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.
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.
You recently conducted a project for young cancer patients…
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.