E-health – the collective name for digital appliances for care at a distance – is gradually changing our care landscape, leading to many patient benefits and cost savings. The real breakthrough is to be expected in the next few years, especially in mental health.
As one of the first care institutions in the Netherlands, the Heart Centre of Isala, a large hospital in Zwolle, conducted trials with care at a distance at the end of the nineties. Important values such as the oxygen levels, CO2 and blood pressure of heart patients were measured at home and monitored remotely from the hospital.
Now, more than two decades later, more and more people are able to recover or recuperate at home after a hospital admission or diagnosis. The measuring devices they take home with them are in contact with the hospital and pass on their data to the local nursing staff. However, according to Myrah Wouters, programme leader of the eHealth Monitor (an annual survey that charts the availability and use of e-health in the Netherlands), it is inevitable that e-health will be used much more widely in the coming years.
Wouters points out that there are several developments that mean that healthcare has to be organised differently. For example, the demand for care and healthcare costs are rising due to the increasing ageing of the population. At the same time, there is a looming shortage of 100 to 125 thousand employees in the care sector by 2022. Total health costs, which are already high, will continue to rise in the coming years. New policies are being developed to deal with these issues, such as in more personalised care, outcome-oriented care and self-management support. According to Wouters, the use of e-health is seen as part of the solution.
Future model
This development is clearly visible in mental health care. In this sector many trials are being held with treatments for depression and/or anxiety disorders at a distance. Mentaal Beter, a curative mental health provider with more than 60 locations throughout the Netherlands, opened an online mental health practice at the end of last year under the name the Digital Practice (‘de Digitale Praktijk’).
According to psychologist Marsha Baboelal, the Digital Practice is the result of a “continuous search for more effective and innovative treatment options” that characterises Mentaal Beter. She has this to say: “Many places in the mental healthcare sector are now taking this approach, but we mostly still see blended care solutions, i.e. partly online and partly face-to-face. The Digital Practice is the next step: we only see our clients on our computer screens.”
The Digital Practice now has dozens of online treatments running and the experiences are definitely positive, says Marsha Baboelal. “Of course it takes some getting used to at first, both for the client and the practitioner. We're so accustomed to meeting a psychologist in a consulting room, but there's no need for that at all. The people I'm treating now are very pleased that they can go through a normal mental health treatment programme from their own home without having to travel or wait. We benefit from the fact that it's much easier to talk to someone who is in their own, familiar setting.”
Marsha Baboelal sees the Digital Practice as the future model in mental health care. She says: “I've been working in mental health care since 2010 and every year the waiting lists get longer. The mental health system is also so large and cumbersome that inefficiency is almost inevitable, even though everyone does their best to get things done as best they can. We're not yet making enough use of the possibilities offered by new technology.”
New applications
In addition to e-health and Mobile First, serious gaming and virtual reality are also on the rise in treatment programmes, says Martin de Heer, director at Mentaal Beter. But all these new different applications from different IT suppliers also cause problems. De Heer: “Practitioners are becoming more accepting of e-health. The problem is that many of them still use modules that are already five or ten years old – and that's very old by IT standards. You can't easily connect all kinds of new applications to that.”
To tackle this problem, Mentaal Beter has recently developed a new connectivity tool called Koppeltaal. “Koppeltaal is a standard that mental health and addiction care providers can use to integrate their information systems, serious games, apps and other applications. Koppeltaal enables mental health institutions to give clients access to e-health modules from various IT suppliers,” says De Heer.
According to De Heer, the Netherlands takes a lead in concepts for Value Based Healthcare, but we are lagging behind in the realisation of the systems. “Mental health institutions have various IT platforms and these work with different languages. If you're a customer of one IT supplier, you can't use e-health solutions of other suppliers. Separate interfaces are also needed for EPD (electronic patient dossier) and ROM (Routine Outcome Monitoring), and these call for major investments and efforts by mental health institutions. With Koppeltaal we can integrate all the information flows into the care provider's work environment. That provides a complete picture in one environment. This is of great importance in the treatment of our clients.”
Huge potential
Although initiatives such as Koppeltaal are effective in helping to roll out e-health applications more widely, the big question remains of when the tipping point for e-health will be reached. This is because the true, large-scale breakthrough of care at a distance is to a very limited extent determined by technical possibilities, write Lies van Gennip, director of Nictiz and Roland Friele, deputy director of Nivel, in their foreword to the eHealth Monitor 2018. “Factors that contribute to progress in the development and application of e-health should be sought with a greater sense of urgency, recognising the added value of e-health and the ability and willingness to change processes. These aspects determine – independently of each other and in their mutual relation – the pace of the development and application of e-health,” say the two directors.
Peter de Lange, managing director of digitalAngel, a new digital medical device platform of healthcare provider Medux, agrees. He believes that the healthcare sector is still too conservative when it comes to embracing new technological developments. “Health care is a rather conservative sector in which new companies with a smart idea find it hard to get a foothold. A digital innovation is only put into use if it has a clear added value,” says De Lange.
There's also room for improvement in the education of prospective doctors, says Martine Breteler. She works for FocusCura, conducts PhD research at UMC Utrecht on telemonitoring and considers the future of health care with other young doctors and healthcare professionals in the Zorg 2025 working group. According to Breteler, e-health is not yet being paid sufficient attention in medical training, and doctors in training are given virtually no tools for innovation. This means that once they start work in a busy practice, they have little interest in using an e-health application.
At the same time, the eHealth Monitor underlines the huge potential of e-health. Not only in terms of better care and cost savings, but also as a basis for preventive medicine. The widespread use of e-health solutions will lead to a reservoir of personal health data, which – in combination with artificial intelligence – will make it possible to recognise disorders much sooner. This allows practitioners to intervene much more effectively, giving the patient a better chance of recovery.
Also read ‘Mentaal Beter launches Digital Practice for online psychiatric care'
