iMinds insights on citizen health empowerment

CITIZEN HEALTH EMPOWERMENT

The potential and challenges of the ‘Do-It-Yourself-Doctor’

TECH UPDATES BASED ON INTERVIEWS WITH ACADEMIC AND INDUSTRY EXPERTS - WWW.IMINDS.BE/INSIGHTS

WE NEED TO FIND OTHER WAYS OF PROVIDING HEALTHCARE THAN SHIPPING PEOPLE OFF TO BIG BUILDINGS. WE’RE TRYING TO MAKE IT EASIER FOR PEOPLE TO STAY AT HOME.

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Geert Houben, CEO Aristoco (Cubigo)

04 EXECUTIVESUMMARY

06 THE POTENTIAL AND CHALLENGES OF THE ‘DO-IT-YOURSELF-DOCTOR’

18 THE ONE-CLICK GATEWAY TO A WORLD OF HEALTH EMPOWERMENTGeert Houben, Aristoco (Cubigo)

24 VIRTUAL COACHING, REAL-LIFE RESULTSClaudia Put and Steven De Peuter, BrandNewHealth

28 A HEALTH APP WITH TRUE HEARTKarin Coninx and Eva Geurts, iMinds - EDM - UHasselt

34SMART DEVICES FOR SMARTER MONITORINGPieter Vandervoort, Ziekenhuis Oost-Limburg

CITIZEN HEALTH EMPOWERMENT: THE POTENTIAL AND CHALLENGES OF THE ‘DO-IT-YOURSELF-DOCTOR’

HOW TECHNOLOGY DEVELOP-ERS CAN EMPOWER CITIZENS TO TAKE BETTER CONTROL OF THEIR OWN HEALTH

With more people living longer than ever before and chronic disease on the rise, healthcare systems are being pushed to their limits. Society’s focus has to shift from disease prevention alone toward promoting healthy lifestyles in which citizens have more control over their individual health — in which they are empow-ered.

Digital technologies are widely expected to play a key role in this by giving people greater access to their personal health information and equipping them with tools and insights to better manage their lifestyles.

Yet to truly enable this, some fundamental questions have to be answered; questions related to

technological standardization and integration, for instance – but also related to integrating these new concepts into the overall health system. And how about winning clinicians’ favor and getting (and keeping) patients on board by focusing on liability and privacy, usability and persuasive technol-ogies? And finally, how to make sure citizen health empowerment solutions will generate revenues for the companies bringing these solutions to the market?

INTEGRATION AND UPTAKE

The complexity of health systems and the proprietary nature of health technologies make estab-lishing interoperable, standardized solutions extremely challenging. Yet interoperability and standards are essential to fostering uptake: interoperability ensures systems can interact regardless of who made them or where data is coming from or going to; standards in this context are a set of technical specifications based on consen-sus among stakeholders allowing systems to be calibrated so that

their measurements are equivalent across applications and platforms.

iMinds works closely with govern-ment authorities to drive interop-erability and standardization forward. Its technical test center and recently founded iMinds Health Lab, for instance, target interoperability issues and provide an environment for testing use cases and business cases based on national and international interop-erability standards. They also host functional and technical integration test sessions, verify the confor-mance of applications and services to interoperability specifications, and support co-creation and stake-holder feedback sessions.

Interoperability is one requirement for integrating digital tools into the health system; convincing practi-tioners of the value of such tools is another. Physicians are wary of formally recommending apps or electronic devices to patients without evidence of their benefit, guidelines for their use or assurance that the patient’s personal infor-mation will remain secure. Insurers

EXECUTIVE SUMMARY

04 | iMinds insights

THERE IS SOCIETAL VALUE TO GIVING PATIENTS ACCESS TO THEIR PERSONAL HEALTH DATA. WELL-INFORMED PATIENTS CAN HAVE BETTER DISCUSSIONS WITH PHYSICIANS. WE THINK IT’S EASIER FOR A GENERAL PRACTITIONER TO ARRIVE AT THE CORRECT DIAGNOSIS AND THERAPEUTIC SOLUTION WHEN PATIENTS HAVE CLEARER EXPECTATIONS AND ARE BETTER INFORMED.

and employer health programs also want clear evidence of benefit. The vast cross-section of stakeholders in health means research must be broadly inclusive to prove that the proposed solutions actually satisfy the needs of all user communities.

GETTING (AND KEEPING) USERS ON BOARD

iMinds’ experience has led to the conclusion that strong end-user involvement in the innovation process is key — not only in pilot trials and beta testing but also during the ideation phase to fully understand users’ needs and the problems to be solved. Also key is for technologies to be ‘persuasive’ — that is, to have built-in mecha-nisms for encouraging people to follow through and improve their lifestyles over the long term.

Citizens will only be empowered to take control of their own health destinies if the tools provided are practical and easy to use, making careful design important. People will also need support understand-ing what their personal health

information really means, meaning some form of translation and inter-pretation will be required.

Another fundamental consider-ation is privacy. The nature of information sharing in a connected, data-driven, personally empowered health future may require a reshap-ing of what ‘privacy’ means — rebal-ancing personal health and societal benefits against the protection of individual data. The EU is currently in the process of reviewing its legal framework on data protec-tion to reflect current evolutions in technology innovation, and iMinds researchers are actively engaged in identifying and addressing relevant questions.

THE PATH TO MARKET

The complexity of the healthcare system poses barriers for entre-preneurs looking to introduce new solutions into the sector and deliver tailored, value-added services to end users with different profiles. iMinds is helping them build successful technologies through business analysis, cost-benefit

calculations, strategy development and a living labs approach that allows technology developers to refine their solutions based directly on user input.

THE WAY FORWARD

In the end, citizen health empow-erment is not about technology — although technology is certainly a driving force. It’s about enabling a new way of fostering health in a person-centered, health-focused system that allows citizens to be active, self-empowered partic-ipants in their personal health management processes.

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“FOR MORE INFORMATION

about iMinds’ collaboration with the health sector, please contactBirgit [email protected] +32 9 331 48 08

Dr. Patrik Vankrunkelsven,Director Cebam

iMinds insights | 05

HOW TECHNOLOGY DEVELOPERS CAN EMPOWER CITIZENS TO TAKE BETTER CONTROL OF THEIR OWN HEALTH

With more people living longer than ever before and chronic disease on the rise, healthcare systems are being pushed to their limits. Society’s focus has to shift from disease prevention alone toward promoting healthy lifestyles in which citizens have more control over their individual health — in which they are empowered.

The World Health Organization (WHO) defines the concept of ‘citizen health empowerment’ as a process that supports citizens in gaining more control of their health by “taking the initiative, solving problems and making decisions.” Digital technologies are widely expected to play a key role in this by giving people greater access to their personal health information and equipping them with tools and insights to better manage their lifestyles.

The ultimate vision proposed by many advocates of citizen health empowerment is a data-driven health dashboard for every person. This is linked to a phenomenon known as the ‘quantified self’ — that is, the measurement and recording of a wide range of body parameters (from heart rates to body mass) as well contextual and social activi-ties such as humidity, air quality, or Twitter use. Quantification is enabled by consumer devices and the smart, networked objects of the emergent Internet of Things — all of which allow people to track more, share more and compile a better picture over time of count-less aspects of their (well)being.

