Low-code in healthcare: 5+1 real life examples

By Health, News

If there is one benefit of the Covid-19 crisis, it is the growth of digital remote care. Resuming regular care in a 1.5-meter setting is simply not possible without digital applications. However, new solutions are needed quickly. These are preferably also affordable, easily adaptable and scalable without any problems. This is at odds with how we have known IT development in healthcare up to now and therefore a different approach is needed. Low-code platforms can provide a solution. They are known for being fast, cheap and flexible. This article uses five plus one examples to illustrate how low-code can make healthcare more digital. 

The advantages of remote care such as less travel, less waiting and less risk of infections have often been highlighted in recent years. Nevertheless, development has always lagged far behind expectations. This has now changed due to the Covid-19 pandemic. The use of digital applications in communication, monitoring and treatment increased rapidly, as did the demand for new applications. More and more patients and healthcare providers are opting for “at home when possible and at the healthcare provider if necessary“. 

Now more than everhealthcare does not benefit from too complex and costly IT processes, which will result in a cumbersome solution after a long time. On the contrary, applications with high ease of use are needed within weeks so patients and caregivers can use them quickly and care delivery can continue and improve. If care provision changes, rapid and controlled adaptation of care is a must. Also, to prevent us from reverting to old behaviour. 

It is striking that, in contrast to other sectors, little is developed with low-code in healthcare. While low-code is intuitive, iterative and flexible and lends itself to (patient) portals, apps or even complex back offices. Developers do not need to master a programming language, but only need to know a program where they set configurations in a graphical user environment. Low-code is therefore fast and adaptive: developers can test the (new) needs of healthcare providers and / or patients directly during development. Another advantage is that it easily integrates with existing IT systems and standards (such as HL7), so new functionalities are added to the existing systems without disrupting the current operation. Leading research firm Gartner expects that by 2024, 65% of all applications will be co-developed or managed with low-code. Well-known players are OutSystemsMendix and Betty Blocks, which already have various applications in healthcare, especially internationally. 

National Coordination Center for Patient Distribution (The Netherlands)
Shortly after the seriousness of the Covid-19 crisis in the Netherlands became clear, the National Coordination Center for Patient Distribution (LCPS) was established. The aim of LCPS is spreading the patient care workload as effectively as possible throughout the Netherlands. To perform this assignment properly, insight is required into the most up-to-date information about available beds and transport capacity. In less than two weeks, an application, the coordination platform, was developed and made operational with low-code to provide this insight into all hospitals in the Netherlands and some in Germany. The coordination platform is used to process the transport movements of patients on request by matching supply and demand. Part of this is finding the best hospital and suitable transport for each patient based on 90+ different input variables. In addition, the platform provides reports that are in the news nationwide.  

Kermit (United States)
The American Kermit developed a low-code analysis platform for medical implants such as pacemakers and insulin pumps within nine months. The application manages contracts and invoices and monitors supplier compliance. The entire process is transparent: from unpacking the material during the treatment to sending the invoice and payment to the supplier. The data-driven platform maps trends to optimize processes, provides buyers with information about fraud and prices, and provides specialists with information for treatment choice. The Kermit platform is now running in 23 hospitals, saving on average 30% of their costs for medical implants. 

Saga Healthcare (United Kingdom)
Years ago, the English Saga entered the homecare market in its own country. The big difference with other healthcare providers was that Saga focused on an agile technology platform. The IT team of 

Saga was able to deliver SACHA, a homecare planning system, within six months. The built application automates a huge amount of manual tasks so that caregivers can use this time for personal care of clients. Building with low-code was mainly of added value for Saga because the expertise was immediately embedded within its own IT department. As a result, it kept control in its own hands without having to commit to third parties. 

Medtronic (United States)
Medtronic has been one of the market leaders in medical devices such as heart implants for years. These implants are constantly collecting data from patients all over the world. It is very complex for healthcare providers to extract timely and actionable insights for the care and well-being of patients from the enormous amounts of data. Therefore, Medtronic built FocusOn in six months based on low-code, which filters 80% of the data for healthcare professionals. In addition to the fact that healthcare professionals can now deliver faster and better remote triages, the application of the low-code platform has also resulted in 50% IT budget savings. The platform makes it quite simple for new clinics to join this new technology: within 15 minutes, new customers and end users are ready to use. Since its launch in 2018, more than 335,000 triages have been performed through FocusOn, saving clinical staff time for 27 year.  

