Innovation & Impact  Medical care

Innovation & Impact  Medical care

Text: Jos Wassink
This box packed with medical instruments lets patients carry out check-ups on themselves, sparing them a trip to the hospital. How has it been received, and is it really cheaper? Delft Matters dives into The Box, a medical home care box.

Some ten years ago, interventional cardiologist Prof. Douwe Atsma saw that Leiden University Medical Centre (LUMC) was getting busier and busier. He noticed a carousel caused by what he calls the ‘supply-driven’ approach: a patient has an appointment for a periodic check-up, the attending physician generally confirms that the patient is stable and treatment is continued as usual.

See you next time. Seeing this inefficient system, Atsma began to wonder whether there was a better way: “What if we only saw patients when necessary and avoided appointments with a clear reason. That was the concept behind what has now become The Box.” Although video conferencing was not as common back then as it is now, Atsma and his team set themselves the objective of transforming 50% of all patient interactions. People recovering from an acute myocardial infarction were picked as the first patient group, because – after undergoing angioplasty – they are usually monitored for a full year, with four visits to the hospital.

Meet Dr. Box

Text: Jos Wassink
This box packed with medical instruments lets patients carry out check-ups on themselves, sparing them a trip to the hospital. How has it been received, and is it really cheaper? Delft Matters dives into The Box, a medical home care box.

Some ten years ago, interventional cardiologist Prof. Douwe Atsma saw that Leiden University Medical Centre (LUMC) was getting busier and busier. He noticed a carousel caused by what he calls the ‘supply-driven’ approach: a patient has an appointment for a periodic check-up, the attending physician generally confirms that the patient is stable and treatment is continued as usual. See you next time. Seeing this inefficient system, Atsma began to wonder whether there was a better way: “What if we only saw patients when necessary and avoided appointments with a clear reason. That was the concept behind what has now become The Box.” Although video conferencing was not as common back then as it is now, Atsma and his team set themselves the objective of transforming 50% of all patient interactions. People recovering from an acute myocardial infarction were picked as the first patient group, because – after undergoing angioplasty – they are usually monitored for a full year, with four visits to the hospital.

SCALING UP

“Initiatives that benefit prevention are usually a tough business case.” Valeria Pannunzio (IDE) explains. “These projects are only profitable if they are adopted on a large scale.” The researchers envision achieving the necessary scale through their Edison RPM (Remote Patient Management funding application to the National Growth Fund, which dispenses 20 billion euros worth to projects promising long-term economic growth every year. The Edison RPM application was made in conjunction with patient associations, a health insurance company and some 50 other partners. The application focuses on three common conditions: diabetes, cardiovascular disease and perioperative care. The goal of the project is to greatly increase the number of patients treated remotely. Furthermore, a data structure will have to be designed to secure the flow of data between patients and doctors. As part of this, AI models will have to be stored in a repository of sorts so that their development can be monitored. Finally, the project also aims to facilitate companies looking to develop integrated digital care systems. Kleinsmann: “Five years from now, I hope that we’ll have successfully managed to scale up and that all care that can be provided at home, is provided at home. That way, patients stay in control and get the best possible care. However, we’ll have to focus on ensuring that healthcare professionals don’t get even more duties, but see their workload shrink.”

Halving hospital care

Atsma: “We wanted to bring the four check-ups down to two, in addition to two video calls, as well as switching to remote ECGs. The next step was to put together a set of devices, which ended up being the project where we introduced The Box. We ran a pilot first, followed by a randomised study: 100 people with The Box and 100 people without one.” In this case, The Box was a kit that consisted of scales, a heart rate monitor, a pedometer, a thermometer and a blood pressure monitor. After an initial tutorial, the patients take measurements at home and send them to the hospital using the LUMC Care App, which gets them into a secure patient record. The user survey showed that people did not mind collecting their own health data and seeing the doctor less often. Health status, measured by tracking blood pressure and body weight, was at least as good in people who used The Box as in the control group, and treatment was slightly cheaper, Atsma says.

‘The more personal an app is, the more likely users are to become attached to it’

SCALING UP

“Initiatives that benefit prevention are usually a tough business case.” Valeria Pannunzio (IDE) explains. “These projects are only profitable if they are adopted on a large scale.” The researchers envision achieving the necessary scale through their Edison RPM (Remote Patient Management funding application to the National Growth Fund, which dispenses 20 billion euros worth to projects promising long-term economic growth every year. The Edison RPM application was made in conjunction with patient associations, a health insurance company and some 50 other partners. The application focuses on three common conditions: diabetes, cardiovascular disease and perioperative care. The goal of the project is to greatly increase the number of patients treated remotely. Furthermore, a data structure will have to be designed to secure the flow of data between patients and doctors. As part of this, AI models will have to be stored in a repository of sorts so that their development can be monitored. Finally, the project also aims to facilitate companies looking to develop integrated digital care systems. Kleinsmann: “Five years from now, I hope that we’ll have successfully managed to scale up and that all care that can be provided at home, is provided at home. That way, patients stay in control and get the best possible care. However, we’ll have to focus on ensuring that healthcare professionals don’t get even more duties, but see their workload shrink.”