Yet to truly enable this, some fundamental questions have to be answered about how citizen health empowerment technologies can be integrated with one another and into the overall health system — and how they’ll be validated to win clinicians’ favor. As well, health technology companies need to be

CITIZEN HEALTH EMPOWERMENT: THE POTENTIAL AND CHALLENGES

OF THE ‘DO-IT-YOURSELF-DOCTOR’

DIGITAL TECHNOLOGIES ARE WIDELY EXPECTED

TO PLAY A KEY ROLE IN EQUIPPING PEOPLE WITH TOOLS TO BETTER MANAGE THEIR LIFESTYLES.“

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confident that their citizen health empowerment solutions will be adopted by users and generate revenue.

iMinds is working with all relevant stakeholders in Flanders — includ-ing ICT companies, formal and informal care providers, insurers and the government — to answer

these questions and make citizen health empowerment a reality.

THE SHIFT IS UNDERWAY

The shift at the heart of citizen health empowerment — away from curing illness and toward data-driven health management —

demands the right tools, including new digital technologies.

If the number of consumer-focused health tools in Apple’s App Store is any indication, there is a public appetite for these kinds of technol-ogies already. A 2013 study of the U.S. App Store conducted by the

>>

THE PATIENT WILL BECOME MORE INVOLVED IN HEALTHCARE DECISION MAKING

IN THE FUTURE

PAYER NOW AS IMPORTANT AS THE PHYSICIAN

NOW

CENTRAL ROLE FOR THE PHYSICIAN

PREVIOUSLY

In the past physicians were key stakeholders acting as gate keepers to healthcare information and treatment options.

As the key budget holders, payers have the most influence today over healthcare treatments and patterns and evaluation of outcomes results.

With the rise of the internet and all its healthcare information, patients are better informed and enabled to participate in the healthcare decision making process.


IMS Institute for Healthcare Infor-matics found that, of the 23,682 apps focused specifically on health-care, more than two thirds (16,275) were designed for consumers and patients.1

Apps, of course, are not the only digital tools enabling citizen health empowerment. Databases, commu-nications technologies, remote sensors, wearables, intelligent algorithms and more all contribute to an overall citizen health empow-erment service offering.

A recent iMinds project looking to mitigate the risk of slips and falls — which are the second leading cause of accidental death among seniors worldwide — demon-strated for instance the ways ‘sensor fusion’ could increase

the efficacy and lower the cost of fall-detection solutions. While conventional monitoring systems are complex, expensive and gener-ate high numbers of false positives and false negatives, the FallRisk project fused data from different kinds of acoustic and visual sensors to cost-effectively deliver more accurate and complete information. Uniquely, FallRisk not only identi-fies when someone has fallen; it also assesses the risk that someone might fall, helping avoid injuries in the first place. The project incor-porated a cloud-based backbone for data handling, with algorithms that assess inputs and dynamically forward alerts to formal and infor-mal caregivers to ensure timely response. As useful as technologies like these

may be, though, they stand little chance of delivering their benefits if they each exist in isolation, unable to interoperate and contribute to the bigger-picture view proposed in the personal health dashboard concept.

IN PURSUIT OF INTEROPERABILITY AND STANDARDIZATION

The complexity of health systems — whose stakeholders include governments, health insurers, care organizations, practitioners and patients — makes establish-ing interoperable, standardized solutions extremely challenging, especially because these various players have their own aims and agendas. Doctors are focused on quality of care, while insurers want


HEALTH-RELATED APPS TARGETED TO CONSUMERS VS. HEALTHCARE PROVIDERS (HCP)

16,275 Consumers

7,407 HCP

IMS Analysis on all apps present in the Apple Store to June 2013 showed 23,682 apps related to health

More than 2/3 of these apps were related to consumers

•

•

Source: IMS Health analysis of widely available healthcare apps

1 IMS Institute for Healthcare Informatics. (2013). Patient apps for improved healthcare: From novelty to mainstream. 08 | iMinds insights

to minimize costs. Consensus can be elusive.

The behavior of health technology companies further complicates things because these organizations tend to specialize in certain product types (e.g., displays, data-process-ing solutions, monitoring technol-ogies). This often leads to the development of closed, standalone technology platforms — a barrier to adoption not only for usability reasons but also because it limits practitioners’ freedom to pick and choose the most suitable apps and tools. Instead, their choices end up being platform-dependent.

Poor standardization has an impact all the way down to the level of the consumer. Popular products like Fitbit, for example, monitor the number of steps their wearers take in a given day. But different tools may measure a ‘step’ differently, meaning their data is non-standard and therefore not aligned with the data measured by other products. Accurate baselining becomes very difficult.

iMinds works closely with govern-ment authorities to drive interop-erability and standardization forward. Its technical test center and recently founded iMinds Health Lab, for instance, target interoperability issues and provide an environment for testing use cases and business cases based on national and international interoperability standards. They also host functional and technical integration test sessions, verify the

conformance of applications and services to interoperability speci-fications, and support co-creation and stakeholder feedback sessions.

HOW TO GET USERS ON BOARD

For citizen health empowerment to succeed, not only interoperability and standardization is required. People need to actively use the tools being put at their disposal. In some countries, including Belgium, this will require a culture shift. Where citizens are not used to paying their own healthcare costs, they may resist paying for solutions not reimbursed by insur-ers; at the same time, insurers may be reluctant to embrace citizen health empowerment because of the potential impact on their profitability.

Separate from the question of who pays for what in the citizen health empowerment future, the stake-holders involved must also look closely at how to encourage uptake of these tools and technologies. iMinds’ experience has led to the conclusion that strong end-user involvement in the innovation process is key — not only in pilot trials and beta testing but also during the ideation phase to fully understand users’ needs and the problems to be solved.

The FallRisk project described earlier engaged relevant stake-holders (i.e., older adults, formal and informal caregivers) to under-stand user needs and the context >>

MOBILE HEART MONITORING

The iMinds-funded start-up Qompium is focused on devel-oping smartphone-based health apps. Its initial product, Fibricheck, is designed to detect irregular heart rhythms and prevent heart failure and strokes. Using powerful algorithms, the app provides rapid, user-friendly diagnostics that are communicated in real time to caregivers over mobile networks.

In the simplest terms, interop-erability is about ensuring systems can exchange data, communicate and interact — regardless of who made them or where data is coming from or going to. Standardization, in this context, is about devel-oping a set of technical speci-fications based on consensus among stakeholders, allowing systems to be calibrated so that their measurements are equivalent across applications and platforms.


in which the FallRisk technology will be used. That led to some inter-esting — sometimes unexpected — findings, with informal and formal caregivers expressing more privacy concerns than older adults, while a number of seniors — the target demographic — felt the proposed solution underestimated their own abilities. User testing with these stakeholders made it possible to iteratively improve the FallRisk interfaces for different stakehold-ers and provide relevant function-ality that ideally will contribute to commercial uptake.

Another key to unlocking the market for citizen health empow-erment technologies is demon-strating added value for stake-holders other than end users. In a complex health system, tools that meet the needs of medical person-nel, coaches and others represent a ‘win-win’ for health technology developers. One example of this is the NEMO project (discussed later in this paper), which provides a single, streamlined interface for health professionals to monitor multiple patients’ health data.

KEEPING USERS ON TRACK

Clearly, not all citizens have an equal desire to be empowered or take greater responsibility for their personal health. Some will embrace it wholeheartedly while others might need a little encouragement; others will choose not to partic-ipate out of disinclination, poor technology skills or lack of access to digital tools.

And there is also the question of persistence. Anyone who has ever attempted a diet knows sticking to a new routine can be challenging.

