Re-designingHealth Care

NeLL

Douwe E. Atsma

Niels H. Chavannes

Cardiovasculair care 1970-2014Acute Myocardial Infarction Care

care

cure1970

Admission: 6 wks

Mortality 50%

2014Admission: 2-3 days

Mortality 1-2%

Treatment of Heart Failure 1980

Digoxin=> 0.05 Euro

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

Significant increase older population

CBS

2011 2020 2025

Costs

09-10-2018 6

Old: episode-based care

New paradigm: patient journey

METHODS RESULTS

R.W. Treskes et al. Neth Heart J 2016: 441-6

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

09-10-2018 In de voettekst is ruimte voor de titel van de presentatie 10

Possibilities

09-10-2018 In de voettekst is ruimte voor de titel van de presentatie 12

https://www.youtube.com/watch?v=3ZUb-furLis

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

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

The Box

Data integratie

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

E-visit

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

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?

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?

Evaluate eHealth scientifically: Thuisarts.nl23

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?

=

• 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?

NeLL app platform

NeLL app platform

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

• d.e.atsma@lumc.nl

09-10-2018 28