Halving hospital care

Atsma: “We wanted to bring the four check-ups down to two, in addition to two video calls, as well as switching to remote ECGs. The next step was to put together a set of devices, which ended up being the project where we introduced The Box. We ran a pilot first, followed by a randomised study: 100 people with The Box and 100 people without one.” In this case, The Box was a kit that consisted of scales, a heart rate monitor, a pedometer, a thermometer and a blood pressure monitor. After an initial tutorial, the patients take measurements at home and send them to the hospital using the LUMC Care App, which gets them into a secure patient record. The user survey showed that people did not mind collecting their own health data and seeing the doctor less often. Health status, measured by tracking blood pressure and body weight, was at least as good in people who used The Box as in the control group, and treatment was slightly cheaper, Atsma says.

‘The more personal an app is, the more likely users are to become attached to it’

The Box is now being developed by LUMC and the Netherlands eHealth Living Lab and has really taken off: some 30 different Boxes have now been put together for conditions as diverse as diabetes, stroke and heart failure. Patients are also monitored from home before and after surgery (perioperative care) or can undergo intensive care at home. The Boxes are issued and collected from the LUMC Box Office, where nurses and technicians familiarise patients with the equipment. Cardiologist Atsma is proud of and pleased with the results so far, but stresses that he still has more plans for the future. His goal is to move half of all hospital care to the home with an even loftier ambition in mind: enabling people to take control of their own health. “We’ll take your blood pressure once a week,” Atsma tells his patients. “All you have to do is wear the smart watch and weigh yourself on the scales every week. They know that I can track their results. I’ve seen countless cases how even a brief email can boost compliance. I’ll email them how well they’re doing and add a quick ‘Could you perhaps…?’ Little gestures like that really help people stay on track.”

The Delft Connection

At the same time, Prof. Maaike Kleinsmann (Faculty of Industrial Design Engineering, IDE) was working on a similar topic in Delft: the digital transformation of healthcare. Kleinsmann was trying to improve our current system by collaborating with a wide range of quite different disciplines. As director of the Cardiolab (part of the Delft Design labs), she worked with the Heart Foundation and Philips on ways to teach people at high risk of heart disease how to live healthier lives. About five years ago, she had an appointment with Atsma.

The Box is now being developed by LUMC and the Netherlands eHealth Living Lab and has really taken off: some 30 different Boxes have now been put together for conditions as diverse as diabetes, stroke and heart failure. Patients are also monitored from home before and after surgery (perioperative care) or can undergo intensive care at home. The Boxes are issued and collected from the LUMC Box Office, where nurses and technicians familiarise patients with the equipment. Cardiologist Atsma is proud of and pleased with the results so far, but stresses that he still has more plans for the future. His goal is to move half of all hospital care to the home with an even loftier ambition in mind: enabling people to take control of their own health. “We’ll take your blood pressure once a week,” Atsma tells his patients. “All you have to do is wear the smart watch and weigh yourself on the scales every week. They know that I can track their results. I’ve seen countless cases how even a brief email can boost compliance. I’ll email them how well they’re doing and add a quick ‘Could you perhaps…?’ Little gestures like that really help people stay on track.”

The Delft Connection

At the same time, Prof. Maaike Kleinsmann (Faculty of Industrial Design Engineering, IDE) was working on a similar topic in Delft: the digital transformation of healthcare. Kleinsmann was trying to improve our current system by collaborating with a wide range of quite different disciplines. As director of the Cardiolab (part of the Delft Design labs), she worked with the Heart Foundation and Philips on ways to teach people at high risk of heart disease how to live healthier lives. About five years ago, she had an appointment with Atsma.

WHAT IS THE BOX?

The Box is a medical home care box developed at the LUMC in Leiden. With the contents of the box, patients can, after instruction, perform measurements themselves at home and send the results to the hospital with an app. The goal is to provide more care at home so the patient does not have to come to the hospital unnecessarily, and it can also be cost-saving. For example, for people who have had an acute heart attack, The Box is filled with a scale, heart rate monitor, pedometer, thermometer and blood pressure monitor. Some 30 different boxes have since been developed for conditions as diverse as diabetes, stroke or heart failure. Patients are also monitored at home before and after surgery or can undergo intensive care at home.
© Marieke de Lorijn

After our presentation, Douwe Atsma said: ‘You guys have put into words what I’ve been trying to do for years,” Kleinsmann recalls. “I was delighted, especially because it opened up an avenue for collaborative research.” Medical Delta, the partnership between TU Delft, LUMC and Erasmus MC, now offers dual appointments that allow research and clinical applications to go hand in hand. Atsma has a Medical Delta appointment at TU Delft, while Kleinsmann is LUMC’s Medical Delta professor of Digital Transformation Design. The Box’s effectiveness hinges on patient compliance: it only works if patients faithfully take and submit their measurements.

