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Blog interview: How UMC Utrecht developed three e-health services in a short period of time

11 November 2016

The University Medical Center Utrecht only needed nine months to develop successful e-health applications for three totally different patient groups: ALS, hypertension, and youth trauma. How did they do this? And what can it teach us? I met with Professor Wouter van Solinge, ambassador for E-Health and Big Data at the University Medical Center Utrecht, to find out.

"Do you see the elevators at the end of the hall? Go up two floors, take a left, head through the red doors, and sign in at the desk." This was the answer to my question of where I could find Wouter's office.

Every time I'm at the University Medical Center Utrecht (UMC Utrecht), I'm amazed at how big it is. The academic hospital has more than 12,000 employees, but you'd never know it walking around one of the departments.

Wouter greets me with a firm handshake. I've known him for a while now and his vision and approach is truly inspirational. One the one hand, he has a keen eye for details, which is important as a clinical chemist and head of the Clinical Chemistry and Hematology Laboratory. On the other hand, he's someone with a clear vision of the future of health care, whose inspiring ideas help get everyone on the same page.

Photo copyright Marcel Bakker

Innovative journey of discovery

"How can a major organization like this set up successful e-health projects in just nine months?" I ask, getting right down to business as we take a seat in Wouter's office. He answers my question with a smile and says: "First of all, we made a very conscious decision to focus on three clinical pictures. We were never tempted to address everything at once. That marked the start of our innovative journey of discovery. We then sketched out our plans with the help of patients, doctors, nurses, and partners."

"There were and still are so many ideas, but which ones will make a real difference in the long term?" "Another success factor is the way we addressed the concrete realization of this dream. There were and still are so many ideas, but which ones will make a real difference in the long term? We focused on those ideas first, one at a time. We would finish one idea before moving on to the next. That's how we addressed the legal, ethical, and technical issues. And there are quite a few, particularly for a project that involves as many parties as ours."

"Another success factor was the decision to work with strong external partners, to build a trusting relationship, and to maintain short lines of communication. These partners include Chipsoft and, of course, FocusCura. But there are also the rehabilitation doctors at De Hoogstraat and the doctors at HUS here in Utrecht, such as Bart van Pinxteren, who's been involved from the start. They all played a crucial role in this."

"And finally, the Board of Directors gave us the room we needed to identify the changing health-care landscape. You need room to move if you want to be successful."

The doctor is in

All of these things helped UMC Utrecht launch three e-health applications in just nine months. These applications have the potential of being implemented throughout the hospital for various patient groups.

"We don't always know what happens to a patient when they leave here," he says, explaining the background of one of their e-health applications. "ALS patients, for instance, come to the outpatient clinic every three months. But because of the progressive nature of the disease, a lot can happen in three months. If after a week there is home measurements an indication of weight loss, which is a sign the patient is not doing well, you want to know right away so you can intervene. We refer to this as 'just in time care'.

"E-health can only be successful if you redesign the care process with the help of all involved health-care providers."According to Wouter, this is an entirely new way of working. "E-health can only be successful if you redesign the care process with the help of all involved health-care providers. On the one hand, this requires integrating technology into daily clinical practice, such as entering external measurement data into our hospital information system (SIS). On the other, it's just as important that health-care providers are willing to adjust their daily processes. Only then will e-health bring any added value. And only then can we make a real difference; of this I'm convinced."

"Many patients with hypertension will make an appointment with their family doctor. Working agreements have been made between family doctors and specialists to arrange joint patient consultations. Better collaboration and coordination is now possible because doctors and specialists have the same accurate information at their disposal, measured by the patients themselves, and can decide on which steps to take in consultation with the patient."

A great example of this is the PhD research carried out by Martine Breteler titled, 'A safe path from ICU to home', which examines the best way to get patients home more quickly following a trauma or a major surgery," says the e-health ambassador.

Scientific approach

According to Wouter, this added value must be proven scientifically. "We try to research the pros and cons of e-health and digitization. UMC Utrecht didn't develop a pedometer because its trendy right now. No, it researched the opportunities to validate this solution in terms of the golden clinical standard. This is befitting of our role as an academic center." "UMC Utrecht didn't develop a pedometer because its trendy right now"

A good example of this is the expertise provided by vascular medicine internist Dr. Wilko Spiering. "I understand why people might assume that a quick at-home blood pressure test is enough to monitor patients remotely," says Wouter. "But research has shown that weekly measurements is the only reliable way to measure blood pressure. So we incorporated these insights and scientific standards into our e-health applications. One of the things that sets us apart is our ability to provide high-quality digital care for even the most complex of patients."

E-health as an enabler

Wouter stresses that innovation cannot be pursued by health-care providers alone. Improving and innovating health care must be done in collaboration with the patients.

"E-health is an enabler that helps us realize a continuum of care and provide patients with higher quality care. We all stress the importance of putting the patient first. But what does that mean? Do we sit the patient down and surround him or her with an army of doctors? How would that make you feel, Daan?" he asks me. "Very uncomfortable," I say. "Exactly! The patient should be part of the team and contribute to the innovative process.''

Empowering patients: What does that mean?

"This was an important lesson for me, too. I experienced firsthand that health-care providers don't always know what's best for a patient. Once, during a round-table discussion with youth trauma patients, I really thought I'd hit the idea jackpot. I thought I could use activity trackers to replace lengthy questionnaires about activities."

"I experienced firsthand that health-care providers don't always know what's best for a patient." "A sixteen-year-old patient set me straight by saying: 'There's no way I'm wearing that thing. First of all, it's stupid. Second of all, my joints hurt because of my disease so I don't like to wear anything on my wrists. And third of all, that thing will be a constant reminder of how bad my disease makes me feel.'"

"On the other hand, an activity tracker was the ideal solution for the parents of an eight-year-old boy who claimed to be active during activity time, but wasn't because of his pain. The tracker makes this easy to see."

"Empowering patients: What does that mean? Well, it means something very different to an eight-year-old child than it does to a sixteen-year-old teenager or a fifty-year-old adult. But you only realize this by sitting down and talking to them about it."

Do it together!

Wouter says he learned a lot in those nine months. "As an academic hospital, it's our social responsibility to determine the best way to implement e-health solutions. This is an incredibly fulfilling and energizing project."

"Together, you find out what works and what doesn't. You also learn that it's okay to make mistakes. Working together means involving all relevant parties: from doctors and rehabilitation specialists to patients, caregivers, and technology partners."

And if I could give one piece of advice to other health-care organizations, it would be: work with partners and have the courage to change so that patients can get the health care they deserve

Professor Wouter van Solinge is a clinical chemist and head of the Clinical Chemistry and Hematology Laboratory at the University Medical Center Utrecht. He is also the ambassador of E-Health and Big Data, a position he pursues in collaboration with Hylexo Nauto, the director of E-Health Innovation.