eLabEL: Technology-supported living labs in primary care

Telecare technologies and eHealth applications can support patients and care professionals. However, these technologies are currently not being implemented in primary care. The eLabEL project aims to contribute to a solution for this problem by establishing Living Labs in which patients, healthcare professionals, entrepreneurs and researchers collaborate during the selection, integration, implementation and evaluation of such technologies in primary care. So far, seven primary care centers across the Netherlands have been included. Needs and requirements of healthcare professionals and patients regarding telecare technologies and eHealth applications were studied using semi-structured interviews and focus group interviews respectively. Healthcare professionals and patients were positive towards the use of technologies that can improve accessibility of care for the entire patient population and also expressed a need for technologies that can support self-management in patients with chronic conditions. Requirements voiced by care professionals were the need for clear organization of the user-interface, availability of workflow directives for eHealth usage, minimal steps to perform a task, and integration with their current information system. Patients indicated that care technology should be easy to use and easy to learn, should provide real-time feedback based on self-measured data, and should improve communication between patients and healthcare professionals. Entrepreneurs from the eLabEL consortium will integrate their eHealth and telecare services to meet the requirements of the end-users. The large scale implementation of these technologies will be monitored and the impact on experiences of patients, professionals and organization of care will be studied during a two-year follow-up study. Stakeholders of the eLabEL consortium will join forces to advance the large scale implementation of telecare technologies and eHealth applications in primary care

Lessons learned from a living lab on the broad adoption of eHealth in primary health care

Background: Electronic health (eHealth) solutions are considered to relieve current and future pressure on the sustainability of primary health care systems. However, evidence of the effectiveness of eHealth in daily practice is missing. Furthermore, eHealth solutions are often not implemented structurally after a pilot phase, even if successful during this phase. Although many studies on barriers and facilitators were published in recent years, eHealth implementation still progresses only slowly. To further unravel the slow implementation process in primary health care and accelerate the implementation of eHealth, a 3-year Living Lab project was set up. In the Living Lab, called eLabEL, patients, health care professionals, small- and medium-sized enterprises (SMEs), and research institutes collaborated to select and integrate fully mature eHealth technologies for implementation in primary health care. Seven primary health care centers, 10 SMEs, and 4 research institutes participated. Objective: This viewpoint paper aims to show the process of adoption of eHealth in primary care from the perspective of different stakeholders in a qualitative way. We provide a real-world view on how such a process occurs, including successes and failures related to the different perspectives. Methods: Reflective and process-based notes from all meetings of the project partners, interview data, and data of focus groups were analyzed systematically using four theoretical models to study the adoption of eHealth in primary care. Results: The results showed that large-scale implementation of eHealth depends on the efforts of and interaction and collaboration among 4 groups of stakeholders: patients, health care professionals, SMEs, and those responsible for health care policy (health care insurers and policy makers). These stakeholders are all acting within their own contexts and with their own values and expectations. We experienced that patients reported expected benefits regarding the use of eHealth for self-management purposes, and health care professionals stressed the potential benefits of eHealth and were interested in using eHealth to distinguish themselves from other care organizations. In addition, eHealth entrepreneurs valued the collaboration among SMEs as they were not big enough to enter the health care market on their own and valued the collaboration with research institutes. Furthermore, health care insurers and policy makers shared the ambition and need for the development and implementation of an integrated eHealth infrastructure. Conclusions: For optimal and sustainable use of eHealth, patients should be actively involved, primary health care professionals need to be reinforced in their management, entrepreneurs should work closely with health care professionals and patients, and the government needs to focus on new health care models stimulating innovations. Only when all these parties act together, starting in local communities with a small range of eHealth tools, the potential of eHealth will be enforced

Expectations and needs of patients with a chronic disease toward self-management and eHealth for self-management purposes