Kuwait Maternity Hospital (Kuwait)
Kuwait Maternity Hospital is one of the largest hospitals in Kuwait. The biggest problem for the hospital was the lack of insight into patient and capacity information due to the paper administration. Within twelve weeks, an external party put a Hospital Management System (HMS) live on low-code. This system offers the user a uniform patient view and provides real-time information for care managers: from the number of occupied beds and appointments to the number of operations and emergencies per day. Within a few weeks of implementation, the total registration time per patient decreased from 45 to 15 minutes. The number of errors in the patient file has also been reduced by 60 percent and communication between hospital departments has improved significantly. Due to its success, five other hospitals are now also using the system. 

National Health Service (United Kingdom)
The National Health Service (NHS) is known as the United Kingdom’s public health system. Especially for doctors with mental health problems, there is a Practitioner Health Program (PHP) within the NHS with free confidential care. The idea behind this is that doctors can return to work faster and more vital after treatment. The NHS started the program for doctors in the London area, but wanted to expand across the country in 2016. To also be able to offer the same confidential service nationwide, PHP has built a mobile app and a fully automated GP care system in seven weeks in low-code. With the app, healthcare providers can find therapists in their area and make an appointment anonymously. The app has now been used by more than 2000 doctors. 

Conclusion
The development of remote and connected care is complicated enough for healthcare providers. Who provides which care and when, who bears what responsibility for the quality of care and who pays for which care? Technology should therefore not be the problem. The development of low-code applications may be easier and faster, but not happens automatically. That is why we end this article with 5 tips to be part of the low-code revolution: 

1) Start small and finish big: start with the (agile) development of a working prototype in a pilot and discover the value of low-code development (proof of value);
2) By the patient, not for the patient: design continuously from the patient’s point of view and experiment with the flexibility of low-code development;
3) From doittogether to doityourself: get advice on the right platform, acquire the right low-code competencies and experience and then build them yourself;
4) Complexity is failed simplicity: work under architecture and don’t allow IT to add unnecessary complexity;
5) You go faster alone, you go further together: never develop alone, but learn from each other by working together. 

Contact
Walter Kien
E: walter.kien@igh.com

This article has also been published on: ICT&health

 

IG&H’s contribution to the National Coordination Center for Patient Evacuation (LCPS)

By Health, News

Due to the national increase in patients with COVID-19, the workload of patient care across the Netherlands needed to be spread as effectively as possible. Not only for patients with COVID-19, but for all patients. The aim of the National Coordination Center for Patient Evacuation (LCPS) is to spread the workload and care capacities across hospitals.

LCPS is being led by Bas Leerink and Bart ter Horst. The Dutch Army offers advice and support in the design, organization and operation. They are being strengthened by experts in the field of acute care, logistics, ICT, statistics and crisis management.

Just before the peak in the number of COVID-19-patients, IG&H, together with Erasmus MC, the Ministry of Defence and other partners, coordinated the setup of LCPS with the aim to spread the workload and care capacities across hospitals.

Journalist Mark de Bruijn has recorded the setup of the LCPS and reconstructed it into an exciting documentary.

Contact
E: info@igh.com

 

Unique Patient Evacuation Coordination management tool build with OutSystems Technology

By Health, News, Technology

IG&H, a partner of OutSystems with offices in the Netherlands and Portugal is coordinating the National Coordination Centre for Patient Evacuation (LCPS). The aim of LCPS is to spread the workload and care capacities across hospitals as effectively as possible. Therefor they needed to manage the available resources in each hospital and coordinate all patient transport movements across hospitals in real-time.

To avoid a possible catastrophic scenario, a management tool needed to be built very fast and with high standards of quality.

PECC was built with OutSystems by IG&H and became up and running in less than 2 weeks. This new centralized tool replaced shared files and whiteboards that were being used before. The result was impressive, not only did it improve the effectiveness of all staff involved, but is also created a new set of capabilities (i.e. auditing and reporting). The adoption by the users was almost instantaneous and the feedback that started to reach the Development Team was great.

The PECC application covers 119 hospitals in the Netherlands and Germany. PECC provides real-time overview dashboards and other web pages that manage the process of each patient’s transport movement. These include the workflow of identifying the criticality of each case, then finding the best hospital and managing the specific transport according to the situation of the patient. These decisions are based on 90+ different input fields, that lead to the most favorable solution.

