71f557911cd215926a7fd7/html5/thumbnails/5.jpg)
Significant increase older population
CBS
2011 2020 2025
![Page 6: Re-designing Health Care NeLL · 2018-10-16 · •Redesign: •Correct care at the correct site •24x7 accessible •Together with patients and patient groups •Clinically-driven,](https://reader034.vdocuments.us/reader034/viewer/2022042923/5f71f557911cd215926a7fd7/html5/thumbnails/6.jpg)
Costs
09-10-2018 6
![Page 7: Re-designing Health Care NeLL · 2018-10-16 · •Redesign: •Correct care at the correct site •24x7 accessible •Together with patients and patient groups •Clinically-driven,](https://reader034.vdocuments.us/reader034/viewer/2022042923/5f71f557911cd215926a7fd7/html5/thumbnails/7.jpg)
Old: episode-based care
![Page 8: Re-designing Health Care NeLL · 2018-10-16 · •Redesign: •Correct care at the correct site •24x7 accessible •Together with patients and patient groups •Clinically-driven,](https://reader034.vdocuments.us/reader034/viewer/2022042923/5f71f557911cd215926a7fd7/html5/thumbnails/8.jpg)
New paradigm: patient journey
METHODS RESULTS
R.W. Treskes et al. Neth Heart J 2016: 441-6
![Page 9: Re-designing Health Care NeLL · 2018-10-16 · •Redesign: •Correct care at the correct site •24x7 accessible •Together with patients and patient groups •Clinically-driven,](https://reader034.vdocuments.us/reader034/viewer/2022042923/5f71f557911cd215926a7fd7/html5/thumbnails/9.jpg)
How to re-design
• What do we want?
• Safe, Effective and Transparant Care
• Patient-centered
• Clinically-driven, technology-enabled
• Connect smart technology to improve care
• Easy access to relevant data
09-10-2018 9
![Page 10: Re-designing Health Care NeLL · 2018-10-16 · •Redesign: •Correct care at the correct site •24x7 accessible •Together with patients and patient groups •Clinically-driven,](https://reader034.vdocuments.us/reader034/viewer/2022042923/5f71f557911cd215926a7fd7/html5/thumbnails/10.jpg)
09-10-2018 In de voettekst is ruimte voor de titel van de presentatie 10
![Page 11: Re-designing Health Care NeLL · 2018-10-16 · •Redesign: •Correct care at the correct site •24x7 accessible •Together with patients and patient groups •Clinically-driven,](https://reader034.vdocuments.us/reader034/viewer/2022042923/5f71f557911cd215926a7fd7/html5/thumbnails/11.jpg)
Possibilities
![Page 12: Re-designing Health Care NeLL · 2018-10-16 · •Redesign: •Correct care at the correct site •24x7 accessible •Together with patients and patient groups •Clinically-driven,](https://reader034.vdocuments.us/reader034/viewer/2022042923/5f71f557911cd215926a7fd7/html5/thumbnails/12.jpg)
09-10-2018 In de voettekst is ruimte voor de titel van de presentatie 12
https://www.youtube.com/watch?v=3ZUb-furLis
![Page 13: Re-designing Health Care NeLL · 2018-10-16 · •Redesign: •Correct care at the correct site •24x7 accessible •Together with patients and patient groups •Clinically-driven,](https://reader034.vdocuments.us/reader034/viewer/2022042923/5f71f557911cd215926a7fd7/html5/thumbnails/13.jpg)
E-Health: what do we want:
• Key issues:
• Address real clinical problems
• Design together with patients
• We want to be on-line 24x7 within 5 years
• Patients have to work on their health status
• We provide the tools and the infrastructure
09-10-2018 13
![Page 14: Re-designing Health Care NeLL · 2018-10-16 · •Redesign: •Correct care at the correct site •24x7 accessible •Together with patients and patient groups •Clinically-driven,](https://reader034.vdocuments.us/reader034/viewer/2022042923/5f71f557911cd215926a7fd7/html5/thumbnails/14.jpg)
How do we do it:
• Principles:
• Most devices are already there
• We use consumer products as much as possible
• We use commercial infrastructure
• If possible: We do not develop or buy any dedicatedsoftware solutions but try to connect the different resources
09-10-2018 14
![Page 15: Re-designing Health Care NeLL · 2018-10-16 · •Redesign: •Correct care at the correct site •24x7 accessible •Together with patients and patient groups •Clinically-driven,](https://reader034.vdocuments.us/reader034/viewer/2022042923/5f71f557911cd215926a7fd7/html5/thumbnails/15.jpg)
The Box
![Page 16: Re-designing Health Care NeLL · 2018-10-16 · •Redesign: •Correct care at the correct site •24x7 accessible •Together with patients and patient groups •Clinically-driven,](https://reader034.vdocuments.us/reader034/viewer/2022042923/5f71f557911cd215926a7fd7/html5/thumbnails/16.jpg)
Data integratie
![Page 17: Re-designing Health Care NeLL · 2018-10-16 · •Redesign: •Correct care at the correct site •24x7 accessible •Together with patients and patient groups •Clinically-driven,](https://reader034.vdocuments.us/reader034/viewer/2022042923/5f71f557911cd215926a7fd7/html5/thumbnails/17.jpg)
Lau et al. iPhone ECG application for community screening to detect silent atrial fibrillation: a novel technology to prevent stroke. Int J Cardiol. 2013: 193-212
![Page 18: Re-designing Health Care NeLL · 2018-10-16 · •Redesign: •Correct care at the correct site •24x7 accessible •Together with patients and patient groups •Clinically-driven,](https://reader034.vdocuments.us/reader034/viewer/2022042923/5f71f557911cd215926a7fd7/html5/thumbnails/18.jpg)
![Page 19: Re-designing Health Care NeLL · 2018-10-16 · •Redesign: •Correct care at the correct site •24x7 accessible •Together with patients and patient groups •Clinically-driven,](https://reader034.vdocuments.us/reader034/viewer/2022042923/5f71f557911cd215926a7fd7/html5/thumbnails/19.jpg)
E-visit
![Page 20: Re-designing Health Care NeLL · 2018-10-16 · •Redesign: •Correct care at the correct site •24x7 accessible •Together with patients and patient groups •Clinically-driven,](https://reader034.vdocuments.us/reader034/viewer/2022042923/5f71f557911cd215926a7fd7/html5/thumbnails/20.jpg)
Example: Instant Blood Pressure app
• “Measure your blood pressure using only your smartphone!”