Background: Self-management is considered as an essential component of chronic care by primary care professionals. eHealth is expected to play an important role in supporting patients in their self-management. For effective implementation of eHealth it is important to investigate patients’ expectations and needs regarding self-management and eHealth. The objectives of this study are to investigate expectations and needs of people with a chronic condition regarding self-management and eHealth for self-management purposes, their willingness to use eHealth, and possible differences between patient groups regarding these topics. Methods: Five focus groups with people with diabetes (n = 14), COPD (n = 9), and a cardiovascular condition (n = 7) were conducted in this qualitative research. Separate focus groups were organized based on patients’ chronic condition. The following themes were discussed: 1) the impact of the chronic disease on patients’ daily life; 2) their opinions and needs regarding self-management; and 3) their expectations and needs regarding, and willingness to use, eHealth for self-management purposes. A conventional content analysis approach was used for coding. Results: Patient groups seem to differ in expectations and needs regarding self-management and eHealth for self-management purposes. People with diabetes reported most needs and benefits regarding self-management and were most willing to use eHealth, followed by the COPD group. People with a cardiovascular condition mentioned having fewer needs for self-management support, because their disease had little impact on their life. In all patient groups it was reported that the patient, not the care professional, should choose whether or not to use eHealth. Moreover, participants reported that eHealth should not replace, but complement personal care. Many participants reported expecting feelings of anxiety by doing measurement themselves and uncertainty about follow-up of deviant data of measurements. In addition, many participants worried about the implementation of eHealth being a consequence of budget cuts in care. Conclusion: This study suggests that aspects of eHealth, and the way in which it should be implemented, should be tailored to the patient. Patients’ expected benefits of using eHealth to support self-management and their perceived controllability over their disease seem to play an important role in patients’ willingness to use eHealth for self-management purposes

A patient perspective on eHealth in primary care: Critical reflections on the implementation and use of online care services

Smart devices like mobile phones with internet are becoming an indispensable part of our everyday lives. Digital solutions are expected to contribute to the healthcare sector (e-health) in the form of online patient portals and home measuring devices. Nevertheless, e-health is being utilised very little in daily practice. This dissertation focuses primarily on the patient's perspective, with the main aim of researching the need and the use of e-health by general practitioners. This dissertation also examines the implementation of e-health in the Netherlands in a broader context. It appears that e-health is not commonly used by patients due to a lack of: 1) understanding and information about the possibilities and advantages of e-health; 2) understanding about the possibilities and skills required to use e-health; and 3) the expected value of e-health in terms of disease-specific characteristics. The low usage rate of e-health may be particularly problematic for patients that could benefit from it, but do not have access to it or the ability or skills to use it. This dissertation found that e-health is not equally relevant for all patients and therefore does not have to be implemented for everyone. Its introduction in GP care depends on the efforts of the parties involved, including patients, healthcare providers, e-health developers, health insurers, the government and researchers. They will have to draw on their own perspectives and values and work together to point the large-scale deployment of e-health in the right direction

Requirements for and barriers towards interoperable ehealth technology in primary care

Despite eHealth technology's rapid growth, eHealth applications are rarely embedded within primary care, mostly because systems lack interoperability. This article identifies requirements for, and barriers towards, interoperable eHealth technology from healthcare professionals' perspective -- the people who decide when (and which) patients use the technology. After distributing surveys and performing interviews, the authors coded the data and applied thematic analyses. They subdivided results according to levels of interoperability, as workflow process, information, applications, and IT infrastructure. They found that implementing interoperable eHealth technology in primary care succeeds only when all identified levels of interoperability are taken into account

The two-edge connected hop-constrained network design problem: valid inequalities and Branch-and-Cut

This article deals with the Two-edge connected Hop-constrained Network Design Problem (or THNDP for short). Given a weighted graph G = (N,E), an integer L >= 2, and a subset of pairs of nodes D, the problem consists of finding the minimum cost subgraph in G containing at least two edge-disjoint paths of at most L hops between all the pairs in D. First, we show that the THNDP is strongly NP-hard even when the demands in D are rooted at some node s and the costs are unitary. However, if the graph is complete, we prove that the problem in this case can be solved in polynomial time. We give an integer programming formulation of the problem in the space of the design variables when L = 2,3. Then we study the associated polytope. In particular, we consider the case where all the pairs of nodes of D are rooted at a node s. We give several classes of valid inequalities along with necessary and/or sufficient conditions for these inequalities to be facet defining. We also derive separation routines for these inequalities. We finally develop a branch-and-cut algorithm based on these results and discuss some computational results for L = 2,3. (c) 2006 Wiley Periodicals, Inc

Geleerde lessen uit e-health onderzoek

Er is een toename van het aanbod van e-health-toepassingen in Nederland, dat blijkt onder meer uit de e-health monitor 2016 (www.e-health-monitor.nl). Eén van de aanbevelingen uit deze monitor is dat meer onderzoek moet plaatsvinden naar veilige en effectieve e-health-toepassingen. In dit artikel bundelen onderzoekers van verschillende kenniscentra hun ervaringen. Zij beschrijven de door hen geleerde lessen