For all of these reasons, research-ers are actively exploring ‘persua-sive technologies’ that motivate people to improve their lifestyles. In the specific case of weight loss, a number of partners have come together under the banner of iMinds’ b-SLIM project to create a digital ‘super coach’ that will promote and encourage healthy eating and exercise. The aim is to break complex behaviors down into addressable components and help users set achievable incremental goals. b-SLIM began in Spring 2014

I DO REMOTE MONITORING WITH MORE THAN 600

PATIENTS, THE MAJORITY OF WHOM HAVE ADVANCED HEART

FAILURE. IF I HAVE A SINGLE PATIENT WITH FOUR DEVICES,

I HAVE TO OPEN UP FOUR DIFFERENT WEBSITES AND

SIFT THROUGH INFORMATION THAT’S ALL DISPLAYED

DIFFERENTLY. IT’S COMPLEX, CUMBERSOME AND TIME-

CONSUMING. WHY NOT JUST HAVE ALL YOUR CLINICAL DATA

COME TO ONE PLACE?

Dr. Pieter VandervoortCo-chair of the Mobile Health Unit, Hasselt UniversityProject lead: iMinds Neutral Mobile Health Platform (NEMO)

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with co-creation sessions, stake-holder interviews and lab testing to narrow down the initial concept to a product design. Real-world testing and validation trials are scheduled for Fall 2015.

But ensuring that people maintain healthy lifestyles is only one aspect of the motivational challenge of the citizen health empowerment future. Another relates to the need for constant information gather-ing - and how to organize that in a smooth way.

Digital technologies have the potential to provide more complete and accurate accounts of a person’s health experience than anecdotal recollections. However, if users are required to manually track and input their daily data, long-term motivation and accuracy may suffer — and some will be disinclined to do it at all. Passive, automated data collection will help ensure dashboard metrics are complete, precise and detailed. iMinds is involved in a new EU Horizon 2020 project called m-Resist, which will use data generated by mobile devices and wearables to help

patients with treatment-resistant schizophrenia self-manage their disorder. In this clinical trial, heart rates, mobility patterns and other metrics will help alert patients of their condition. iMinds researchers are leading both the user research for the project as well as the proto-typing of the mobile app that will take all the data into account.

‘USER FRIENDLY’ IS A MUSTEnsuring that people persist with using digital health tools requires the tools themselves to be simple, practical and user-friendly, and to deliver clear and immediate value. Individuals should not have to inconvenience themselves or become trained specialists to be ‘health-empowered’.

This emphasis on usability is embed-ded in the iMinds approach — from involving potential end users at every point in the innovation cycle to designing the finest details of the technologies themselves. For example, usability was a key concern when iMinds researchers developed a cycling app for heart patients — extending not only to >>

RESEARCHERS ARE EXPLORING

PERSUASIVE TECHNOLOGIES THAT MOTIVATE

PEOPLE TO IMPROVE THEIR LIFESTYLES.

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A PERSONAL COACH WHO TRAVELS WITH YOU

Lieven Maesschalck, a physiotherapist and founder of the rehabili-tation practice Move to Cure, has worked with iMinds on a portable therapeutic coaching system that high-end athletes can take with them wherever they go. Using sophisticated camera technology and expert analysis, Maesschalck and his team diagnose how people’s movement patterns may cause them physical problems and then assign personalized rehabilitative exercises.

Instead of requiring a live, in-person coach, Maesschalck is develop-ing an avatar that can capture user movements and offer corrections in real time. Progress is monitored remotely by a real-world therapist; the therapy can continue even if client and trainer are continents apart.

With access to thousands of electronic health records, MyHealthData will provide an excellent opportunity for health data benchmarking. Yet with the question of benchmarking, other considerations come into play. As well, some form of professional judgment must be built in to help users appreciate the relative signif-icance of changes in their data.

This is true not only for MyHealth-Data but also in general. Certain health measures in an individual may vary widely from the average but have little impact, while a slight elevation or decrease in another measure could be cause for immediate concern. This discern-ment, which can come only from the medical community, is essen-tial to ensuring citizens relate appropriately to their health data. Otherwise, fears that “something might be wrong” could lead users to seek out health services they don’t actually need — serving only to perpetuate the burden on the system that citizen health empow-erment seeks to relieve.

TOWARD A LITERACY OF PRIVACY

The nature of information sharing in a connected, data-driven, person-

the user interface and functional-ity of the app but also, practically, to how the screen would cope with the glare of the sun.

MAKING HEALTH INFORMATION MEANINGFUL

Without the benefit of having gone to medical school, few of us have the ability to make sense of our personal health data. Some form of translation or interpretation is required — and if citizens are going to be genuinely empowered to look after their own wellbeing, some of that intelligence will need to reside within the health-care apps themselves.

MyHealthData, an iMinds ICON project launched in January 2015, aims to give patients access to their own health data in a format they can understand. That doesn’t mean simply offering definitions of technical terms; it means helping patients understand the impli-cations of their data and how it compares to various baselines. This kind of comprehension is lacking today for people whose go-to source of medical informa-tion is Google, where they look up generic symptoms, compare them to their own and draw ill-informed conclusions.



ally empowered health future may require a reshaping of fundamen-tal notions of privacy — rebalan- cing personal health and societal benefits against the protection of individual data.

This is not as radical as it may sound. Privacy, after all, is not a standalone right; it exists within a social context. Genome sequen-cing, for example, will continue to yield insights into diseases, leading to new treatments and preventa-tive approaches. The benefits of such sequencing come with scale, sampling ever-larger numbers of individuals’ genetic data. It’s not always possible for such data to remain perfectly anonymous, though — and it might not provide as much value if kept anonymous.

Society as a whole must decide where it stands on the tradeoffs. The decision can’t be made solely by industry or policymakers. Citizens also need to be informed and involved. Today’s model of ‘informed consent’, which typically amounts to clicking “I agree” after scrolling through unread reams of legal copy, is not sufficient for this future scenario. Greater engage-ment and some form of privacy literacy are needed.

The EU is currently in the process of reviewing its legal framework on data protection — not creating something wholly new but updating existing concepts, which date back to 1995, to reflect current evolu-tions in technology innovation.

While the framework provides standards and regulations, citizen health empowerment raises questions that are both ethical and legal, demanding further societal debate. Going back to the example of genome sequencing: by its very nature, the process reveals infor-mation not only about you but also your parents, your siblings and your children. Yet under the current legal framework, informa-tion concerning third parties should not be communicated without that party’s consent. However, insisting on the agreement of all affected third parties could be cumbersome and potentially prevent individuals in need from accessing valuable, life-changing treatments and thera-pies.

It is complex questions like these that need to be solved. iMinds researchers are actively engaged in unraveling the answers — contrib-uting, for example, to the legal and ethical frameworks of projects such as MyHealthData. >>

THERE IS SOCIETAL VALUE TO GIVING PATIENTS ACCESS TO THEIR PERSONAL HEALTH DATA. WELL-INFORMED PATIENTS CAN HAVE BETTER DISCUSSIONS WITH PHYSICIANS. WE THINK IT’S EASIER FOR A GENERAL PRACTITIONER TO ARRIVE AT THE CORRECT DIAGNOSIS AND THERAPEUTIC SOLUTION WHEN PATIENTS HAVE CLEARER EXPECTATIONS AND ARE BETTER INFORMED.

