Objective: Structural reimbursement can be an important factor for large-scale implementing and upscaling of remote patient monitoring (RPM). During the COVID-19 pandemic, the Dutch Healthcare... Show moreObjective: Structural reimbursement can be an important factor for large-scale implementing and upscaling of remote patient monitoring (RPM). During the COVID-19 pandemic, the Dutch Healthcare Authority expanded regulations, creating novel opportunities to reimburse RPM. Despite these regulations, barriers to the reim-bursement of RPM remain. This study aimed to identify the barriers and facilitators of structural reimbursement of RPM in hospital care in the Netherlands and to propose actionable recommendations. Methods: This is an exploratory qualitative study with relevant stakeholders in the Dutch purchasing market: the Dutch Healthcare Authority, health insurers, and healthcare providers. Semi-structured interviews were held between October and December of 2020. All interviews were conducted using a digital medium, transcribed verbatim, and thematically analyzed. Results: Multiple perceived barriers were mentioned: wrong pocket problems (i.e. the entity that bears the costs of implementation does not receive the benefits), no uniform quality and outcome indicators, lack of willingness to redesign care pathways by providers, and difficulties implementing cross-sector models. Perceived facilitators included interdisciplinary cooperation and transparency, the use of alternative payment models, increase in the total number of patients per RPM project, and the optional reimbursement scheme. Conclusion: Our interviews found barriers and facilitators concerning structural reimbursement of RPM in hos-pital settings in the Netherlands. Our results emphasize that the successful integration of structural reimburse-ment requires: 1) understanding the improvement potential of RPM by creating business cases, 2) co-creation (redesigning care paths) from the outset of an RPM project, 3) and allocating financial risk by providers and insurers. Public Interest Summary: The COVID-19 pandemic has demonstrated the strong potential of consultation and monitoring patients at a distance. Remote patient monitoring -the use of information technologies for moni-toring patients at a distance -is seen as a potential solution to urgent challenges in the healthcare system. Nevertheless, embedding remote patient monitoring innovations into routine healthcare is often challenging, partly due to difficulties in reimbursing these initiatives. Barriers to reimbursing remote patient monitoring included organizational factors, no uniform quality and outcome indicators, and difficulties using different payment models. Perceived facilitators included an increase in the total number of patients per project, better interdisciplinary cooperation and transparency, and help from the Dutch Healthcare Authority. Introducing these insights into healthcare policy dialogues could support reimbursement of remote patient monitoring and stim-ulate the collaboration of healthcare stakeholders responsible for implementing and scaling up remote patient monitoring projects. Show less
ObjectiveStructural reimbursement can be an important factor for large-scale implementing and upscaling of remote patient monitoring (RPM). During the COVID-19 pandemic, the Dutch Healthcare... Show moreObjectiveStructural reimbursement can be an important factor for large-scale implementing and upscaling of remote patient monitoring (RPM). During the COVID-19 pandemic, the Dutch Healthcare Authority expanded regulations, creating novel opportunities to reimburse RPM. Despite these regulations, barriers to the reimbursement of RPM remain. This study aimed to identify the barriers and facilitators of structural reimbursement of RPM in hospital care in the Netherlands and to propose actionable recommendations.MethodsThis is an exploratory qualitative study with relevant stakeholders in the Dutch purchasing market: the Dutch Healthcare Authority, health insurers, and healthcare providers. Semi-structured interviews were held between October and December of 2020. All interviews were conducted using a digital medium, transcribed verbatim, and thematically analyzed.ResultsMultiple perceived barriers were mentioned: wrong pocket problems (i.e. the entity that bears the costs of implementation does not receive the benefits), no uniform quality and outcome indicators, lack of willingness to redesign care pathways by providers, and difficulties implementing cross-sector models. Perceived facilitators included interdisciplinary cooperation and transparency, the use of alternative payment models, increase in the total number of patients per RPM project, and the optional reimbursement scheme.ConclusionOur interviews found barriers and facilitators concerning structural reimbursement of RPM in hospital settings in the Netherlands. Our results emphasize that the successful integration of structural reimbursement requires: 1) understanding the improvement potential of RPM by creating business cases, 2) co-creation (redesigning care paths) from the outset of an RPM project, 3) and allocating financial risk by providers and insurers. Show less
Silven, A.V.; Peet, P.G. van; Boers, S.N.; Tabak, M.; Groot, A. de; Hendriks, D.; ... ; Villalobos-Quesada, M.J. 2022
Background Implementation of digital health (eHealth) generally involves adapting pre-established and carefully considered processes or routines, and still raises multiple ethical and legal... Show moreBackground Implementation of digital health (eHealth) generally involves adapting pre-established and carefully considered processes or routines, and still raises multiple ethical and legal dilemmas. This study aimed to identify challenges regarding responsibility and liability when prescribing digital health in clinical practice. This was part of an overarching project aiming to explore the most pressing ethical and legal obstacles regarding the implementation and adoption of digital health in the Netherlands, and to propose actionable solutions. Methods A series of multidisciplinary focus groups with stakeholders who have relevant digital health expertise were analysed through thematic analysis. Results The emerging general theme was 'uncertainty regarding responsibilities' when adopting digital health. Key dilemmas take place in clinical settings and within the doctor-patient relationship ('professional digital health'). This context is particularly challenging because different stakeholders interact. In the absence of appropriate legal frameworks and codes of conduct tailored to