Following the success of PECC, LCPS identified one other urgent necessity that could be tackled with Low Code, the result is the COVID19 NL-DE Kooperation Webportal and a tool managing the allocation and distribution of mission critical equipment like ventilators and IV-pumps called MedOps. The Kooperation portal has been built with OutSystems and is a web application portal that manages the availability of German hospitals to receive Dutch ICU-patients. Dashboards and web pages deliver the information that the application receives directly from the hospitals and transform it in a way that immediately shows the users the most useful information quickly and if needed that information can be drilled down to the required level of detail.

This solution was only possible due to the contributions of OutSystems by providing the necessary infrastructure, deep expertise and support, the Dutch Ministry of Health and the Dutch Army that helped defining the solution process, and by IG&H Health sector knowledge.

Contact
Nuno Pacheco
E: nuno.pacheco@igh.com

A look inside the National Coordination Center for Patient Evacuation (LCPS)

By Health, News

About LCPS
Due to the national increase in patients with COVID-19, the workload of patient care across the Netherlands needed to be spread as effectively as possible. Not only for patients with COVID-19, but for all patients. The aim of the National Coordination Center for Patient Evacuation (LCPS) is to spread the workload and care capacities across hospitals. LCPS is being led by Bas Leerink and Bart ter Horst. The Dutch Army offers advice and support in the design, organization and operation. They are being strengthened by experts in the field of acute care, logistics, ICT, statistics and crisis management.

I interviewed Bas Leerink (partner healthcare at IG&H) and Bart ter Horst (director healthcare at IG&H) about their important roles in setting up and coordinating the National Coordination Centre for Patient Evacuation(LCPS) 

First of all, how are you doing?
Actually, things are going pretty well. Although the pressure and responsibilities are very high, it feels good to be able to contribute to society. And to be honest we both don’t believe we would have been very suitable for working from home anyway.

How did you get involved?
Bas Leerink: I got a call from the Ministry of Health(VWS) saying they were looking for someone to set up the National Coordination Center for Patient Evacuation (LCPS), and they thought that I might be the one. Before I could even react, they continued with: “o and by the way, we are gathering today at 2 PM”. So I immediately called some of my colleagues ,including Bart, and we both drove to Rotterdam. Once arrived Ernst Kuiper (CEO Erasmus MC) welcomed us.

Soon enough we found out that we had to start from scratch, because there was literally nothing except a piece of paper on the wall, which was as a matter of fact, almost completely blank.

What can you tell us about the cooperation between the different parties that are involved?
We got a very important and complicated task, so each party that is involved brings some of their expertise to the table, which is extremely valuable. For example: the Dutch Army is very experienced when it comes to crisis operations like patient evacuation, so we really benefited from their knowledge. Within 2 days we evacuated the first patients. This wouldn’t have been possible without smart collaboration between all involved parties.

What is it that IG&H offers then?
Probably our sector knowledge and ‘getting things done’ mentality. Not to forget that our tagline is “Make strategy work” and that summarizes exactly what we are doing here. We are not only analyzing or making advices on paper, we are here in the field creating a working coordination center, of course in close collaboration with all other parties that are involved.

It has been three weeks since the set-up of LCPS, what has been achieved so far?
Within five days we made the system operational. Which means we were able to answer requests of hospitals, track patients and organize the whole evacuation process. Not only did we evacuate Intensive-care patients across hospitals in The Netherlands, but we also evacuated some to Germany. At the same time, we started distributing medical equipment as well. Meanwhile the team has grown to a group of approximately 60 people that are continuously trying to optimize processes and keep a smooth information provision among all involved parties.

Can you paint a picture of a typical day at LCPS?
For both of us the day starts around 7 AM, with getting our first call of the day while being in the car or on a bike. Not a single day is typical at the LCPS, but thanks to the Dutch Army we have a “battle rhythm”.  So we kick every morning off with a commander’s update briefing (CUB). Followed by a commander’s intent in which Bas Leerink states the most important goal or topic of the day. Furthermore, important decisions are being made. Around twelve there is a consultation with all chairs of the ROAZ’s, that’s when we inform and ask about any updates in general regarding the patient evacuation. Around 2 PM we get an update about the forecasts, so we know what we should and can prepare for. Then there are a lot of phone calls to be made, up until around 4PM when the press conference preparation takes place. And at the end of the day there is another CUB in which we discuss the progress of the day.