Dr. Patrik Vankrunkelsven,Director Cebam

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pg15


HOW TO KEEP USERS ON BOARD IN

THE LONG RUN?

The concept of citizen health empowerment is based on a totally new framework; one that needs both a legal and ethical foundation if we want to keep users (caregivers as well as patients) on board in the long run.

An example: in a typical care model, the caregiver is responsible and accountable for the decisions he or she takes – based on direct interactions with a patient. But what if – in the future – this patient is not physi-cally present, and can no longer be identified in a classical way?

What we have to avoid in this scenario by all means, is that medical doctors would discard the whole idea

of citizen health empowerment because they could be held accountable for establishing a wrong diagno-sis based on erroneous data or a faulty identification process. And at the same time, we risk losing out on patients – as they might not be willing to assume a greater personal responsibility when providing their doctor with medical data.

“In many cases, the existing law already applies quite well to these new equations – but we need to check if there are no flaws as there is no room for error,” says Prof Dr Anton Vedder, a judicial and ethical expert of iMinds - KU Leuven. “What is needed, is a legisla-tion that is technology-agnostic. But we do not want to completely rewrite the current legislation. That exercise is fully ongoing, both on a national and on a European level.”

In the meantime, the privacy-related and ethical debates are ongoing as well. The European Union is currently working on a new regulation that deals with protecting and processing personal data; a regulation that will also apply to medical data.

“Based on what we know so far, it seems like this EU regulation will be pretty strict,” Prof. Vedder continues. “But in the end, the whole society – every one of us – needs to reflect properly on which direction to take: perhaps we do want to give up a piece of privacy in return for optimized medical care?”

“In order to decide on that, conducting an open and public debate is absolutely mandatory. In the UK – for instance – a new concept on electronic patient records was recently introduced, leaving more room for making medical data available for research purposes. The concept did not get the support from the medical doctors, however, which complicated things substan-tially,” he concludes.



VALIDATING CITIZEN HEALTH EMPOWERMENT SOLUTIONS

Getting users on board is just one piece of the equation. Another aspect of the citizen health empow-erment vision is that digital tools will be recommended or formally prescribed as an integrated part of healthcare practice. Despite the issues around interoperability and standardization, this is already happening in some cases, albeit on a mostly ad hoc basis. For it to become more systematic, health-care professionals need greater confidence in consumer-oriented digital tools as well as clinical evidence demonstrating their value.

On the whole, physicians are wary of formally recommending apps or electronic devices to patients without evidence of their benefit, guidelines for their use or assurance that the patient’s personal infor-mation will remain secure. Insur-ers and employer health programs also want clear evidence of benefit before considering reimbursement or promoting the use of digital tools.

Health authorities have only just begun to respond to this need. A 2013 paper published in the European Journal of ePractice concluded that:

Both the EU and US regulators are struggling to keep up with recent advances in technology… Both regulatory bodies have launched programmes to solicit feedback from the user commu-nity and update regulations. The [United States Food and Drug Administration (FDA)] intends to use its authority to regulate mobile medical applications that will impact a variety of industries developing, marketing and selling mobile health products, but it is not yet evident how much the FDA intends to extend its regulatory arm. […] Fundamental changes in [European standard CE marking] regulations are anticipated in a 2015/16 timeframe.2

Separate from regulatory approval, the value of digital health technolo-gies must be proven for practitioners to recommend them to patients. This may be easier said than done

given that many research projects focusing on health technologies — iMinds projects included — lack the timescales for such evidence-based evaluations. What’s clear, however, is that given the vast cross-section of stakeholders in health, research must be broadly inclusive if it is to prove that the proposed solutions will actually satisfy the needs of all user communities. The participa-tory design strategy behind iMinds’ A Touch of Memory (AToM) project, for example, involved people suffer-ing from dementia as well as their partners, friends, caregivers and even local shopkeepers in develop-ing an app that could track patients’ food preferences to support independent living.

CLEARING THE PATH TO MARKET

Healthcare systems represent complex value networks involving governments, care providers, insur-ance payers, patients and citizens. That complexity poses barriers for entrepreneurs looking to intro-duce new solutions into the sector and deliver tailored, value-added >>

2 Papadopoulos, H., Sheth, V.B., & Wurst, M. (2013). “Comparison of US and EU regulatory approaches to mobile health apps: Use cases of myVisionTrack and USEFIL.” European Journal of ePractice, 21. Gedownload van: https://joinup.ec.europa.eu/community/epractice/og_page/european-journal-epractice. iMinds insights | 15

services to end users with different profiles. It isn’t always clear who will reap the benefits — or who actually holds the purse strings.

The last point is especially signifi-cant considering that health innova-tion can demand heavy investment, stimulating debate about alternative means of financing such as crowd-funding. (From a citizen health empowerment perspective, crowd-funding makes sense because it brings the citizen into the process of deciding which digital solutions are needed most.)

While some jurisdictions today already empower citizens by giving them the freedom to choose

their preferred health practitioner (meaning one could purposely select a practitioner who offers teleconsultations, for instance), this is not universally true across Europe. On the other hand, some jurisdic-tions have unwittingly embedded systemic obstacles to citizen health empowerment — for example, by instituting reimbursement rules that reinforce the illness-based health-care model or consider only in-per-son doctor visits (versus telehealth or web-based consultations) as billable.

The sales pitch for consum-er-friendly apps and other e-health services is also challenged by the fact that there is little proof yet of

the value of such solutions. More research is needed — into cost efficiencies, value calculations and the user experience — to qualify and quantify the benefits of digital health technologies.

Living lab approaches provide one way of building this kind of evidence. Through its Living Labs, iMinds is helping entrepreneurs build successful technologies based directly on user input.

The iMinds Living Lab methodol-ogy builds inclusive, user-centered innovation toward large-scale, real-world pilot testing. The Flemish Care Living Labs, for example, serves as a test-bed for novel technologies

THE APP MATURITY MODEL

LEVE

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ATUR

ITY O

F APP

PRE

SCRI

BING

INCREASING EVIDENCE OF HEALTHCARE BENEFITS

TIME

PROM

OTIN

G AD

OPTIO

N

IM

PLEM

ENTA

TION

RECOGNITION OF APPS

SECURITY AND PRIVACY GUIDELINES

CURATION AND EVALUATION OF APPSINTEGRATION WITH HEALTH IT SYSTEMS

INDIVIDUAL PHYSICIAN RECOMMENDATIONA small number of progressive physicians are recommending apps to their patients

SYSTEMATIC USE OF MOBILE APPS IN HEALTHCARESystems and policies in place to enable widespread use of apps in healthcare

FULLY INTEGRATED DELIVERY OF HEALTHCAREApps have a fully integrated role in the delivery of healthcare

Source: IMS Health analysis of widely available healthcare apps



and concepts such as Cubigo, an online community-based social care platform.

Other iMinds research groups analyze the potential for stake-holders to be involved in the digital health services innovation value network, generate business cases, calculate costs and potential returns on investment, and devise go-to-market strategies.

While the complexity of healthcare ultimately means there may be multiple potential business models for citizen health empowerment, essential to them all will be partner-ship and collaboration among the various players who have a role in

the innovation value networks that deliver solutions to market.

THE WAY FORWARD

iMinds is committed to working with all relevant stakeholders to develop, test and commercialize solutions that will realize the vision of citizen health empowerment — specifically, by providing research and business support, user-driven co-creation opportunities through its Living Labs, and insights into the legal and ethical questions that still need to be answered.

