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The rise of eHealth

Rob Blaauboer
Rob Blaauboer
Integration Consultant & WSO2 Trainer
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Medicine, and in a larger perspective also healthcare, is undergoing a rapid and continuous change. Of course I’m not talking as opposed to the time that leeches were popular. I am talking about our current time where over the last twenty, years, we’ve seen a tremendous change. Partly, of course, because treatment has gotten better. We are able to, more precisely target treatment to conditions and illness. But, also important, in what I would call the registration of patient data and the (self) registration of data outside of hospitals and clinics.

EHealth is on the rise. However, healthcare and the available options, implementation and so on vary by country or even by state. In this blog, I will give some examples that outline the strong increase in eHealth.

Cincinnati Children’s Hospital

With the corona pandemic, there has been a large uptake in eHealth. As with many of these things. the driver was the fact that there was little or no alternative. By that, I mean, that we did not have an alternative to go to the hospital like in the example of Cincinnati Children’s Hospital. So, in that case you need to do something.

According to data from Parks Associates and the Cincinnati Children’s Hospital in the United States is that the number of tele health consults has grown dramatically. And they were able to do that in a very short period. Under pressure everything becomes liquid as they say. What normally took six months to a year before it was handed over to a department suddenly was no longer possible. They needed to act fast and they did.

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Figure 1 Before the pandemic, eHealth initiatives went through a lengthy process

Then COVID-19 hit and suddenly telehealth started to skyrocket. New telehealth services were quickly introduced in a timeframe unimaginable before. The last three bars show the number of telehealth consults and from 300 it went up to 4,900 March 25.000+ in April to 29.000+ in May. Now that in-person care is coming back the numbers are lower. But telehealth is here to stay.

This data comes from a Parks Associates Conference and can be viewed here 

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Figure 2 Telehealth Visits by month

So, there is a very promising future although, as said before, the roadmap will be different.

Measuring yourself

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One of the examples that I found very striking is an example from the Netherlands. It was a project of the Leiden University Hospital LUMC (Heart Lung Center) using the devices of Withings, a vendor of personal health devices like connected bathroom scales, thermometers and a watch that can detect possible Atrial Fibrillation (AFib or AF for short.) The Withing devices all work together with an app and make measurement and subsequent uploading of data effortless. That is exactly what you want when you introduce eHealth. Of course integration of that data directly in the hospital’s EMR system is a project on it’s own.

The app on the smartphone will show data related to the user like temperature, activity, sleep, weight, ECG and so on. Only of course if the user has the devices to measure it.

Figure 3 Withings App

It is exactly what you need when you are doing a project to see if self measurement adds value to patients and the hospital. The project was done in the cardiology department. And basically, what they have been doing is offering patients that have had a myocardial infarction a set of tools to do home monitoring.

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Figure 4 Photo of “the Box” -by Arno Massee fotografie

It is actually a set of tools that they call “the Box”. It is a thermometer. that will read your temperature from your forehead. It is a blood pressure cuff that measures your blood pressure, as well as your heart rate. It is a pair of scales that will measure the amount you weigh but also the amount of fat, the bone mass, etc. And it is a watch that allows you to record a single lead ECG directly from your wrist, without having to go into hospital. It is not the same as a 12 lead ECG but suffices to indicate possible AFIB. Basically, the key data that is relevant for a cardiologist but also for other specialisms. The benefit of only measuring for instance blood pressure in the four visits to the hospital as part of the process of care after an infarct, the physician gets a weekly measurement.

Figure 5  YouTube movie of  “the Box” (in Dutch)

The hardware side of the box is a relatively cheap solution for home measurement. There are multiple boxes with various hardware for a specific goal. A box used after heart surgery is about 300 euros and can be reused by multiple patients after, of course, thorough cleaning. Boxes for patients who had a myocardial infarction (aka a heart attack) are theirs to keep.

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Long in the making

The LUMC has been planning this project before COVID-19. PhD candidate Roderick Treskes did his thesis on it to see if it offered good or even better-quality care, increased patient satisfaction and perhaps reduced cost. The answer is in general yes, but due to the relatively small size of the patient group it is hard to say something statistically significant. The final research report on cost and effect is due in a couple of weeks, the study on clinical data and patient satisfaction have been published already

Figure 6 PhD candidate Roderick Treskes – photo by Josje Deekens

Getting data in it

When I hear about a project like the project of LUMC, I instantly try to figure out how we can get data from devices like this into an a patient’s medical records. Because the data gets meaning when it is combined with an Electronic Medical Record system (EMR) like for example Epic. Epic is used around the world for delivering quality care and, also very important, Epic is one of the systems for which there is a connector in WSO2 that uses the fhir2 healthcare standard for exchanging patient data. So we are able to connect to a system like EPIC using the technology from WSO2. Furthermore, I have looked into the Withings technology and they have a set of APIs that allow you to connect to the data and transmit it to the patient in the Electronic Medical Record system (EMR), again using the technology from WSO2.

Our Connext Platform and Connext Go! Integration-as-a-Service solutions, can bridge the worlds of the patient home monitoring and the hospital medical data. Whether you create the integrations yourself while using the Connext Platform or we build and manage your integrations with Connext Go!, we’ll make sure you are covered without investing in hardware or skills to enable or integrate eHealth devices and systems. Learn more about Connext or feel free to contact us for more information!