The number of patients on the IC continues to drop, what is your take on that?
The average of patients on the IC in The Netherlands before COVID-19 were approximately 800. Now there are just under 1.300 patient with COVID-19. We have to watch out and not be too cheerful too soon, because immediately lowering measures can be very dangerous and lead to a resurgence of COVID-19. Also given the fact that the workload at the Intensive cares is still way too high, and has been for quite some time, we should be very careful about the sustainability of these scaled-up wards. So, despite the drop we are still working on automating processes to make them more efficient and less sensitive to errors and preparing ourselves to spread workload evenly and effectively across Dutch healthcare institutions.

Watch the episode about LCPS on EenVandaag

‘Flevoland healthcare landscape has all ingredients to continue to deliver high-quality and accessible healthcare’

By Health, News

The current Dutch Flevoland healthcare landscape has all the ingredients to continue to deliver high-quality and accessible healthcare – now and in the future. That’s the main conclusion from a report by Bas Leerink, explorer of the future and partner at IG&H.

Download the full report here (in Dutch).

In the past few months, Leerink and his team of IG&H consultants have defined a vision of healthcare in the Dutch province Flevoland from 2020 onwards. To this end, they’ve had extensive talks with residents, healthcare providers, health insurers, and the local government. They’ve also made extensive calculations and analyses of all scenarios. Moreover, regulators NZA (Dutch Healthcare Authority) and IGJ (Health and Youth Care Inspectorate) have been actively involved and have responded to the report. They don’t have any objections.

As an explorer of the future, Leerink recommends a step-by-step improvement of the current healthcare provision as the best approach for Flevoland. The province shouldn’t seek to restore the situation that existed before the bankruptcy. Therefore, the emergency room and acute obstetrics will not be reopened in Lelystad.

This is a difficult matter for many parties involved, but restoring the situation that existed before the bankruptcy doesn’t offer a solution for future demand. Furthermore, it’s neither realistic nor feasible in the short term. In the report, Leerink makes several recommendations. If this Agenda for Healthcare is realized, it will turn Flevoland into a leading region in the sector.

Importance of close collaboration

The bankruptcy of the former MC IJsselmeer hospitals has damaged the citizen’s trust in healthcare (parties) and the extent to which they’re able to really put the public interest in available, accessible, and good healthcare first. Now, researchers observe that healthcare (particularly the networks of healthcare professionals) is being restored in terms of content. The trust of citizens – reflected in local governments, the Flevoland Patient Federation (FPF), and Stichting Actie Behoud Ziekenhuis Lelystad (foundation to promote the preservation of a general hospital in Lelystad) – is still fragile.

Therefore, the explorer of the future proposes to keep analyzing and monitoring the situation carefully, and to continue consulting with all parties involved through Zorgtafel Flevoland (healthcare table Flevoland) in the coming year. The latter is supported by a progress meeting, chaired by the Ministry of Health, Welfare, and Sport. It also offers the option of addressing bottlenecks and escalating progress-related problems. The Ministry of Health, Welfare, and Sport can use the outcomes of the meeting to inform the Dutch Lower House of Parliament.

Acute healthcare

One of the issues that damaged trust encompasses concerns about accessible emergency care. Before the bankruptcy, patients with an acute, life-threatening condition, such as a heart attack, were sent to the Zwolle-based hospital. This procedure will be maintained. Because of the emergency outpatient department in Lelystad and the local emergency room in Emmeloord, it’s possible to provide care in the area in the case of low-complex emergency conditions.

To relieve pressure on these surrounding hospitals, it’s important to set up an acute care data science team in Flevoland. The team can contribute to the improvement of processes, which can increase the availability and effectiveness of emergency rooms. Currently, the St Jansdal hospital provides the emergency outpatient department at the Lelystad location and the emergency room at the Harderwijk location, which means it’s logical to start with this hospital.

By deploying data and new technology in the right way, ambulance care in Flevoland can take the lead in data-driven process improvement in the short term. This may serve as an example for other regional ambulance facilities in the Netherlands in the long term.

Obstetric care

The disappearance of acute obstetrics in Lelystad means that part of the people in Flevoland need to travel a longer distance in acute obstetric situations. The increase in travel distance means it’s easier to use an ambulance.

