The care system is under pressure. People want the best quality of care but an ageing population, staff shortages and budget caps are making that increasingly difficult. Technical innovations may be a solution but they rarely find their way into existing care. The Flagship Programme ‘Consultation Room 2030 – Continuity of Care from Hospital to Home’ is focusing on the systematic use of digital technology to unburden care systems in a way that meets the needs of patients.

Joke Hendriks is Professor of Surgery at Erasmus MC. She specialises in vascular surgery. Her working week always includes appointment with patients who have been discharged after surgery. ‘People regularly tell me they are doing very well. They feel good, they are walking a lot, and longer distances. Obviously, that’s what we like to see. But it isn’t effective care. People who are doing well don’t need to see a doctor. On the other hand, there are a lot of patients for whom those contacts are important. It is important to keep that option open for the people who want it, but more efficiently where possible. That leaves us more time for patients who really need to see a doctor.’

Gateway

‘We need a transition in health care,’ says Richard Goossens, Professor of Physical Ergonomics at the Faculty of Industrial Design at Delft University of Technology. ‘Care should be delivered as efficiently as possible in a way that is right for the patient. This means keeping consultations in the hospital to a minimum and doing as much as possible in patients’ own familiar surroundings. That transition begins in the consultation room, the gateway to care. This is where we start on identifying the ongoing processes and possible ways of redesigning them.’

Transition

Numerous techniques and programmes have been developed in recent years to unburden the care system. ‘Digital health technologies,’ is the term used by Kees Ahaus, Professor of Health Services Management & Organisation at Erasmus University (EUR). ‘These are digital products and services for the prevention, diagnosis, monitoring and treatment of health conditions. This is a new type of care that has to be embedded in existing care processes. At the Erasmus MC, there is a major programme in place to weave digital health technologies into 350 care pathways. The goals here are to ensure that patients can go home earlier on average and to improve the transition from hospital to home. Home monitoring also makes it possible to spare patients the stress of going to the hospital.’

Digital information

This programme includes five tracks: acute patients, chronic patients, complex care, mental health care and palliative care. Hendriks: ‘A pulmonologist lets chronic patients with pulmonary fibrosis test their pulmonary function at home using an app. A specialist nurse is notified if there is any decline. The nurse can adjust the medication, where necessary in consultation with the pulmonologist. A gynaecologist monitors pregnant women remotely to detect possible complications in pregnancy and delivery at an early stage. An anaesthesiologist offers patients a choice. They can come in for a consultation, as is usually the case at present for all patients; alternatively, young and healthy patients can opt for digital information and a video, and possibly a shorter online appointment with the anaesthesiologist if there are any questions.’ Ahaus: ‘In mental health care, we are using tools that monitor sleep, with the results being used in clinical practice. And in palliative care, some monitoring of patients takes place remotely so they can stay at home whenever possible.’

Safe

The Flagship Project ties in with these projects. Hendriks: ‘We want to use the available technology better. A crucial question here is: what does the patient think? The doctor may be happy with an app but, ultimately, it’s the patient who matters. Patients should be comfortable with a sensor or wearable, for example, and they should feel they have someone to turn to with questions. They must also have the opportunity to view their data in appropriate ways. Some people only have an old Nokia: the quality of their care should be just as high. How do you achieve that? That is what we are studying in the Flagship Project.’ Ahaus: ‘We are also looking at how this care can be funded in all five tracks. Home monitoring costs money but it also replaces other care. Who pays? Another overarching question relates to data infrastructure. How do you make sure you collect, save and deliver the right data in a safe and appropriate way? And finally, all the Flagship initiatives are evaluated in a formative way.’

Disruptive

The Flagship Project brings together all the specific insights from the care pathways in those five tracks, says Goossens. ‘Design disciplines are good at connecting domains that were separate in the past. Working with patients and other stakeholders, we will explore how we can incorporate the available technology in existing care processes in a way that ties in with the needs and desires of different patient groups. To achieve genuine change, we need to think disruptively: to drop everything and start from scratch in order to build the consultation room of the future at Erasmus MC. That will be a physical location for those who want or need it, and online for people who find that environment convenient, pleasant, useful or normal.’

Opportunities

Hendriks: ‘The three universities involved each have their own way of conducting research, a different way of asking questions. The implementation and evaluation of technology solutions is one example. In the medical world, we prefer to study these solutions in randomised controlled trials. But the EUR and the designers at TU Delft have other, more direct approaches that are also reliable and valid. In this way, we make each other stronger.’ Ahaus: ‘There are numerous openings in the domain of home monitoring, and the preventive and predictive anticipation of patients’ care needs. Thanks to this Convergence, we are also really in a position to make the most of those openings.’ Hendriks: ‘In five years from now, the Flagship Project will be a national knowledge centre in this field.’