• Top 50 best sold apps in Apples App Store after launch in 2014
• Price per download $ 3,99 148000 downloads
• Almost 80% of real hypertension (high blood pressure) missed!
• In July 2015 removed from App Store without explanation
20
![Page 21: Re-designing Health Care NeLL · 2018-10-16 · •Redesign: •Correct care at the correct site •24x7 accessible •Together with patients and patient groups •Clinically-driven,](https://reader034.vdocuments.us/reader034/viewer/2022042923/5f71f557911cd215926a7fd7/html5/thumbnails/21.jpg)
Example: Lumosity app
• Lumosity: “app helps to prevent Alzheimer’s disease and dementia”
• $11.95 per month or $299.95 lifetime membership
• Android: 10.000.000 - 50.000.000 downloads (sept. 2016)
• Federal trade commission Court: Lumos Labs must “possess and rely upon competent and reliable scientific evidence.”
09-10-201821NeLL: wat laat de praktijk aan eHealth zien?
![Page 22: Re-designing Health Care NeLL · 2018-10-16 · •Redesign: •Correct care at the correct site •24x7 accessible •Together with patients and patient groups •Clinically-driven,](https://reader034.vdocuments.us/reader034/viewer/2022042923/5f71f557911cd215926a7fd7/html5/thumbnails/22.jpg)
Example: Lumosity app
• Lumosity vs. active control (crossword puzzles). N = 4,715; Follow-up: 10 weeks.
• Clinical relevance? • Effect on dementia risk?
09-10-201822NeLL: wat laat de praktijk aan eHealth zien?
![Page 23: Re-designing Health Care NeLL · 2018-10-16 · •Redesign: •Correct care at the correct site •24x7 accessible •Together with patients and patient groups •Clinically-driven,](https://reader034.vdocuments.us/reader034/viewer/2022042923/5f71f557911cd215926a7fd7/html5/thumbnails/23.jpg)
Evaluate eHealth scientifically: Thuisarts.nl23
![Page 24: Re-designing Health Care NeLL · 2018-10-16 · •Redesign: •Correct care at the correct site •24x7 accessible •Together with patients and patient groups •Clinically-driven,](https://reader034.vdocuments.us/reader034/viewer/2022042923/5f71f557911cd215926a7fd7/html5/thumbnails/24.jpg)
eHealth for smoking cessation:
Recommendations
• Personalized works better!
• eHealth interventions (internet or smartphone) double smoking quitters (from 5-10% to 9-21%)
• eHealth likely more effective as part of blended care
09-10-201824NeLL: wat laat de praktijk aan eHealth zien?
![Page 25: Re-designing Health Care NeLL · 2018-10-16 · •Redesign: •Correct care at the correct site •24x7 accessible •Together with patients and patient groups •Clinically-driven,](https://reader034.vdocuments.us/reader034/viewer/2022042923/5f71f557911cd215926a7fd7/html5/thumbnails/25.jpg)
=
• Physical activity: most natural and effective way to achieve cardiovascular-events free life!1
• Knowledge gap: measuring physical activity• No 24-hour data
• Sleep-wake cycle
• Face-to-face contact 1-2/year• Lifestyle change takes place at home
Research using eHealth: Mijn Hart Telt! app
09-10-201825
1 Franco OH, Arch Int Med 2005
NeLL: wat laat de praktijk aan eHealth zien?
![Page 26: Re-designing Health Care NeLL · 2018-10-16 · •Redesign: •Correct care at the correct site •24x7 accessible •Together with patients and patient groups •Clinically-driven,](https://reader034.vdocuments.us/reader034/viewer/2022042923/5f71f557911cd215926a7fd7/html5/thumbnails/26.jpg)
NeLL app platform
![Page 27: Re-designing Health Care NeLL · 2018-10-16 · •Redesign: •Correct care at the correct site •24x7 accessible •Together with patients and patient groups •Clinically-driven,](https://reader034.vdocuments.us/reader034/viewer/2022042923/5f71f557911cd215926a7fd7/html5/thumbnails/27.jpg)
NeLL app platform
![Page 28: Re-designing Health Care NeLL · 2018-10-16 · •Redesign: •Correct care at the correct site •24x7 accessible •Together with patients and patient groups •Clinically-driven,](https://reader034.vdocuments.us/reader034/viewer/2022042923/5f71f557911cd215926a7fd7/html5/thumbnails/28.jpg)
Conclusion
• Care will change dramatically during the next 5 years
• Redesign:• Correct care at the correct site
• 24x7 accessible
• Together with patients and patient groups
• Clinically-driven, technology-enabled
• Scientific evaluation essential
• www.NeLL.eu
09-10-2018 28