In the end, citizen health empow-erment is not about technology —

although technology is certainly a driving force. It’s about enabling a new way of fostering health in a person-centered, health-focused system that allows citizens to be active, self-empowered participants in their personal health manage-ment processes.

SPOTLIGHT ON IMINDS LIVING LABS

iMinds Living Labs is a leading organization in the European Network of Living Labs (ENoLL), which utilizes state-of-the-art tools and scientifically validated R&D methods to advance digital technology research. Involving users at every step of the innovation process, iMinds Living Labs include an:• Exploration lab for early stage innovation processes• Experimental lab for exploring solution boundaries and creating and

testing first prototypes• Evaluation lab for validating user interest in an innovation and/or the

business model behind it


CITIZEN HEALTH

EMPOWERMENT

GEERT HOUBEN, CEO Aristoco (Cubigo)18 | iMinds insights

THE ONE-CLICK GATEWAY TO A WORLD OF HEALTH EMPOWERMENT

As they age, more and more baby boomers are making the decision to avoid retirement facilities and spend their golden years at home. To support this and give older people more control over their health and wellbeing, software company Aristoco developed Cubigo, a platform that integrates diverse healthcare apps and programs into a single, simple interface. We spoke to Aristoco CEO GEERT HOUBEN to learn more about how the company is using its technology to create “caring communities” for aging populations.

Q: Do older people today approach healthcare differently than previous generations?

Geert Houben: Sure. They have a different view of their golden years than their parents did. We’re seeing a lot of baby boomers decide they want to avoid going to rest homes or assisted living facilities for as long as possible. As a software company, we’re looking at this trend from a technology perspective, trying to create tools that will help these older people take their care into their own hands. Not only is this what many older people want, but it also helps reduce government spending for elder care, which in Belgium and the rest of the world is

going through the roof. We need to find other ways of providing health-care than shipping people off to big buildings full of services, many of which they might not use. We’re trying to make it easier for people to stay at home.

Q: How does the idea of the “caring community” fit into this?

Geert Houben: When you decen-tralize care, move it away from rest homes and hospitals to homes, the neighborhood and the local environment become very import-ant. That’s the caring community—a community that helps take care of you, and there are different players in different roles. You have yourself, >>


of course, then your family, then the neighborhood. The neighborhood is critically important, because, for example, you might not have family living near you—your kids might be 50 kilometers away, so the people next door might be a huge help. That concept, the caring community, is something we want to empower. We want to give the entire community the tools they need to care for each other.

Q: How does Cubigo work?

Geert Houben: Cubigo is a dashboard that brings together a number of healthcare and social applications through a single, simplified user interface. Each app is represented graphically by a cube. So, if you order meals online, or instant message with your neighbors, or video chat with your nurse, you can do all that through an easy-to-use inter-face. You sign in once with a single password, whether on your laptop, iPad, smartphone, digital television, whatever, and you’re ready to go.

Q: Where did the concept come from?

Geert Houben: We were noticing more and more healthcare-re-lated organizations, compa-nies and stakeholders making their own online programs and apps. The problem is, they’re all distinct pieces of technology, like a website to book online medical appointments, or pharmaceuti-cal refill reminders sent to your email. That can be difficult for an older demographic. If they use tech, they want it to be reliable, accessible, and above all, easy to use. So the Cubigo concept is to simplify all of that. Kind of like a TV remote control. If you buy a TV from one manufacturer, a DVR from another, a Blu-ray player from a third, you’ve got three different remotes with a lot of the same buttons but in a different order. We make the universal remote, and we make it especially easy to use. We’re empowering people to do as much as they can to control their own healthcare, at home.

Q: What kind of applications are supported and enabled by Cubigo?

Geert Houben: We did a large study to find out what sorts of tools

WE MAKE THE UNIVERSAL REMOTE,

AND WE MAKE IT ESPECIALLY EASY

TO USE.

“

“

THE ONE-CLICK GATEWAYTO A WORLD OF HEALTH EMPOWERMENT


people needed to stay at home as long as possible. We found that the results could be grouped into three categories: social tools, comfort services, and security and care. The social aspect is about fighting loneliness. People need to stay in contact with friends and family. In Cubigo, we have a way to send messages through the dashboard that go directly to your kids’ Facebook, so they don’t have to have Cubigo to stay in contact. We also have a tool that lets you list activities and interests, and it’ll match you up with other people in your immediate neighborhood who have similar interests. So, I like to play chess, and I can easily find other people nearby to play with. There’s a big social aspect to Cubigo.

Q: And you mentioned comfort services and security as well?

Geert Houben: Comfort services are about finding help to do things that may become more difficult as you age. So, gardening, for example, or groceries, or prepar-ing meals and cleaning house. We want to make it easy for local

businesses to offer services that can be ordered online. The third pillar is security and care. If I fall down and injure myself, I want to be able to alert someone easily—not necessarily emergency services or the kids, but maybe a neighbor who can lend a hand. Cubigo can enable that kind of contact. We’re also looking at connecting weight scales, blood pressure monitors, those kinds of devices. The results from that monitoring would be sent to the nurse or doctor, who can set an appointment if there’s something concerning, rather than having patients in once a week if there’s no need.

Q: Are app creators on board with having their applications aggregated in this way?

Geert Houben: Absolutely. Because in the end, we’re using their services, bringing them business. Yes, they have to let go of their user interface, but they don’t have to do any extra work. They still build and distribute their app just as they normally would, they just have a new service channel.

Q: What has been the response so far?

Geert Houben: Very good. We’re active in Belgium, the Nether-lands, Spain and the USA. They’re very different markets because the healthcare systems are so differ-ent. In Belgium, for instance, the federal government is in charge of healthcare budgets, but in the Netherlands it’s the municipalities, so care is more localized. The latter works really well for our model, because we can sell the platform to the municipalities, and they can ask all the different local provid-ers to offer their services through Cubigo. We also work directly with organizations like assisted living facilities. So, a facility with, say, 50 apartments can give the platform to everyone in the building, and they have a button that calls a nurse, or they can order their meals, and things like that.

Q: What has iMinds’ role been?

Geert Houben: They are the program office for the Flemish Care Living Labs, which we’re actively involved in. In the Living Labs we >>


use cohorts and communities of our users—with their permission, of course, and following the rules of the labs—to research new products, services, new ways of doing care. Instead of testing these things in a closed laboratory, in isolation, we can test them in the real world. The Flemish Care Living Labs provide a method for testing whether a good idea or concept can, in a natural environment, be converted into a successful product or service. A lot of organizations are missing that step today. Looking ahead, we see opportunities for iMinds to connect us with universities and other academic institutions for further research. They can match-make and bring us together with groups that share our view of the future of healthcare.

Q: Finally, congratulations on being accepted into the Google Blackbox program. How did that come about?

Geert Houben: We went through iMinds’ Go Global program in 2013 for help accessing the U.S. market. That led to our involvement with Aging2.0, an organization focused on innovation related to aging. They invited us to participate in their global summit as an international best practice example. They put forward a shortlist of startups from their network as candidates for the Blackbox program, and we were chosen as the startup from our sector to participate. We’re proud of that, and the fact that we’re the first Flemish company to be invited into the Blackbox program.

ARISTOCO

Aristoco’s Cubigo software is an online ‘app’-plat-form with services that provide people the tools to let them live in their own environment as long and as comfortably as possible. Cubes are developed in the three main pillars: social contacts (Cubigo Social), self-care (Cubigo Care) and comfort (Cubigo Services). Cubigo lets users choose which care and services they need, keeping control over their own lives as long as possible.