A new type of collaboration is needed to keep providing good birth care. Carefully organizing the unchanged demand for care within the context of the altered care provision – both primary and secondary care – is a priority. Recently, new partnerships have already been established between all care providers involved. They have given tremendous effort to reach additional agreements, which has strengthened cooperation and mutual trust.The explorer of the future also recommends that birth care in Lelystad is supported for one year.

The starting point is to offer birth care in the pregnant woman’s area if possible, and to provide it in a clinical setting as quickly as possible if the case in question so requires. Birth care providers are obstetricians or obstetrically active primary care physicians, secondary and tertiary care obstetricians and gynecologists, the regional ambulance facility (only in the case of acute obstetrics), and maternity care.

Care and support for vulnerable groups of people

The growing number of vulnerable elderly people with a complex, often cross-domain demand for care and the increasing health differences between socio-economic groups require far-reaching cooperation between care and welfare organizations and municipalities.

An adapted form of the neighborhood clinic in Amsterdam would be an interesting initiative for Lelystad. This clinic’s target group consists of patients with a combination of geriatric problems and, for example, pneumonia, COPD, heart failure, a bladder infection, or neurological symptoms. The results are positive – patients experience less loss of function, and the number of readmissions and emergency room visits is reduced, among other things. Several parties have now entered into discussions, and the first plans for such an initiative in Lelystad are being developed.

There is also a demand for primary care plus in the Noordoostpolder. Chain partners have signed a letter of intent for the new health plaza to be built in Emmeloord. This care concept will offer room for day treatments, convalescence, and observation beds, among other things. The various parties’ involvement enables far-reaching cooperation.

Furthermore, the number of residents with a chronic condition, which is already relatively high in Lelystad, is expected to increase sharply. One of the numerous action points that should be implemented according to the explorer of the future is the deployment of e-health initiatives. However, it is essential to pay attention to the limited digital and health literacy among part of the population. Finally, it is important for health insurers to support these initiatives – that is, if they don’t already.

Vision for the future of healthcare in Flevoland

In January, after the sudden bankruptcy of the IJsselmeer hospitals last fall, minister Bruno Bruins appointed Leerink. The disappearance of the emergency room and obstetric care caused much unrest in Flevoland. As an explorer of the future, it was Leerink’s job to make a thorough inventory of the healthcare market in Flevoland and to subsequently outline both short-term and long-term needs.

Healthcare vendors want less market and more cooperation

By Health, News

Purchasing and selling between healthcare providers and insurers is increasingly a strategic activity. New mutual agreements do not merely consist of budgeting and enabling expense claims. On the contrary, both parties contribute their strategic intentions. As a result, healthcare contracting becomes the starting point for joint projects. IG&H conducted a research among hospital healthcare vendors and found that healthcare contracting is increasingly at the heart of the healthcare system. To cope with core healthcare issues, however, more cooperation is required.

Download the Zorgverkoopmonitor 2019 (healthcare vendor monitor 2019) here (in Dutch).

In the Zorgverkoopmonitor 2019, IG&H takes stock with healthcare vendors and looks at the future. Nearly 25 healthcare vendors and finance managers at hospitals and clinics participated in the research. Together, they represent a total revenue of approximately €8 billion.

It turns out healthcare vendors want to set aside twice as much time to discuss policy themes and quality with insurers. Currently, price and volume still dominate more than 60% of all meetings. If it is up to healthcare vendors, 50% rather than 25% of meetings will be about substantive themes, such as the right care in the right place, meaningful care, and a vision of the region.

Approximately half of the respondents have concluded long-range agreements with the largest insurer – and a quarter of them with nearly all insurers – laying a solid foundation for a different type of meeting. ‘Unfortunately,’ not all of these are cooperations between providers and insurers. Part of the long-range agreements are simply concluded because banks require financial security. However, these long-range agreements provide peace of mind and room for a different type of meeting.

There’s a reason why healthcare vendors appreciate insurers bringing their own vision of healthcare to the table. You may disagree on this vision, but it is the main reason why 45% of healthcare vendors consider Zilveren Kruis the most professional of healthcare purchasers, and 25% believe it to be VGZ. According to healthcare vendors, they have set up a proper foundation for healthcare purchasing, and it is now time to give healthcare purchasers more authority and room for customization.

Ultimately, 30% of healthcare vendors consider the affordability of healthcare as the main challenge – especially the gradual transition (25%) to a different healthcare landscape (25%).

