THINKINNOVATION
Jaap Trappenburg
eHealth innovation in theNetherlands, the Utrecht region andTHINC.
Hi Emma,I am your assistant doctor
Outline
• eHealth – some framing• eHealth innovation in the Netherlands• regional innovation ecoystem eHealth
Utrecht• THINC. - The Healthcare Innovation Center • My own research – example projects
ehealth
ehealth
ehealth
Different (& less strict) regulatory evaluation process• To market after CE approval (if required)• The focus is on ‘safety and techical feasibility’ i.s.o. clinical effectiveness• Different market – shorter life cycle• Lower budgets – less time
Increasingly data driven + autonomousEmerging technologies: AI, precision medicine, genomics, blockchain etc.
Increasingly disruptiveDigital transformation, substitution, citizen-centric,
Democratized, digital innovation is increasingly a non-academic activityGlobal market: 2017 - USD 47.60 billion, 2023 - USD 132.35 billion
They come with many + highly diverse i.e. > 335.000 mobile health apps
Outline
• eHealth – some framing• eHealth innovation in the Netherlands• regional innovation ecoystem eHealth
Utrecht• The Healthcare Innovation Center • My own research – example projects
Drivers eHealth innovation in NL
• Because we need it• Policy (top down)• Knowledge economy / innovation
(bottom up)
Because we need it
Healthcare expenditureAnnual increase of 2.9%
By 2040 174 billion Euro (9.6 K / person)
By 2022, a shortage of 100 to 125 thousand healthcare employees is
expected
Active policy • Set SMART goals
– >80% of chronically ill access to their medical records– 75% of chronically ill able to monitor certain aspects of their own health and share the data with their health
provider– People receiving care at home should be able to communicate with their care provider 24 hours a day via a
screen, if they wish.
• Measure longitudinal trends in eHealth uptake / barriers / facilitators (annualeHealth monitor)
• Sharing knowhow (i.e. annual eHealth week)• Improve digital integration and harmonized national data standards (i.e. Legal
framework for mandatory exchange of data, legal certification for a digital ledger solution blockchain)• Stimulate innovation (i.e. Research Grants, public private partnership matching,
ZorgInnovatie.nl : community for innovation in healthcare and wellbeing, providing a platform and database for more than 3300 communities and 700 innovations.
Set SMART goals • >80% of chronically ill access to their medical records• 75% of chronically ill able to monitor certain aspects of
their own health and share the data with their health provider
• People receiving care at home should be able tocommunicate with their care provider 24 hours a day via a screen, if they wish
Measure longitudinal trends in eHealth uptake, barriersand facilitators annual eHealth monitor
Improve digital integration and harmonized national data standards i.e. Legal framework for mandatory exchange of data, legal certification for a digital ledger solution incl. blockchain
Stimulate innovation i.e. Research Grants, public private partnership matching, ZorgInnovatie.nl : community for innovation in healthcare and wellbeing, providing a platform and database for more than 3300 communities and 700 innovations.
Sharing knowhow i.e. annual eHealth week
Government policy
(1) Are we doingwell ? (online access)
88%
50%Any form of online contact with HC provider
E-consultation 55%
22%
Video consultation2% 26%
Make an online appoinment 53%
23%
Primary care Secondary care
eHealth monitor 2019, RIVM, NICTIZ
(2) Are we doingwell ? (self-management / personal health environments)
64%Seeks information on internet
Uses internet to decide to consult a GP 37%
Tracking of physical activity
Yes14%
Tracking health (general)
34%
Any user
eHealth monitor 2019, RIVM, NICTIZ
Chronic disease
Yes10%
(3) Are we doingwell ? (remote support)
47%37%Telemonitoring
Personal alarm
Movement sensors
GPS trackers / door sensors
Primary care Secondary care
eHealth monitor 2019, RIVM, NICTIZ
14%
87%
66%
23%
Nursinghome / elderly care
Care robots10%
Dutch Innovation ecosystem
Worlds most concentrated Life Sciences & Health cluster• Worldwide #1 for number of medical technology patents • #1 EuroHealth Consumer Index 2014, 2015, 2016, 2017• 3rd for number of biotechnology patents• 7th for number of pharmaceutical patents• Areas and diseases of focus include:
• Biopharmaceuticals • Biotech• Molecular imaging• Medical technology• e-Health• One Health
• Biomaterials and regenerative medicine• Biobanking• Vaccines• Oncology• Cardiovascular diseases• Health systems and research infrastructure
Life Sciences & Health cluster
Regional Health Innovation hubs
Health Hub Utrecht – Healthy Urban Living
Utrecht region
• Most highly educated workforcein the Netherlands: 46% of working population has a university degree
• 8 million skilled employees within an hour’s travel of Utrecht.
• Life science and health community: 1,700 researchersand 1,750 PhD candidates
The Utrecht region has been ranked the most competitive place on the European
mainland by the European Commission since 2010
Health Hub Utrecht
• Most highly educated workforcein the Netherlands: 46% of working population has a university degree
• 8 million skilled employees within an hour’s travel of Utrecht.
• Life science and health community: 1,700 researchersand 1,750 PhD candidates
27,200 jobs108 companies51.500 students
Health Hub Utrecht
Community-focusedprevention
(lifestyle, health literacyetc.)