digital health, physicians' responsibility is to be found in their general duty of care. In other words: to do what is best for patients (not causing harm and doing good). Professional organisations could take a leading role to provide more clarity with respect to physicians' responsibility, by developing guidance describing physicians' duty of care in the context of digital health, and to address the resulting responsibilities. Conclusions Although legal frameworks governing medical practice describe core ethical principles, rights and obligations of physicians, they do not suffice to clarify their responsibilities in the setting of professional digital health. Here we present a series of recommendations to provide more clarity in this respect, offering the opportunity to improve quality of care and patients' health. The recommendations can be used as a starting point to develop professional guidance and have the potential to be adapted to other healthcare professionals and systems. Show less
Silven, A.V.; Peet, P.G. van; Boers, S.N.; Tabak, M.; Groot, A. de; Hendriks, D.; ... ; Villalobos-Quesada, M. 2022
BackgroundImplementation of digital health (eHealth) generally involves adapting pre-established and carefully considered processes or routines, and still raises multiple ethical and legal dilemmas... Show moreBackgroundImplementation of digital health (eHealth) generally involves adapting pre-established and carefully considered processes or routines, and still raises multiple ethical and legal dilemmas. This study aimed to identify challenges regarding responsibility and liability when prescribing digital health in clinical practice. This was part of an overarching project aiming to explore the most pressing ethical and legal obstacles regarding the implementation and adoption of digital health in the Netherlands, and to propose actionable solutions.MethodsA series of multidisciplinary focus groups with stakeholders who have relevant digital health expertise were analysed through thematic analysis.ResultsThe emerging general theme was ‘uncertainty regarding responsibilities’ when adopting digital health. Key dilemmas take place in clinical settings and within the doctor-patient relationship (‘professional digital health’). This context is particularly challenging because different stakeholders interact. In the absence of appropriate legal frameworks and codes of conduct tailored to digital health, physicians’ responsibility is to be found in their general duty of care. In other words: to do what is best for patients (not causing harm and doing good). Professional organisations could take a leading role to provide more clarity with respect to physicians’ responsibility, by developing guidance describing physicians’ duty of care in the context of digital health, and to address the resulting responsibilities.ConclusionsAlthough legal frameworks governing medical practice describe core ethical principles, rights and obligations of physicians, they do not suffice to clarify their responsibilities in the setting of professional digital health. Here we present a series of recommendations to provide more clarity in this respect, offering the opportunity to improve quality of care and patients’ health. The recommendations can be used as a starting point to develop professional guidance and have the potential to be adapted to other healthcare professionals and systems. Show less
While the opportunities of ML and AI in healthcare are promising, the growth of complex data-driven prediction models requires careful quality and applicability assessment before they are applied... Show moreWhile the opportunities of ML and AI in healthcare are promising, the growth of complex data-driven prediction models requires careful quality and applicability assessment before they are applied and disseminated in daily practice. This scoping review aimed to identify actionable guidance for those closely involved in AI-based prediction model (AIPM) development, evaluation and implementation including software engineers, data scientists, and healthcare professionals and to identify potential gaps in this guidance. We performed a scoping review of the relevant literature providing guidance or quality criteria regarding the development, evaluation, and implementation of AIPMs using a comprehensive multi-stage screening strategy. PubMed, Web of Science, and the ACM Digital Library were searched, and AI experts were consulted. Topics were extracted from the identified literature and summarized across the six phases at the core of this review: (1) data preparation, (2) AIPM development, (3) AIPM validation, (4) software development, (5) AIPM impact assessment, and (6) AIPM implementation into daily healthcare practice. From 2683 unique hits, 72 relevant guidance documents were identified. Substantial guidance was found for data preparation, AIPM development and AIPM validation (phases 1-3), while later phases clearly have received less attention (software development, impact assessment and implementation) in the scientific literature. The six phases of the AIPM development, evaluation and implementation cycle provide a framework for responsible introduction of AI-based prediction models in healthcare. Additional domain and technology specific research may be necessary and more practical experience with implementing AIPMs is needed to support further guidance. Show less
Despite significant efforts, the COVID-19 pandemic has put enormous pressure on health care systems around the world, threatening the quality of patient care. Telemonitoring offers the opportunity... Show moreDespite significant efforts, the COVID-19 pandemic has put enormous pressure on health care systems around the world, threatening the quality of patient care. Telemonitoring offers the opportunity to carefully monitor patients with a confirmed or suspected case of COVID-19 from home and allows for the timely identification of worsening symptoms. Additionally, it may decrease the number of hospital visits and admissions, thereby reducing the use of scarce resources, optimizing health care capacity, and minimizing the risk of viral transmission. In this paper, we present a COVID-19 telemonitoring care pathway developed at a tertiary care hospital in the Netherlands, which combined the monitoring of vital parameters with video consultations for adequate clinical assessment. Additionally, we report a series of medical, scientific, organizational, and ethical recommendations that may be used as a guide for the design and implementation of telemonitoring pathways for COVID-19 and other diseases worldwide. Show less