Healthcare vendors mainly want realistic financing, and they are willing to contribute to a financial transition. They, too, realize that healthcare should remain affordable for everyone. At the same time, they also need to deal with fixed accommodation and staff expenses, which means they can’t rush into cutting costs.

The art of concluding contracts in a new era

Even though they seem to have conflicting interests at times, healthcare providers and insurers face the same task. Of course, it can be completed through harsh negotiations, but lowering revenues and costs together requires a substantive cooperation.

The latter starts with mutual trust, which is created by truly empathizing with the other party.

The next step is for both parties to define a shared ambition that serves each party’s interests. Develop a vision of the region or certain types of healthcare, look beyond your own organization, and determine what it is you want to achieve together. Set up a joint project group, allow each other access to data, and perform the analysis together. Joining forces will automatically eliminate old behavioral habits. Discussions will no longer be about each letter in the contract but about what is good for the patient, the policy holder, and society. This will ultimately benefit insurers and healthcare providers, too.

By Walter Kien, Senior Manager Healthcare

IG&H and GroupLife combine forces

By Banking, Health, Insurance, News, Pensions, Retail

Consultancy firms IG&H and GroupLife are moving forward together under the name IG&H, resulting in a specialized consulting group that is able to help realize business and technology transformations from start to finish.

Both companies have in-depth sectoral knowledge, close customer relationships, high quality people and service. By combining their expertise in strategy, organizational transformation, data analytics and technology, they will be able to more effectively help organizations with transformative matters. The new consortium includes more than 220 specialized professionals.

Execution of strategy requires integral approach

Jan van Hasenbroek, managing partner IG&H: “The rapid developments in the technology sector have an enormous impact on the business models of our clients. In order to remain successful in the future, our vision must include addressing organization and technology together. This will lead to corporate strategies being immediately operable, providing concrete results and sustainable organizational transformation. GroupLife has an impressive track record and a proven methodology in business modelling, implementation of technological platforms, and data management. That’s why a collaboration fits well within IG&H’s strategy to continually strengthen its technological ecosystem.”

Wim Groenen and Tom Bottinga, co-founders of GroupLife: “In previous projects with joint clients, we discovered that we had similar ideas about how to address complex business transformations. IG&H knows how to combine its expertise in strategy, data analytics, technology and organizational transformation with sector knowledge. We are delighted with the collaboration and together with IG&H we can make an even greater contribution to the success of our clients.”

About IG&H

IG&H is committed to help leading organisations in the financial services, retail and healthcare sectors. With 160 involved and enterprising professionals, the consultancy and implementation firm, based in Utrecht, helps organizations take steps towards radical customer centricity. They set high standards for themselves and their way of working. With in-depth knowledge and a personal approach, they aid their clients to help them improve the sector. IG&H is recognized as a ‘Great Place to Work’ and puts a lot of emphasis on a high net promotor score.

Are we in the Dutch healthcare market looking forward to Amazon?

By Health, Healthcare, News

Last year, Amazon entered into a partnership with Berkshire Hathaway and JPMorgan Chase & Co. The company also bought Pillpack, an online pharmacy. Both initiatives aim to offer good care at a low price. This step arouses unrest: the share prices of several companies in the med tech and pharmaceutical industries fell. Has a new disruptive healthcare player emerged? And what will the effect be on the Netherlands?

By entering into a partnership with Berkshire Hathaway and JPMorgan Chase, Amazon is circumventing the health insurer. The purchase of Pillpack and the plans to open clinics indicate that the ambitions of the web giant go beyond just financing care. If Amazon interferes with technological developments in the healthcare market, the impact will be vast. It fits in with the strength and motivation with which the company has also entered the supermarket sector, for example.

Opportunities for digital platforms in the Netherlands

In other markets, we see tech parties that bring supply and demand together on a single digital platform emerge. This excludes intermediaries, as Airbnb and Netflix are already doing.

Does Amazon have this healthcare role in mind and is their plan to take it outside the US? There are many intermediaries active in the Dutch healthcare sector, for example in health insurance, pharmacy or medical devices. For Amazon and other online disruptive players, there are plenty of opportunities to integrate and digitise the role of these intermediaries.

Exciting, because they will significantly increase the competitive pressure in the healthcare market. A platform offers many advantages in terms of ease of use and experience. It also makes the offer transparent, which lowers prices. And that is the – so far only – goal communicated by Amazon, Berkshire Hathaway and JPMorgan Chase.

