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E-Health breaks with established patterns in health care

Eveline Wouters is Professor of Successful Technological Innovations in Care at Tranzo, Tilburg University, and lecturer in Health Innovations and Technology at Fontys, paramedical highschool. Her research interests in technology include its acceptance and implementation in the domain of care and wellbeing. New technology, robotics, and e-Health offer better opportunities to help patients, she argues. However, since many more stakeholders are involved, we need to make sure that we do not lose sight of the objective, the equal care of every patient. This requires tailor-made solutions and intensive collaboration, argues Wouters.

Photography: Gerdien Wolthaus Paauw

Photography: Gerdien Wolthaus Paauw


Interview with Professor of Computation, Communication, and Cognition, Eveline Wouters

'The need for care has grown enormously and it has also become more differentiated. Before the Second World War, many people died of infectious diseases. As a result of technological innovations, for instance, the development of antibiotics, better hygiene, the installation of drains and sewers, and improvements in the field of nutrition, we now live much longer. The downside of ageing, however, is that we are more prone to chronic conditions. These health problems are thus related to the aging population. They are a burden to the health care system, which, in its present form, no longer meets existing needs.

E-health requires different approach to health care

I see many technology-driven opportunities, like sensor technology, virtual reality, and robotics, and I am really optimistic! Since all these technological developments continue to accelerate, people should in principle be getting increasingly better care. The problem, however, is the practical application and implementation of this ‘new care’. E-Health requires a completely different approach to health care. More and different stakeholders are involved, for instance, care professionals, patients and the people in their networks, policy makers, insurers, technologists, and companies. They need to work differently and change the way they collaborate. They face new duties and responsibilities and need to share knowledge. We have much more data from our patients at our disposal and those big data need to be processed properly and used appropriately. Patients’ privacy and autonomy must come first. Since e-Health breaks with established patterns in healthcare, it is often seen as 'disruptive', but you could also see it as enabling different solutions.

Wearables

Wouters has worked in health care as well as in healthcare education and research for 40 years, so she knows how things have changed over the years. She studied medicine, worked in obstetrics and gynaecology, and later in education at Fontys and Rotterdam University of Applied Sciences. She obtained a PhD on obesity and conducted many projects related to the application of technology in long-term care, studying, for example, how ICT can contribute to diagnostics in dementia. Her passion is people-centered care and enabling technology that can benefit all stakeholders involved in care. A fine example of such technology is the so-called wearable, wristbands and other sensors that people can wear, for instance, to monitor movement. One specific example of ongoing research is about monitoring various parameters, such as heart rate and skin conductance, that can predict stress. It can give a voice to people who cannot or can no longer express themselves by means of language. This helps carers to better understand what circumstances raise patients’ stress levels and to take this into account when caring for them.

Tailored care

‘Technological applications in care are currently coming up against social and human factors. Carers will have to think out of the box. In the past, patients with chronic conditions were monitored at fixed intervals, for instance, the blood pressure, weight, heart rate, and blood levels of patients with heart failure. But monitoring is much more refined these days. All kinds of values can now be continuously monitored, and therefore deviations from the standard can be detected much earlier. This allows us to provide more tailored and timely care. I sometimes compare it to Uber, need-based assistance and the right care in the right place.

Lifestyle monitoring

Another example: people with dementia are often a major burden for the carer. We can now monitor them, if necessary, using sensor technology in the home, also known as lifestyle monitoring, so that they can live longer at home safely and without too intrusive technology. For example, you can see whether someone goes to the toilet frequently, has taken a fall, or has stopped getting food from the fridge. But then the data must be interpreted with the right expertise, and the right people involved must be kept informed in the manner agreed on. These developments require a reorganization of care and mutual coordination. What I am interested in is how best to serve the values and interests of all parties involved and to organize them in better ways, without losing track of the things that are important to those involved.

Digital divide

A different problem is the so-called ‘digital divide’, experienced by people who need care. Much of the technology, for instance, as used in eHealth, to some extent requires certain skills. This could be literacy skills (much information is in written form) but also computer skills. Besides, much that is newly developed is as yet insufficiently tailored to patients. Technology offers great opportunities for care, but not without further elaboration. It requires tailored solutions and intensive collaboration, and an eye for the needs, values, and capabilities of all the people involved.’