THE ONE-CLICK GATEWAYTO A WORLD OF HEALTH EMPOWERMENT


THE FLEMISH CARE LIVING LABS PROVIDE

A METHOD FOR TESTING WHETHER A GOOD IDEA

OR CONCEPT CAN BE CONVERTED INTO A

SUCCESSFUL PRODUCT OR SERVICE. A LOT OF ORGANIZATIONS ARE MISSING THAT STEP

TODAY.

““

GEERT HOUBEN, CEO Aristoco (Cubigo)


VIRTUAL COACHING, REAL-LIFE RESULTSWith obesity a growing problem in Europe and North America, healthcare professionals are on the hunt for ways to help people make better choices about food and physical activity. Under the banner of the iMinds b-SLIM project, a diverse group of partners are creating a “Super Coach” digital app to help people lose weight — and keep it off. We spoke to BrandNewHealth researcher DR. STEVEN DE PEUTER and FOUNDER DR. CLAUDIA PUT about the app and its potential.

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CITIZEN HEALTH

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Q: Why is weight loss so difficult for many people?

Steven De Peuter: It’s not so much losing the weight as it is keeping it off. You can do a crash diet in a short period of time and shed some weight, but it’s very unlikely you’ll be able to maintain that weight. Sustainable, healthy weight loss takes time and continuous effort, especially for the obese, who need more time to reach a healthy weight.

Claudia Put: In the end, success comes from changing behavior. That can be tough. Unhealthy habits can be hard to break, especially related to diet. For many of us, food is essential to who we are, what we do, how we feel. People may use food for comfort. When you feel bad, it’s easy to grab a sweet or salty snack. So breaking that habit can negatively impact your mood in the short term.

Q: What will the Super Coach app offer that other programs don’t?

Steven De Peuter: What sets our approach apart is that our app

won’t tell the user what to do, it will give suggestions and advice on how to change behavior and self-manage their weight, physical activity and diet. It’s about creating unique, personalized plans specific to the new behaviors the user is trying to learn.

Claudia Put: We’re essentially breaking down complex behavior patterns into smaller, more achiev-able steps with intermediary goals. We’re also looking at helping users plan in advance for what to do when they encounter a barrier or a setback. The app provides encour-agement every step of the way, for every small change.

Q: How will the application collect the data used to make the personalized plans?

Steven De Peuter: A lot of it will be self-reported. We’re creating both web-based and mobile versions for accessibility. When users regis-ter, they’ll fill out questionnaires for their most important behaviors, what they like to eat, how often they exercise, things like that. We may also have them identify with >>

VIRTUAL COACHING, REAL-LIFE RESULTS

“

“

WE’RE LOOKING AT HELPING USERS PLAN IN ADVANCE FOR WHAT TO DO WHEN

THEY ENCOUNTER A BARRIER OR A SETBACK. THE APP PROVIDES ENCOURAGEMENT

EVERY STEP OF THE WAY.


a list of barriers: maybe they don’t like the taste of fruits and vegeta-bles, for example. And we’ll help determine what motivates them, distinguishing between intrinsic and extrinsic motivators. Intrin-sic motivators—doing something because you want to feel better, or because it’s fun—are much more effective than extrinsic motivators, such as doing something because you have to or to obtain some sort of reward.

Q: Will the app depend exclusively on user-based reporting?

Steven De Peuter: No, we will also gather objective data. For example, we’re incorporating an accelerom-eter that will keep track of physical activity, and there will be an element that baselines shopping habits and tracks changes over the course of time. One of the interesting things about the project is that we’ll be able to compare the self-reported data with the objective data to see how accurately people report on their own behavior. Furthermore, we’ll be able to investigate whether objective tracking of physical activ-

ity is necessary for behavior change, or just nice-to-have. We’ll be doing this partially through a clinical trial.

Q: What else do you hope to investigate through the clinical trial?

Steven De Peuter: We want to better understand the effectiveness of digital coaching. We’ll be compar-ing groups who use only the appli-cation—without direct contact from doctors and researchers—and those who follow more traditional weight loss approaches, such as meeting with a dietician or physical activity coach. We will also do extensive 3D modeling of the people in the trial to help them visualize their weight loss, how their body is changing. We’re hoping we can develop a comprehensive model for weight loss in the obese. It’s not something that’s really out there. There’s some literature on different body types, such as “pear-shaped” or “apple-shaped,” but we want to add to that a model specific to the obese.

Q: The project has a number of partners. What do they each bring to the table?

WE WANT TO BETTER

UNDERSTAND THE EFFECTIVENESS

OF DIGITAL COACHING.

“

“

VIRTUAL COACHING, REAL-LIFE RESULTS


Claudia Put: iMinds was essen-tial to bringing all the partners together and is providing a lot of the research. Under the iMinds umbrella, the iMinds Vision Lab at the University of Antwerp will work with the iMinds Medical Imaging Research Center at the University of Leuven to help create 3D scans of users’ faces and bodies. Through a series of interviews, the iMinds Center for Usability Research at the University of Leuven will research the barriers and difficul-ties users might face, and will probe user expectations of a weight loss application. iMinds-STADIUS at KU Leuven is working on data analy-sis, data mining, and predictive and visual analytics. The University of Leuven’s Departments of Kinesiol-ogy and Clinical and Experimental Endocrinology are taking the lead on the clinical trial and providing advice on diet and physical activity.

Q: Outside of research organizations you also have industry partners, correct?

Claudia Put: Yes, well, there’s us at BrandNewHealth, and also YorBody Belgium, which is providing the

activity tracker and the necessary algorithms to interpret the data, and building the project’s database. The Delhaize Group, which owns a chain of supermarkets, will help us create suggested shopping lists and track users’ shopping habits to see if the app’s suggestions influ-ence buying patterns.

Q: How soon do you expect to launch the app?

Steven De Peuter: We began the project in April of 2014; the clini-cal trial begins in October 2015. We hope to have the application fully designed by September 2015 at the latest to have it ready for use by approximately 100 obese persons in the clinical trial. iMinds has assembled such a diverse team with expertise in different areas, we’re confident we’ll be able to create something to address obesity and support people in confidently, health-consciously and sustainably losing weight.

ABOUT B-SLIMiMinds’ b-SLIM project is looking to develop a digital application to monitor diet, physical activity and motiva-tion for users hoping to sustainably lose weight. The application will integrate a variety of data streams and provide tailored advice, support and sugges-tions. Read more online: http://www.iminds.be/en/projects/2014/03/20/b-slim.

ABOUT BRAND-NEWHEALTHBrandNewHealth is a pioneer in cost-effective digital health coaching that combines psychology, health sciences, ICT and communications to deliver effective, individual-ized support to large groups of people.


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EVA GEURTS en KARIN CONINX, iMinds - EDM - UHasselt28 | iMinds insights

Q: There are a number of health and wellness apps that focus on encouraging and tracking ex-ercise. What makes this particular application so potentially useful to cardiac patients?

Eva Geurts: The technology is basically familiar to users: a smart-phone and smartwatch to monitor heart rate. The difference between our app and cycling apps for healthy people is that ours is designed to put heart patients at ease with the level of exercise they can safely perform. People who have suffered heart attacks need to prioritize fitness, and many of them do. But once they leave the rehab facil-ity—typically after three months of

closely supervised exercise—many are hesitant to do the work on their own. They worry they’ll push too hard or too far and put themselves at risk. So we end up seeing a lot of patients undertrain.