A dynamic regio-alliance that aims at highlighting ‘the sense of urgency’ (increasing costsand lack of personnel) and ‘the sense of opportunity’ (unique regional proposition)
Digital transformation
(eHealth, personal health environments, serious
games)
Attractive job market
(professional development,
leadership)
Innovation journey – an iterative multi-stakeholder proces
Idea Research | Development | Validation CommercialisationOr implementation
Scaling up
Science-based & user centered development
Innovation journey - a bumpy road
EFFECTIVE
USED
REACH
???
Health benefitsCost-effectiveness
Many innovation are not effective, are not used or do not reach limited value for patientsprofessionals and society
Systematic flaws, fragmentation and limitedstreamlining of the innovation process
Researcher Professional User Designer Techno-logical/ ICT
Entre-preneurial
There’s an urgent need for
• Faster and better available science• Flexible methodology & tailored
scientific services• …that are offered agile through
public-private partnerships
The Healthcare Innovation Center
Access topatients
Network of experts
Experienceand cases
Innovativemethodology
Innovation processes
Data & data science
Scienceas a Service
Appl@b user-centered roadmap(+ scientific engineering services)
Background, context & content analysis Participatory eHealth development(User-centered, persuasive & data driven)
Theoryidentifi-cation
Problem / target
analysis
Needsanalysis
Currentpractice / contextual
analysis
Value specifi-cation
Logic modeling
IdeationScenario-
basedtesting
Paper / mock-up
prototyping
Alphausabilitytesting
LiteratureReview (scoping / systematic)
Iterativesoftware develop-
ment
Require-ments
definition
Fieldusabilitytesting
Evaluation
Full scaleevaluation
Feasibility / pilot
testing
Focus groupsQualitative interviewsSurveys
Desk researchStakeholder analysis
Delphi studies Focus groups / qualitative interviews with patients/experts/ professionalsBehavioral analysis (BCT / COM-B)
Background, context & content analysis
Value drivers(Early) HTABusiness modeling
Modeling Workingmechanismof change
Identify quality indicators:Set safety / technicalsecurity / privacy / legal / ethical thresholds
Pressure cooker sessionsFocus groupsNominal Group Techniques
User-storiesQualitative interviewsFocus groups
High / low fidelityPrototyping Qualitative research
Task-analysis HeuristicsCognitive walkthroughsQualitative interviews
Observational feasibility studies(acceptablity, integration, demand, practicality, adaptation, implemenation, expansion, limited efficacy)Diagnostic / prognosic accuracystudies
Full/quasi experimental studiesObservational (data-driven) studies
eHealthsolutions that:
are EFFECTIVE✓(health benefits, access,
efficiency etc.)
are USED✓(maximum fit with end-users
needs)
REACH end-users✓(survive the competitive eHealth
ecoystem)
Proof of mechanism Proof of concept Proof of principle
Background, context & content analysis Participatory eHealth development(User-centered, persuasive & data driven)
Theoryidentifi-cation
Problem / target
analysis
Needsanalysis
Currentpractice / contextual
analysis
Value specifi-cation
Logic modeling
IdeationScenario-
basedtesting
Paper / mock-up
prototyping
Alphausabilitytesting
Iterativesoftware develop-
ment
Require-ments
definition
Fieldusabilitytesting
Evaluation
Full scaleevaluation
Feasibility / pilot
testing
Background, context & content analysis
eHealthsolutions that:
are EFFECTIVE✓(health benefits, access,
efficiency etc.)
are USED✓(maximum fit with end-users
needs)
REACH end-users✓(survive the competitive eHealth
ecoystem)
Portfolio: systematic reduction of insecurity with regarding to effectiveness, fit with end-users and feasibility in Dutch primary care.
9 mnd
Usability
ObjectiveTo evaluate the usability (system, user, en medical) of serious game Wind Tales in children with Cystic Fibrosis
MethodsN=5-10, mixed-methods triangulation of video observations, semi-structured interviews and think aloud data
Feasibility
ObjectiveEvaluation of the real-world feasiblity (acceptation, demand, implementation, integrationand preliminary efficacy) behoefte, implementatie, integratie en voorlopige werkzaamheid) of NightWatch during 4 months follow-up in patients with epilepsy (>12 years) their parents / loved-ones, and professionals in home care and in patient care..
MethodN=50, longitudinal mixed-methods triangulation study
Impact of COPD exacerbations
Lung functionQuality of life
29.000 admissions / year25% dies within 1 year
> € 500 Mil / jaar
Prior
During
After
Exacerbations & self-management
OBJECTIVE
To develop a tailored mHealth intervention to decrease the impact of exacerbations by enhancing exacerbation-related self-management in
COPD patients.
More specifically a mHealth intervention that is;• Meeting patient’s needs, perceptions and preferences.• Able to manage heterogeneity of exacerbations in and between patients.• Focusing on target behaviors identified by scientific evidence.• Safe, literacy sensitive and patient friendly.• Feasible in current Dutch COPD care.
Learning by doing
USER-CENTERED DEVELOPMENT
(based on: Johnston, 2009; Van Meijel, 2004; Graig, 2008)
4 YEARS OF RESEARCH (2014-2018)
DeliverableConsensus on relevant and feasible self-management behaviors prior, during and after an exacerbation
Deliverablesomst• potential barrieres
and limitations of mHealth use in exacebation-related SM
• needs regarding intervention components and mode of delivery
DeliverablesConceptueel model ‘factors that influenceexacerbation-relatedself-management behavior’
DeliverableOverview of determinants of self-management capacity in COPD patients
CONCEPTUAL MODEL
Contact:[email protected]+31-(0)6-48060052http://www.thinc.healthcare/
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