Aims and scope
© Colourbox
In 2018, The Lage land Hospital together with a number of partners started a project which was aimed to create a personal health environment for patients (PGO= Persoonlijke Gezondheids Omgeving) with better information exchange that would benefit patients. With a PGO, patients are able to access their medical data at one place and share and manage their data. In this way, both the patient and the health provider can see (changes in) the status of health and treatments. The project also aimed for achieving the MedMij (WithMe) certificate. MedMij is an organisation that develops a standard for data use for PGO. They develop rules and provide a certificate to organisations that match the standards and rules of their certificate.
The initial objectives of the projects were to 1) increase self-management regarding medical services, 2) to create a platform to exchange medical data, and 3) to pilot-test this new medical service in collaboration with professionals outside the hospital. The pilot testing was necessary because implementing such a system (and thus the medical services for patients) needed co-production of the hospital with first health care providers (like general practitioners, physiotherapists, etc.), the municipality, cloak caregivers (mantelzorgers), etc. These objectives did not change throughout the project.
The eHealth platform provides an interactive communication between the patient and professional. Users regain control and access their own health services. This helps professionals to provide the best medical care for patients, which aligns with interprofessional collaboration-methods. The personal health data is collected, stored and communicated between relevant stakeholders in such way that all users would benefit from this innovation, because it provides the possibility to link different data registrations systems.
Main collaborative innovation conditions
Ideas were generated via interactions between individuals. One of the difficulties encountered was to integrate the ICT platform in the existing environment within the time-frame that was scheduled for this project. Other partners and professionals outside the hospital and partnership encountered the same problems, which were revolving around a lack of data. By combining these fragments of information it became possible to investigate the full lifestyle of patient from many perspectives with different insights from multiple experts. For most implementing actors, this had to be undertaken besides the normal workload (which is usually high in health care) and this was mentioned as a difficulty. So various respondents indicated that active process management by the coordinators and other ‘boundary spanners’ in the organisation were very important to keep the process going.
The implementation phase was mainly guided and implemented by managers and professionals from Fundis (a network organisation of care providers who also had an innovation fund: https://www.fundis.nl/), SGZ (a joint foundation of primary care organisations in Zoetermeer) and the Lange land Hospital. Currently, the actors are actively involved with finding solutions for upscaling opportunities. There were some regulatory restraints in terms of legislation to initiate the program (GDPR related issues).
The involved actors managed the process in several ways:
- The organisational arrangements (project team, directors table etc.) provided the actors with a platform to interact and connect to each other
- Rules for interaction (like the unanimity rule) provided solid ground for interactions between the actors and grounded expectations for the actors of each other
- Intensive interactions had to secure that the process proceeded and everyone was connected to the project
- New ideas were inserted for introduced by planned visits to other facilities to learn from other experiences and by asking for advice from transition coaches and a professor from Leiden.
User involvement was an important element in the process. Patients, MedMij and professionals were involved users. They were ‘active’ during the pilot-testing phase of the project. The professionals were included in a focus group in which various professional were represented and they could look at and comment on both the development and implementation during the process.
Implications and lessons learned
If we summarize the main lessons learned, these could be summarized in a few points: the user involvement, the overall organisation of the process and the learning that took place
- Users had room for input, so that the partnership could learn from mistakes and improve the project. This was done via the knowledge, user-experience and new perspectives (also on legal terrains) from users. Various factors caused this success: All health professionals were organized in one organisation (1), there was good communication- and expectation management to involve users in the project (2) and the high numbers of users that participated show its success (3). Around 40 users were involved and committed to help with the pilot-testing phase.
- The partnership had committed and participating stakeholders who collaboratively worked on the innovation and cordially invited users to share their knowledge and experiences towards the project. This led to a successful and smooth implementation of the project, which is still ongoing.
- Intensive process management and intensive connections made between partners.
To read more about the case study, see D7.1 – Practices of external collaboration for service delivery. Comparative case studies on external collaboration in eHealth partnerships report.
About the Authors
Erik-Hans Klijn, Erasmus University Rotterdam
Vidar Stevens, Mulier Institute (previously - Erasmus University Rotterdam)