Getting a foothold is difficult

Before a digital player like Amazon gets a foothold in the Netherlands, it will have to overcome many hurdles. Our complex financing structure leaves little space for new business models. The patient is not or hardly willing to pay extra for new services, on top of the premium. This is a major entry barrier for new initiatives.

Health care systems across the globe vary considerably, making it more difficult for platforms to scale up across borders. Crucial to the success of digital platforms is the low cost of an additional user. With different systems, this success factor does not seem to work. Truly successful digital players need a minimum scale that is larger than the Dutch market alone.

To be successful, digital disruptive parties use data and algorithms. In Dutch healthcare, mass data and especially medical data are well protected by laws and regulations. Previously, the national EPD had already failed in the Senate for privacy reasons. Technological innovations in data exchange offer a solution, but are still in pilot phase and not widely implemented.

Finally, healthcare is a service par excellence for which human contact is essential. There is a relationship of trust between doctors, pharmacists and their patients. This can be supported, but it is difficult to replace it entirely by a digital platform of an American tech giant.

Pressure on these barriers is increasing: breakthroughs are imminent

However, we cannot assume that a party like Amazon will be held back by this. Health insurers are increasingly looking for innovative ways to reduce healthcare costs. This may change the payment culture among patients, making them more sensitive to the supply of new parties. Progress is also being made on digital data exchange. This will hopefully be further accelerated by the obligation to share patient data digitally, recently announced by Minister Bruins.

As a result of these developments, the aforementioned stumbling blocks for tech players are becoming less threatening. The current healthcare market can see this as an opportunity for further development. Tech players are successful because in their business operations, they put their customers first. They offer more convenience and excellent service. Ask yourself whether your organisation still meets the needs of the patient or customer to the maximum. Identify the steps you can take to match this level, perhaps in collaboration with successful tech players.

Wondering how (digital) disruptions can take your organization to the next level? At IG&H we are happy to think along with you.

By: Roos Blankena (r.blankena@igh.nl) and Linda de Jong (l.dejong@igh.nl).

Bas Leerink new Health partner at IG&H

By Health, News

On January 1, Bas Leerink will join IG&H as a partner. Leerink has in-depth sector knowledge about healthcare and wants to use his knowledge for the benefit of the patient.

Leerink previously worked as a director at health insurer Menzis, and afterwards as chairman of the board at top clinical hospital Medisch Spectrum Twente. At the time of his appointment in 2013, the hospital was facing difficult times; it came under strict supervision, while at the same time a new hospital was being built. In the last six years, Leerink focused on more transparency and received a lot of praise for doing so. Presumably, the organization is currently doing very well financially. Leerink has also put Value-Based Health Care on the agenda, together with the other Santeon Hospitals.

He wants to apply this knowledge to healthcare institutions and insurers in a broad sense. On his move to IG&H, Leerink says: “There is a lot to do in healthcare. Society expects better services, continuous introduction of new medical techniques and medicines, more “joint decision”, and more possibilities for healthcare at home, at the same cost. For me, the continuous focus IG&H places on the end-user of healthcare or health insurance is an important reason to make this transition. Besides of course the team of people with whom I will be working. “

Princess Máxima Centre: Providing a path for medical technology

By Health, News

The run-up to the opening of the Princess Máxima Centre was a special time. Today, the third blog of a series in which we discuss the following question with the experts involved: how did the centre so quickly go from dream to reality in no more than 8 months?

“What do you need to put into what type of medical situation?”

“We only just began tackling the question of medical technology this past December 2017. Only a half year before the opening”, says Wilco Kleine, healthcare technology and innovation manager. At that time, there had not yet been a single thought about what the centre would need in this area. “What demands do we have to put into place regarding equipment? Which brands do we choose? How do we get the ultimately 3000 different types of medical devices delivered on time? Which healthcare professionals need what type of training to be able to work safely and efficiently with the equipment involved? And what if a device breaks down during use? These kinds of questions had not been answered until that moment. Which is why we had to go through the entire process quickly. “This was not easy, because it involves a lot of regulations and medical technology that directly affects patient care. For example, you can not just go out and buy a hospital device and install and use it.” Kleine: “You have to think carefully about what you need to do exactly for any medical situation that may arise. So we first determined which devices would fit in the new care processes, such as patient monitors. Afterwards, together with the healthcare professionals, we looked at the requirements that were set, which providers could supply the right equipment, and which configuration was best suited for our centre.”

