Lucien Engelen is director of the Radboud REshape & Innovation
Centre at Radboud University Nijmegen medical centre
in the Netherlands. His work looks at how new technologies can change patient
care models in the context of rising demand for healthcare, shortages of
skilled staff and restrictive budgets. He is organising TEDxMaastricht "The Future of
Health" on 2 April.
How could social networks be used to improve
healthcare provision?
We tend not to use the biggest resource in healthcare – the patients
themselves. So I'm trying to figure out possible uses for digital technologies
like Facebook but also real-life social networks to improve healthcare
provision.
How have we got to this position, where patients
aren't listened to?
Over the past decades we have tended to take healthcare away from the
people themselves. This started with bringing people into hospitals rather than
caring for them in their homes. Healthcare has become centralised in
institutions, rather than in networks as it was in the old days. But new
technology is enabling us to reverse that, while keeping the same high
standards.
For example?
I wanted patients to be able to talk to their physician via video much like
they would via Skype – however Skype is not secure enough for healthcare
legislative standards. There are video conferencing systems but they require
dedicated hardware. So we designed a hardware-free system. This means that
patients who would normally have to visit their physician four times a month,
for example, can know do three of these consultations via video.
What do doctors think about this?
Doctors are aware of the challenges of double health care demand – the idea
that, mainly because of demographic changes, the demand on healthcare
professionals over the next 20 years will double. Moreover their budgets are
frozen and there are shortages of skilled personnel, so we have to come up with
smart solutions. This is one of the examples that could help to make healthcare
provision affordable and easier.
Older people are big users of healthcare. Are
you concerned that some might not want to use computers?
It's a misconception that people over 65 do not use computers. They love
them, they are always consulting Dr Google.
At the hospital we have a hang-out spot for young cancer patients,
with internet and coffee and someone to talk to about problems – for example
problems at work, or how to get finance. They asked us to set up an online
version, so they could interact with each other when they weren't undergoing
chemotherapy. So we built a secure online community called AYA4 ("all
information you have ever asked for") for young Dutch cancer patients. The
nice thing is that in this online community there are no physicians or nurses,
we just have a community manager to answer technical queries. There is a button
for medical questions, which are sent directly to an oncologist who answers
back to the community.
The users love it. They can talk about their health problems, which they
can't on Twitter. We can point them to the right information about their
cancer, so they get peace of mind. The community includes information about
diet, finance, law etc, and they give us feedback on how we could do a better
job. We are now rolling it out to six other hospitals in the Netherlands.
You have also built an app so users can report
the location of automated external defibrillators (AEDs) throughout Holland…
Yes, at present we have 17,000 locations and we are in contact with 10
other institutions to set up maps in their countries. No one is registering
their AEDs – I can buy one and no one knows I have it. The Dutch Red Cross is
helping us validate the locations, so over time the database will become more
accurate. Then if a someone you are with has a cardiac problem you can use the
app to find the nearest AED, saving valuable time.
You also tried uploading your weight to Google
health and tweeting it every morning…
Yes I was flabbergasted by the reaction. People would say "Lucien you
should have a light lunch today" – it was peer pressure. Setting this up
in closed communities for obese people or people who want to stop smoking could
help them stay more healthy.
Privacy is a controversial topic and health data
is particularly sensitive…
I think we overestimate this – youngsters are far less engaged with privacy
than people of a mature age. They share a lot of things that you and I would
get grey hair about. But we need more legislation to guide it.
What do we do with this incredible amount of
health data?
That is a real challenge. We need new ways of finding our way through it.
On the intersection between big data and narration is where we can really
change healthcare for the better.
You want people to take control of their own
health?
Only if they want to. If they want to but they can't, we will teach them.
If they want to but they can't because there is no system or technology, we
will build it for them. But if they don't want to we will deliver healthcare in
the regular way. Some people think it is one way or the other, but it's not.