Karin Coninx: This is especially true when it comes to cycling, which is an excellent exercise for cardiac patients. In the Limburg area, there is an extensive network of popular bike paths that allows people to define bike tours flexibly. But start-ing a bike tour can be intimidating for a patient who’s unsure of his or her ability complete the full route, especially when some slopes will increase the effort required. Our app can tell a person to slow down,

A HEALTH APP WITH TRUE HEARTFor patients recovering from heart attacks, regular exercise is a critical part of the rehabilitation process. But once out of the hospital, it can be hard for patients to stay motivated. That’s why Hasselt University—working with Jessa Hospital—developed an app that not only encourages exercise but also gives heart patients the tools to do it safely and effectively. EVA GEURTS helped create the app as part of her Master’s thesis in informatics. She and professor DR. KARIN CONINX from iMinds’ Expertise center for Digital Media (EDM) at UHasselt explained to us how the app could help save lives.

>>


pick up the pace, and even suggests adapted support for people riding e-bikes. It’s all about building confi-dence for users. Part of that confi-dence comes, I think too, from the fact that this app has been devel-oped collaboratively by a hospital—it’s not just coming out of the app development space. There’s solid healthcare expertise behind it.

Q: Why bicycling?

Karin Coninx: A lot of exercise apps focus on walking, often using pedometers or accelerometers to register steps and activity. But many people prefer biking, especially elderly patients. We want to make it easier for patients to engage in a wide variety of exercises so they can suit their mood on any given day.

Q: What challenges did you face in developing the app?

Eva Geurts: Most fitness apps are designed for healthy people only. Ours is designed for those who have been ill—who have heart disease and are rehabilitating—and for healthy persons who want to consciously prevent health risk factors and engage in physi-

PART OF THE CONFIDENCE COMES FROM THE

FACT THAT THIS APP HAS BEEN DEVELOPED

COLLABORATIVELY BY A HOSPITAL.

“

“

A HEALTH APP WITH TRUE HEART


cal exercise. So we needed to be able to offer specific, personal-ized suggestions to guide people’s physical efforts that wouldn’t exist with a typical fitness app.

Q: That raises an interesting question. How does the app de-termine a safe heart rate?

Eva Geurts: It’s completely person-alized. Every patient goes through a physical exam guided by the medical team at the rehabilita-tion center, and that data is used to create the parameters for their exercise. The patient knows their data is specific to their needs, their program and their bodies, which gives an added level of confidence.

Q: What other challenges did you face?Karin Coninx: I would say a second challenge had to do with the general user experience. That relates to the research interests of EDM. Making sure anyone in the general public could use this tool introduces some very practical considerations. For example, because the app is used while cycling, we put a lot of thought into readability and clear presenta-tion of information. The screen has to be readable in a glance to avoid

distracting the cyclist from the environment. We also focused on unobtrusive data collection. That’s why we use a smartwatch rather than a chest strap to measure heart rate. Furthermore, the user should not be bothered with techni-cal details, and the watch and the smartphone connect automatically through the app to exchange data. Besides heart rate, other data such as burned calories and distance are collected or calculated. Then you have to show the relevant informa-tion to the patient in a really clear way.

Q: Outside of monitoring health and exertion, what else does the app do?

Eva Geurts: It actually comes pre-loaded with local bicycle routes, paths and tours. We’ve included recommended stops and places to recharge electric bikes. Users can create their own paths by linking stops together, or we can suggest new routes based on their level of fitness and how they’re progressing in the rehabilitation program. We’re also able to vary routes based on how long the user wants to bike or how far. We want to make the train-ing effort as pleasant as possible.

Karin Coninx: We’re currently working with a graphic designer in our human-computer interaction group to ensure the user interface is not only easy to use but also graph-ically appealing and fun. It’s not gamification we’re looking for, but it needs to be playful, a pleasure to use—again, it’s all about encourag-ing people to exercise safely.

Q: The app clearly has a lot of benefits for patients. What about caregivers and health workers?

Karin Coninx: That’s the next step. We’re currently working on the caregiver side: a caregiver dashboard that will allow us to feed the app with the patient’s individ-ual training parameters, analyze data collected by the app, and use the resulting insights to design future exercises. For caregivers, it is very important to have a concise overview of data from several patients at the same time, and to be able to integrate this into daily practice at the rehab center.

Q: Where does the app stand now?

Eva Geurts: We’ve done a number of trials with healthy users and >>


some patients, and the response has been great. When testing with more patients, the challenge is to generate credible evidence of value from using the app that will prove the nature and magnitude of behavioral changes among people using the app.

Q: Will the app have a market beyond heart patients?

Karin Coninx: We’re really inter-ested in broadening the user base. Currently, we’re focused on rehabilitation. But when it comes to cardiac patients, rehabilitation is very close to prevention. You’re trying to avoid a second heart attack, which is very close to using the app in a preventive way for either patients or healthy persons.

So this kind of application would be useful for heart patients, people with diabetes, the obese, or people simply trying to lose weight and stay healthy. Since the basic infra-structure and interface is already designed, it’s really flexible, and we can see that it can be used by a lot of different people. Not only is that good for the user but it’s also good for us, since a broad user base can help secure financing for further development and possibly to move into the commercial marketplace.

ABOUT IMINDS - EDM - UHASSELTThe Expertise center for Digital Media (EDM) is the ICT research institute of Hasselt University and part of the iMinds research community. EDM performs research in computer science since 1987. Research focuses on two core competences: ‘Visual Computing’ and ‘Human-Computer Interac-tion’. EDM is active in the full range of the research contin-uum: from fundamental to basic and applied research as well as contract R&D. EDM’s key objective is to be a leading research institute in human-computer interaction, computer graphics, multime-dia networking, computer vision and virtual environ-ments..

A HEALTH APP WITH TRUE HEART


CURRENTLY, WE’RE FOCUSED ON

REHABILITATION. BUT WHEN IT COMES TO CARDIAC PATIENTS,

REHABILITATION IS VERY CLOSE TO

PREVENTION.

““

KARIN CONINX, iMinds - EDM - UHasselt


Remote monitoring streamlines healthcare by allowing practitioners to collect data from patients without requiring visits to the office or the hospital. The ubiquity of smartphones and other connected consumer technologies like pedometers and accelerometers means practi-tioners have more potential data sources to draw from than ever before, helping bring context to more traditional data from pacemakers, glucose meters and the like.

Dr. Pieter Vandervoort, cardiologist at Ziekenhuis Oost-Limburg

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Q: What, in a nutshell, is NEMO?

Dr. Pieter Vandervoort: NEMO pulls together remote monitoring data from different vendors and devices, analyzes it, and presents it through a single dashboard for clinical use.

Q: What’s driving the need for this kind of solution?

Dr. Pieter Vandervoort: Just imagine: I do remote monitoring with more than 600 patients, a majority of whom have advanced heart failure. All of them have implanted devices like resynchro-nization-pacemakers or defibrilla-tors, made by four or five differ-ent vendors. That means different data standards, databases, proto-cols and algorithms. Many of these patients are also using other devices such as blood pressure

monitors, weight scales and activity trackers, whose informa-tion is processed using different visualization tools and presented on different websites. If I have a single patient with four devices, I have to open up four different websites and sift through informa-tion that’s all displayed differently. It’s complex, cumbersome, and time-consuming. Instead of going to four different websites, why not just have all your clinical data come to one place?

