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The rise of the personal health journey  

Why the seed of innovation lies with open systems and standardization  



Geert Pruisman can usually be found in his garden, raking up leaves and trimming trees.


He’s a very active and sprightly 79-year-old gentleman from Odoorn, the Netherlands and, looking at him now, you wouldn’t believe that there was a time when he could barely manage a walk of 50 meters, let alone spend the day patiently taking care of his flower beds.*


What you might not realize if you were to meet him today is that Mr. Pruisman is suffering from both the most severe form of heart failure and COPD. Not so long ago, he didn’t have the stamina to tend his garden, and his weeks were an exhausting cycle of doctor’s appointments and trips to the hospital. So, what changed?


The eHealth Triumph

Happily, in 2010, Mr. Pruisman elected to take part in an eHealth (telemonitoring) trial at the Scheper hospital in Emmen, the Netherlands. Data relating to his weight, blood pressure and cardiac rhythm was streamed from his home directly to the eHealth center at the hospital – this is still happening today. Wietse Veenstra, Mr. Pruisman's specialist heart-failure nurse, monitors the results and will call him straight away if they are not within his ideal range or subtle deterioration is noticed.


A senior using a Philips telehealth solution at home


Since then, regular hospital trips and endless check-ups are a thing of the past, and Mr. Pruisman has suffered no further acute decline in his health.


This trial was a success but what really made the difference to Mr. Pruisman was not just health trackers and 24/7 monitoring, but the fact that he was given the information and advice to empower him to take charge of his own health. 


This green-fingered gentleman now knows to maintain his weight at 78.2 kg, because that's the weight at which he feels most energetic. He understands when it’s time to take a break from cutting the grass and when he should take it easy for a few days. He feels secure because he is supported by his care team around the clock, but he relies on them less and less because he better understands how to stay as healthy as possible.


Why has this method of care made such a positive difference to Mr. Pruisman’s life? Well, the crucial factors were access to health data, self-management and the highly personalized interaction between the patient and caregiver. With the approval of Mr. Pruisman, his authorized care team members were given access to all the necessary data, from multiple devices, which, combined with Electronic Medical Record (EMR) data, allowed them to remotely monitor his Personal Health Journey.


The Rise of the Electronic Personal Health Journey


I know what you are thinking. What is a Personal Health Journey? An electronic Personal Health Journey is much more than just an electronic file containing health data, or a Personal Health Record (PHR). It combines data that is continuously ingested during someone’s health and care path from multiple sources, devices and systems, all of which is then normalized to create better understanding (for example, inches are converted to meters). All this information is finally analyzed to support clinical decisions, daily behavioral nudges and timely interventions. A Personal Health Journey turns data into actionable information.


Mr. Pruisman would benefit even more from having access to his Personal Health Journey because it brings together longitudinal information from all the people involved in his treatment, such as his COPD specialist, his general practitioner and the nurses providing care in his home. It gives him insight into his past status and his current status, and a plan for the future.

Collectively this information creates a holistic picture of the patient, enabling caregivers to make personalized decisions based on facts and figures, rather than out-of-date notes from other doctors or imperfect explanations from the patient: it’s the ideal combination of lifestyle information, behavioral aspects, medication compliance detail and clinical data.


Currently only 9% of all patients in the Netherlands, the majority of whom suffer from a chronic condition, have access to at least part of their health data. This is nowhere near the target set by Dutch Health, Welfare and Sport Minister Edith Schippers. Her bold ambition is for 80% of patients with a chronic condition and at least 40% of other patients to have access to their own medical data within five years. This is a necessary but not totally sufficient condition to have major impact on chronic disease.


From Connectivity to Interoperability


It’s not enough for everyone to have a Personal Health Record or the more intelligent Personal Health Journey. It’s not even enough to help them understand what it means for them individually. In order to get the greatest benefit from the data, to make the right connections and decisions, systems collecting and storing patient data need to be able to truly communicate with one another: they need to understand each other.


For this to be possible, we need extensive standardization in care-ICT (information and communication technology) protocols driving true interoperability. Data only has meaning when properly interpreted and viewed within the context of a specific condition and an individual patient's circumstances. Without that context it can be, at best, unhelpful, and at worst, completely misleading.


Ideally, the Personal Health Journey should evolve to the place where up-to-date personal health data is gathered and normalized, with the patients indicating what information can be shared, with whom and under what circumstances. If doctors have a completely up-to-date context, they’ll be able to focus clearly on the patient, identify timely interventions and ultimately reduce the cost of healthcare.


Studies into eHealth such as the one involving Mr. Pruisman and other patients show a decline in hospital admissions as well as significant cost savings, in addition to better outcomes. Great results were obtained in a telehealth pilot program at Banner Health in the U.S., where costs of care were reduced by 27 percent and hospitalizations by 45 percent. These metrics should further improve as the patient experience gets better and capabilities and processes for eHealth further mature.

In order to reap the benefits we need to ensure that a patient's data can be securely accessed and interpreted by all stakeholders in the same way, anytime, anywhere. To achieve this we have to commit to standard terminologies and coding systems. What we need is truly open platforms for data exchange and storage. Suppliers of healthcare systems are understandably not always keen to open up their applications to services that other parties can access; however, if healthcare organizations required this within their purchasing policies, it could make all the difference. Data needs to flow to have a real impact on a patient’s health.


In other sectors, standardization has led to breakthroughs that have simplified and improved our lives considerably. Thanks to standardization in the financial world, in many countries we’re now able to use a PIN to access our money virtually anywhere in the world, and often merely waving our card or smartphone over a sensor is enough to make small purchases. Imagine how much easier life might be if our healthcare systems were aligned so well and all relevant information was available at the point of care, even in acute situations.


Although standardization is the means, the end goal is to provide the healthcare profession with the tools that will help patients control their condition more effectively, and to allow care teams to offer the right intervention at the right time and help doctors to make the right diagnosis.


From Interoperability to a Step Change in Care Experience


All of this sounds miraculous but unfortunately it won’t be an easy task. Major challenges can be expected when carrying out the necessary system changes.


The first of these is that healthcare stakeholders (for example, GPs, practices, hospitals, community care providers and health insurers) need to start working together as part of a network. No easy task for an industry that is largely siloed today. This requires the ability to support patients remotely, working in multidisciplinary care teams formed to deal with patient cohorts with similar characteristics and needs. It requires a new definition of roles and responsibilities within the network.


In order to encourage collaboration around the patient, we need to move to a payment system that focuses on outcomes rather than input. This means no longer paying individual organizations per discrete procedure, but paying them on the basis of their contribution to improving a patient's health and their contribution to lowering healthcare costs – for example, by reducing the need for hospital admissions and emergency care.


There are hundreds of thousands of Dutch citizens – and citizens around the world – who, like Geert Pruisman, would benefit from these healthcare innovations. The future offers unprecedented opportunities that will help patients live longer, happier lives.


*That's what he told us when we met him last year during a practical survey carried out jointly by six hospitals, three major insurance companies and Philips into the use of eHealth in healthcare.

Jeroen Tas


CEO, Healthcare Informatics Solutions and Services Philips  

Jeroen Tas has over 30 years of global experience as an entrepreneur and senior executive in the financial services, healthcare and information technology industries. Currently he is the CEO of the Philips Healthcare Informatics Solutions and Services Business Group.


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