Healthcare will always remain human

Spreeuwenberg: “After my quantitative and statistical training, I gradually shifted towards more patient-centred and participatory research. This is a true necessity when developing digital technology: you need to understand the needs and pain points of the patient. It took a long time before we could really scale up projects; often, inclusion did not exceed 100 participants. Embedding technology into healthcare was out of the question. Digital technology existed alongside regular care, rather than being integrated into it.

That has changed due to the coronavirus pandemic: there is now a real transformation of healthcare underway. Artificial Intelligence (AI) and digital healthcare are playing an increasingly prominent role, and care pathways are increasingly being adapted to hybrid care – a combination of digital and physical care. I am now very involved in embedding technology in the healthcare setting. My team has developed several apps for patients with cardiovascular problems, cancer pain, diabetes, rheumatism and COPD. In these types of projects, we work closely with patients, data scientists, ethicists, healthcare professionals and ICT companies. We also support organisations in preparing for this transition: how can you design processes in such a way that there is room to experiment with digital healthcare and how can you shape a digital strategy? What decision rules do you apply? How do you determine when the experimental phase is over and it is time to make an innovation part of standard care? As a result, my field of work has become much more strategic”.

Spreeuwenberg: “Healthcare organisations need room to experiment in order to develop new technologies. The MUMC+ Care Innovation Lab, with which I work closely to connect research and education with practice, is an example of such a space. The lab is open to ideas that come from within the organisation. To investigate these ideas, a process called “the car wash” has been set up. This process includes organising so-called speed date sessions, where all relevant supporting experts in areas such as contract management, procurement, IT infrastructure, business development and information security sit down together to ensure in advance that an innovation can actually be embedded in the organisation after a successful pilot.

One of the projects within my chair is a study we are conducting together with pulmonologist Sami Simons to determine whether we can use the voice to detect whether people with COPD will experience a worsening of symptoms or a lung attack. This should result in an app that allows patients to record their voice at home every day. If something appears to be wrong, they will receive advice on, for example, adjusting their behaviour or medication, or a request to come to the hospital. Another example is AI prediction models such as Carrier, which we are developing in collaboration with data scientists and technicians. Based on data, we can use this to predict whether or not a person is likely to develop a cardiovascular condition within five years. Based on this outcome, lifestyle advice is given. What is exiting is that developments which initially applied to a small group, with a one-size-fits-all approach, can now be made available to a larger group and making them more personalised. It is also important to make the application accessible to everyone, tailored to a person's language proficiency or digital skills”.

Spreeuwenberg: "That brings me to the final theme within my chair: digital inclusion. I estimate that around 15% of people struggle to keep up. With our digital inclusion programme, we are looking at how digital healthcare can be made as inclusive as possible. I am doing this together with Nicole van Eldik from the MUMC+ Digital Healthcare programme and Prof. Matty Crone, among others. In the NFU (now UMCNL) Citrien programme Digitaal Mee in de Zorg (Digital Participation in Healthcare), we talk to many end users. The problems people encounter are not only related to the design of a technology, but often go much further. It's about trust, not understanding difficult language or feeling ashamed because you can't keep up. We are sometimes really shocked by the stories we hear. This theme is therefore very close to my heart. There is significant inequality of opportunity in the Netherlands and it really matters which family you grow up in. It must not happen that digitalisation further widens the gap between rich and poor or between those who can keep up and those who cannot. That gap must be reduced”.

Spreeuwenberg: "Digital technology can be a partial solution to many challenges, and I am pleased to see that digital technology is finally being embraced in healthcare. We have been conducting research for a long time, and much of it has not come to full fruition. What we are doing now is truly landing in practice and is being scaled up. I think we were often simply too early. There is now much to be gained from making care pathways hybrid, whereby people are monitored at home and only come to hospital when necessary. I also expect a lot of AI's ability to better predict the effectiveness of treatments. Where will we be in five years' time? We don't know. Developments are happening very quickly. But it won't be a fully robot-controlled hospital. Healthcare will always remain human”.

From 27–29 January, the ICT & Health Congress will take place in Maastricht. Spreeuwenberg: “Over the past two years, I have given the Master's programme in Health and Digital Transformation a prominent role here. This time, we are hosting a number of sessions on the theme of digital inclusion. The programme also covers many other very interesting and topical subjects, and since we know that this is the future, I would make sure you were there!”

Text: Eline Dekker
Photo: Joey Roberts

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