Q: What kinds of data will NEMO aggregate?

Dr. Pieter Vandervoort: We’re looking at integrating data not only from clinical devices but also from consumer products, such as smart-phones, smartwatches or activity trackers like Withings, FitBit or the Nike FuelBand. The ultimate goal

SMART DEVICES FOR SMARTER MONITORINGiMinds’ neutral mobile health platform (NEMO) project in Limburg is looking at creating a platform to collect, analyze and display remote monitoring information from a wide variety of technologies and products. We spoke to the project’s initiator, DR. PIETER VANDERVOORT—cardiologist at Zieken-huis Oost Limburg, Genk and co-chairman Mobile Health Unit at UHasselt—about how NEMO may help reinvent remote monitoring.

>>


is to combine data from clinical and consumer devices and make them both clinically relevant. It’s all about context, about getting a fuller picture of the patient.

Q: Can you give an example of how that might work?

Dr. Pieter Vandervoort: Consider a patient with a pacemaker. That pacemaker can give you informa-tion about the patient’s heartbeat, but it can’t tell you what they’re doing at any given time. An activ-ity meter like an accelerometer can do that, and can put the heart rate into context. If the heart rate is rising, it makes a difference whether the person is biking or sitting on a couch watching televi-sion. People’s glucose measure-ments also might take on different meanings if we could relate them to their activities during the day. Bringing in a wealth of data from a variety of sensors and looking at it together—you’re going to see a lot of relations that you might not otherwise notice. One plus one is going to be more than two, in this case. That’s the kind of thing that’s going to be possible with this type of platform.

Q: What other benefits do you envision?

Dr. Pieter Vandervoort: NEMO will facilitate remote monitoring in clinical practice, for sure, making it easier for healthcare providers, family physicians, nurses, home care providers, all these people to find and interpret data that’s collected outside of the doctor’s office or the hospital. It’s also better for the patient. People take an interest in their own health, right? That’s why they buy the types of consumer devices we’re talking about. So NEMO will make it easier for patients to look at a single picture with all of their data in context and make decisions and adjustments about their activity or behavior in real time.

There could also be benefits for primary prevention. If we can track a large number of patients with different activity sensors—and have all the data in the same place—we could really show the impact of certain activities on a simple parameter, such as weight. We know that if we decrease the weight of a population in an area by one kilogram, for example, then we’ll have fewer patients with diabetes, hypertension, heart disease, strokes, et cetera. It will

help us really show benefits at the population level.

Q: How far along are you in the NEMO project—and what is iMinds’ role?

Dr. Pieter Vandervoort: We’re still in the conceptual stages. We’ve done a lot of preliminary research into visualizing different data sources, and have worked on the analyzing software, combining glucose meter data with blood pressure and accelerometer data. These are all different parts of what will eventu-ally be NEMO, but NEMO itself is just at the beginning. iMinds Health has just started, and what they’re doing is really bringing all this research and clinical experience together into one place, facilitating the collaboration between hospi-tals and Hasselt University. As well as helping us find the funding to take NEMO to the next level.

Q: What are the key research challenges you face at the moment?

Dr. Pieter Vandervoort: There are technical challenges, certainly, with different transfer protocols and data collection methods. But these will be solved. Improvements in wi-fi, in 3G and 4G availability, in data trans-

SMART DEVICES FOR SMARTER MONITORING


fer protocols will deal with those issues. In the four or five years in which we’ve been actively monitor-ing patients remotely, we’ve seen enormous progress on the technical front for devices like pacemakers, for example. So I’m not too concerned about that. We do have challenges when it comes to data identification and privacy, however.

Q: What would those be?

Dr. Pieter Vandervoort: With something like a pacemaker, there’s no question about which patient a set of remote monitoring data pertains to. But say we’re collect-ing information from a smart-phone, or a wireless scale. We technically don’t know who’s using the device—someone could have lent their spouse their phone, let’s say. Then there’s the issue of data privacy, which is a big concern. We want to make sure the data can only be accessed by people with a therapeutic relationship with the patient. That’s also a concern for the device manufacturers. There’s no way a pacemaker manufacturer is going to allow their data to be collected on a platform that’s run by a competitor, for example. That’s why our platform is going to be vendor independent, “neutral,” as we call it. We sign a generic agree-

ment with manufacturers spelling out the rules of exchange — for the project specifically.

Q: What sort of response do you anticipate once NEMO is ready to roll out?

Dr. Pieter Vandervoort: I think the benefits of the project will be clear. Uptake might be diffi-cult at first because of reimburse-ment issues. Currently in Belgium and most of Europe—even in the U.S.—doctors are paid through insurance only if there’s a physical encounter with a patient. There’s no real reimbursement option for remote monitoring and follow up. That might limit clinical use in the immediate future. But as technol-ogy changes, it invariably pushes policy forward, and governments and insurance companies will have to follow. I hope NEMO can be part of that evolution, that we can start with a small group of believers and champions and prove the concept works for patients and practi-tioners, then move on to convince insurance companies and govern-ments to change the system.

ABOUT NEMO

iMinds’ neutral mobile health platform (NEMO) provides a single view of remote monitoring data originating from both ‘traditional’ medical devices (such as pacemakers and glucose meters) as well as consumer devices (such as smartphones equipped with pedometers and accel-erometers). The concept is being tested, validated and integrated in the workflow of partner hospitals, with initial experiments expected for the third quarter of 2015.


BIRGIT MORLIONProgram Director iMinds Health

LIST OF CONTRIBUTORS TO THIS PAPER:

ANN ACKAERTPost-Doctoral ResearcheriMinds - IBCN - UGent

JAN AERTS Assistant ProfessoriMinds - STADIUS - KU Leuven

LAURA BELENGUER QUEROLDirector Strategy & Innovation iMinds Medical Information Technolo-gies Department

KARIN CONINXProfessor iMinds - EDM - UHasselt

STEVEN DE PEUTERResearcher BrandNewHealth

EVA GEURTSResearcher iMinds - EDM - UHasselt

GEERT HOUBENCEO Aristoco (Cubigo)

AN JACOBSProfessor iMinds - SMIT - VUB

LIEVEN MAESSCHALCKFounder, Physical TherapistMove to Cure

BIRGIT MORLIONProgram Director iMinds Health

CLAUDIA PUT CEO BrandNewHealth

KARIN SLEGERSAssistant ProfessoriMinds - CUO - KU Leuven

ERIC VAN DER HULSTProgram Manager iMinds Health

PIETER VANDERVOORTCardiologist Ziekenhuis Oost Limburg

FREDERIC VANNIEUWENBORGDoctoral ResearcheriMinds - IBCN - UGent

JAN VAN OOTEGHEMResearcher iMinds - IBCN - UGent

ANTON VEDDERProfessor iMinds - ICRI - KU Leuven

GRIET VERHENNEMANResearcher iMinds - ICRI - KU Leuven

iMinds Insights editorial team: Sven De Cleyn, Koen De Vos, Thomas Kallstenius, Els Van

Bruystegem, Wim Van Daele, Stefan Vermeulen

Copy: Ascribe Communications

Design: Coming-Soon.be

Photography: Lieven Dirckx, Nils Blanckaert

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iMinds insights on citizen health empowerment

Healthcare

Transcript of iMinds insights on citizen health empowerment