This document discusses how e-health technologies may help change behaviors for chronic disease management. It proposes creating a nonprofit foundation to develop and test remote care concepts using e-health and m-health. The focus would be on conditions like COPD, CHF and diabetes. A patient journey mapping process revealed insights into patients' experiences and perspectives, which differ from doctors'. Lessons from pilots suggest e-health portals could strengthen patient-caregiver relationships, support lifestyle changes, and integrate monitoring, education and social support to better manage conditions. The document argues e-health has the potential to change behaviors if it empowers patients and optimizes care processes for both patients and caregivers.

1. Can we change behaviour
through e-health??
Laurens Touwen
Donderdag 25 november 2010
Care within reach

2. A Foundation
• Not a joint venture, but
• A new entity:
a not-for profit
Foundation
- project plan
- money
• I saw idealism
Insurance company
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3. Mission statement
Improving access to health care and quality of life
of chronically ill patients and the acquisition of trust
in medical professionals, government and other
authorities and patients by providing and promoting
‘’Care at a distance’’
and
the development and implementation of proven
concepts for remote solutions for
chronically ill patients
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4. Trend in Chronic care
Increase the coming 15 - 20 years:
• Diabetes 70%
• COPD 35%
• CHF 40% (bron RIVM)
Shortage of 500.000 workers in
2025… in the Netherlands?
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5. What is our focus?
New solutions for: With:
CHF e-health
M-health
COPD Engineering
Diabetes Change management
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6. Our process
Concept- Financiering
Generating
ontwikkeling Grootschalig Part of health Free for
concepts
werkgroepen
testing
testen
basis- De markt
care insurance
verzekering market
           
1 year 3 year
2010 1,5 year 2012
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7. Behavior change examples
• Banking – everyone a bankcard
from visiting a bank towards internet
• Direct life – movement program
monitoring and coaching your movement
• Example Stockholm http://www.youtube.com/watch?v=2lXh2n0aPyw
Challenging your imagination
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8. Through the patients eyes
Not technology is leading, but the
appreciation of Patient and caregiver
So: We did a ‘patient journey’
and a ‘caregiver journey’

9. Journey of COPD
Celebrating Jan’s birthday
Insights:
• smoking is part of the
fun in life and it’s a
strong part of your social
life: you smoke together,
it’s a form of ‘social
cohesion’

10. At the GP’s practice
Insights:
• Sometimes, the GP doesn’t
recognize and
acknowledge the fact that
you have COPD, but deep
down, you know
something’s wrong.
• You need to feel that you
can tell your story to the
GP, that he really listens
and that he is direct and
honest to you.

11. At the lung specialist’s office
Insights:
• You already had an idea deep down
that something’s wrong. The shock
comes from the fact that you now
become conscious of the fact that
you will never heal, which is in big
contrast with the idea of a ‘bad
condition’.
• You don’t really realize what the
doctors tell you about the need to
stop smoking.
• You also tend to forget many of the
things the specialist has said.
• When you are proven right, you are
angry, but eventually this turns into
Emotions: self blame for not acting more
• Shocked assertively to the GP.
• Anger
• Self blame

12. Conflict of interests
Insights:
• It’s important that family and
friends understand what you
have. I.e. they know what to do
when it’s clear that the illness
causes complaints (during
short term wheezyness for
example). This makes you feel
safe.
• You also expect family and
friends to take account of you.
• The feeling that you’re
dependent on others is a
terrible feeling, it emphasizes
that you cannot do things on
Emotions: your own.
• (un)safe
• Not taken account of
• Dependent , angry ,low
self esteem

13. COPD
Heal thyself
Causes Causes/Effects Effects
• Smoking Illness: • Disrupted
• Bad eating habits • COPD relationships with
• Little exercise 3 your environment
• Etc. • Freedom is taken
away
1 • Life doesn’t make
Shortcomings: sense anymore
• Tiredness • ...
• Bad physical condition
• Short of breath
• Etc.
Experience of doctors Experience of patients
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Two completely different points of views :
1. Doctors conclude you have an illness, whereas patients conclude you have
shortcomings
2. Doctors clearly point to the causes (and dangers) of the illness, while a
patient focuses on the effects of the shortcomings
3. NB: After a longer period of complaints, patients do begin to realize that 13
there is a connection between smoking and their shortcomings

14. Concerns
• Strengthen the relation Patient- Caregiver
• Caregivers less work, more role as coach
- more partner than authority
• Psychology is the key in self management
- find short-cycle feedback
• Focus is mainly on change of lifestyle
• Web portal
- with specific and practical applications
- Personal Health Record
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15. Lessons learned for web portals
Develop solutions close to patient in 0-and first line:
• The measurement of vital and relevant values at
home or close to home - monitoring
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16. Lessons learned for web portals
Personal health record with education and action:
• Combines all patient information in one platform
with self-learning algorithms:
guide disease management
selecting appropriate education
brings peers together
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17. Lessons learned for web portals
• Behavioral Science to ensure compliance
Both compliance to medicine as lifestyle
Work with goal setting and diary
moving
eating
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18. Lessons learned for web portals
• Lead to optimization of the "work flow"
• Managing multiple chronic conditions
• Insight in the quality of care (pi's)
• Supporting treatment at home
• Focus on ‘’Mantelzorger’’
Technology is an "enabler" and not the distinctive
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19. Can e-health change us?
• There is evidence in many trials that the patient
can profit from e-health:
- patient experiences more freedom
- patient improves his well-being
- patient is taking the lead
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20. Can e-health change us?
• Can the caregiver profit??
- only when the care process has been changed
- the workload has to lower
- web tools must be integrated in his system
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21. Perspective
We believe e-health will change the future
And behavior will be changed through e-health!
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