Personal feedback

But how can you best motivate patients to submit their data? Professor of human-centred design Prof. Alessandro Bozzon (IDE) is developing artificial intelligence (AI) models to do just that. “User loyalty increases with greater resonance between the app and the users,” he says. In other words: the more personal an app feels, the more likely users are to become attached to it. That is why Bozzon’s AI application collects as much information as possible about users to provide personal feedback. “If an app recommends that you go for a walk in the park but you don’t have a park nearby, it will lose credibility,” he explains. He stresses that the user’s privacy will always be respected. AI can also interpret patient data, such as by identifying outliers in blood pressure or sugar levels. But as more data comes in, AI models become even better at interpreting anomalies. “AI models are not static,” Bozzon explains. “They’re evolving algorithms.” So how do users perceive remote care systems? This was studied by PhD candidate Valeria Pannunzio (IDE), analysing more than a thousand articles on patient and staff experiences with eHealth systems. Remarkably, only one article dealt with cost savings (estimated at 10 to 20 percent), while system safety (one patient died at home two weeks after surgery due to a leak) and acceptance are deemed considerably more important. Pannunzio made an interesting discovery: “If the technology does not mesh well with the hospital’s standard practices, the effect is counterproductive, as nurses will quit because they don’t like their job anymore.” In other words: employees have to believe the tech. “Just because the people at LUMC love The Box, it does not mean that it’ll be universally accepted,” Pannunzio warns. “Every hospital will want a custom product,” she expects.

© Montage: Ontwerpwerk | Photos: Agrobacter | Illustrations: Visual Generation

WHAT IS THE BOX?

The Box is a medical home care box developed at the LUMC in Leiden. With the contents of the box, patients can, after instruction, perform measurements themselves at home and send the results
to the hospital with an app. The goal is to provide more care at home so the patient does not have to come to the hospital unnecessarily, and it can also be cost-saving. For example, for people who have had an acute heart attack, The Box is filled with a scale, heart rate monitor, pedometer, thermometer and blood pressure monitor. Some 30 different boxes have since been developed for conditions as diverse as diabetes, stroke or heart failure. Patients are also monitored at home before and after surgery or can undergo intensive care at home.
© Marieke de Lorijn

After our presentation, Douwe Atsma said: ‘You guys have put into words what I’ve been trying to do for years,” Kleinsmann recalls. “I was delighted, especially because it opened up an avenue for collaborative research.” Medical Delta, the partnership between TU Delft, LUMC and Erasmus MC, now offers dual appointments that allow research and clinical applications to go hand in hand. Atsma has a Medical Delta appointment at TU Delft, while Kleinsmann is LUMC’s Medical Delta professor of Digital Transformation Design. The Box’s effectiveness hinges on patient compliance: it only works if patients faithfully take and submit their measurements.

Personal feedback

But how can you best motivate patients to submit their data? Professor of human-centred design Prof. Alessandro Bozzon (IDE) is developing artificial intelligence (AI) models to do just that. “User loyalty increases with greater resonance between the app and the users,” he says. In other words: the more personal an app feels, the more likely users are to become attached to it. That is why Bozzon’s AI application collects as much information as possible about users to provide personal feedback. “If an app recommends that you go for a walk in the park but you don’t have a park nearby, it will lose credibility,” he explains. He stresses that the user’s privacy will always be respected. AI can also interpret patient data, such as by identifying outliers in blood pressure or sugar levels. But as more data comes in, AI models become even better at interpreting anomalies. “AI models are not static,” Bozzon explains. “They’re evolving algorithms.” So how do users perceive remote care systems? This was studied by PhD candidate Valeria Pannunzio (IDE), analysing more than a thousand articles on patient and staff experiences with eHealth systems. Remarkably, only one article dealt with cost savings (estimated at 10 to 20 percent), while system safety (one patient died at home two weeks after surgery due to a leak) and acceptance are deemed considerably more important. Pannunzio made an interesting discovery: “If the technology does not mesh well with the hospital’s standard practices, the effect is counterproductive, as nurses will quit because they don’t like their job anymore.” In other words: employees have to believe the tech. “Just because the people at LUMC love The Box, it does not mean that it’ll be universally accepted,” Pannunzio warns. “Every hospital will want a custom product,” she expects.

© Montage: Ontwerpwerk | Photos: Agrobacter | Illustrations: Visual Generation
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