“It was like shooting at moving targets”

The fact that everyone took care of a specific task during the transition period, especially within their own domain, did not always make it easier. “Everything had to be done quickly and therefore run simultaneously”, says Kleine. “In this context, it is very difficult to keep the various disciplines well-managed. IG & H participated in all program lines and monitored the coordination within the organisation, which was fully ensconced in the construction and set-up phase. There was a great added value in that.”

Arvid Glerum, consultant at IG&H, adds: “For us it was one of the biggest challenges to get everything done in time. At the organisational level, all sorts of things are so new and interesting that you want to share them, but we always had to weigh up: when is something just interesting to know and when is it critical?” Because everyone at the Prinses Máxima Centre was making choices at the same time in order to organise everything properly, there were a lot of mutual dependencies. For example, when something changed in the building, this had consequences for the technology needed, and vice versa. “It was like shooting at moving targets”, says Arvid. And Kleine agrees with this: “We have managed to keep a good grip on things by putting together a multidisciplinary group with which we have managed the whole process. This included representatives from all areas: from care to purchasing to technology. This made it easier to discuss developments with each other on a weekly basis. Arvid informed us about all the relevant developments in the other programs and provided us with progress reports with which we kept the entire transition organisation up-to-date.”

“Everything had to work out and everything had to be safe”

Because the subject of medical technology came relatively late on the agenda, the team encountered the necessary problems. That often required making swift decisions. “Once you have ordered a monitor, for example, there’s not much you can change”, says Kleine. “So there were times when we had to tell the organisation that it was really time for a final decision. In this way, we have also been able to set the framework.”

“Because some decisions were postponed, we often had to join forces with the suppliers”, says Arvid. “We once had a supplier show up at the door, having driven in his own car during the weekend, with equipment in the boot of his car.” Kleine thought it was nice to see that everyone came together in this success mode: “Everything had to work out and everything had to be safe. The equipment not only had to arrive on time, but also comply with all the regulations. The quality of care is indeed a precondition for the centre.”

The balance that was established provided a solid framework. We mapped the risks and determined how we would tackle them. “We opted for a more pragmatic approach for less risky systems, while we used very detailed procedures for high-risk systems”, Kleine explains. “We have done everything neatly and meticulously, but without the stagnating bureaucracy that you often encounter in existing hospitals.”

“Hands-on, a-typical, successful: the process was unique”

The Princess Máxima Centre attaches great importance to keeping patients mobile. This was the mentality throughout the entire process. Kleine: “The patient must go through the care process smoothly. For children, it is very important for them to be able to move around and get out of their room. The centre works with innovative care concepts, which we had to design technologically during the transition.” Because the opening date of 18 May was rapidly approaching and medical equipment normally had delivery periods of a few months, the team had to act quickly: “We have organised the medical technology in such a way that the centre is ready for innovative care concepts, now and in the future. For example, we have ensured that nurses can monitor all the vital parameters of patients remotely, via smartphones, and even watch them live on monitors. But perhaps the most important thing is that patients are actually mobile now!”

Another important and complex part of the project was the training of health care professionals. Starting up with a completely new organisation has had its share of challenges, but also unique opportunities. For example, through transition meetings we have been able to train all doctors’ assistants, nurses, and medical specialists on all the risky equipment and critical work processes. Even before they started working in patient care. Super-users have also been given extra training and brought into the position for providing support at the workplace, as well as training new colleagues in the future. In fully operational hospitals this is often difficult to manage.

Both Kleine and Arvid proudly look back on a fantastic process. Because of the hands-on mentality and solidarity within the collaboration, but also because it has been a very a-typical experience in hospital care. “Within a ‘pressure cooker setting’ we achieved a solid, final result in a very short time”, says Arvid. “The entire centre, from the doctors to the employees, really came together in the final weeks. Together we rolled up our sleeves. It was very special to see and experience that.”

“We have built a centre completely from scratch: a new organisation, in a new building, with new stuff”, adds Kleine. “We had a successful dynamic with each other, throughout the entire transition. And we achieved this through a combination of being able to shift gears quickly when necessary and maintaining an organisation-wide view when making decisions. It was a wonderful, unique, and inspiring experience.”