The Digital Health Centre - Observatory of Public Sector Innovation

The project improves quality of life for people with a chronical illness by developing and integrating digital solutions in the education of patients. It supplements the physical training but replaces the traditional education in a health centre and offers patients a far more flexible solution. Patients can participate in webinars from home and chat with healthcare professionals and other patients. The use of digital solutions results in both resource optimization and patient empowerment.

Innovation Summary

Innovation Overview

More and more citizens are living with a chronic condition, and for the individual this can minimize the ability to lead a fulfilling life. At the same time the increase in patients puts a pressure on the resources within the healthcare system. A factor in the development of chronic illnesses is unhealthy lifestyles and inequality in health.

The digital health centre project is focused on supporting citizens with type 2 diabetes and/or heart conditions. The main tasks of the municipal health centres are to provide health promotion and disease prevention aimed at the citizens. This is e.g. done through guidance and counselling on a healthy lifestyle. The focus is on providing tools, motivation and support for self-managing a change of their lifestyle and routines. They also create network possibilities for citizens, as well as provide knowledge to health organisations in the civil society. They support rehabilitation after interventions at the hospital and offer preventive home visits to citizens above the age of 75. The health centres employ nurses, dieticians, physiotherapists and doctors.

The challenges for the health centres are:

• Increase in the number of at-risk citizens
• Difficulties engaging the citizens in patient education (for geographic, economic, physical or time reasons)
• Maintaining lifestyle changes has proved very challenging

The limited accessibility and flexibility in the traditional social care services is not compatible with the fact that many citizens have geographical, economical, physical and time limitations. In some cases there are large distances between the patients’ home and the health care centre, and often the services are only available during working hours where many patients are at work. Some patients are unable to use public transportation and some are uncomfortable with group sessions. So there are many reasons why many patients do not attend or drop out of the traditional patient courses offered to help them understand and control their chronic disease. At the same time studies show that the motivation for lifestyle changes are dynamic and often vary over time making it necessary for flexible and long-term services. At the moment this is hard to provide as a lot of the smaller municipalities only have a limited amount of resources available.

The vision of The Digital Healthcare Center is to contribute to solving some of the challenges described above by integrating digital solutions in the social care sector’s services within prevention and health promotion. The vision’s overall aim is to:

1. Increase flexibility and accessibility of the services of the social care sector’s health centres
2. Ensure that lifestyle changes are maintained by developing differentiated services and thereby increasing the citizens’ motivation
3. Support resource optimisation by enabling health care professionals across municipality lines to collaborate on digital services reaching more patients and ensuring that more patients are able to support themselves

The first part of the Digital Health Centre is the Digital Patient Education. This part had two purposes:

1. To develop, test a nd scale up digital services for patient education for citizens with type 2 diabetes and/or heart disease
2. To experiment with different applications to communicate health information in relation to preventative measures in the local health care centres

Two Patient Education Programs called “Live your life with diabetes” and “Live your life with heart disease” has already been successfully implemented and tested. The Patient Education Program consists of three supporting elements:

1. Individual contact between the citizen and the healthcare professional, start- and end sessions
2. Help-to-selfhelp in the form of a series of e-learning modules
3. Online group sessions facilitated by healthcare professionals as webinars

Results of the project so far have been good with higher user satisfaction, fewer drop-outs and more efficient use of healthcare resources. Since the smaller municipalities can join together to produce content to the online-platform and therapists can be used to a wide range of citizens from different areas resources can be better used. Patients that do not like to be in physical sessions with others can join and they have the possibility to go back and revisit the information when they are motivated to implement a change.

The project is now in operation in more than 12 municipalities in the Region of Southern Denmark and is planned to be scaled out nationally in 2020. The perspectives of the solution are wide and include the possibilities for both a geographical spread and the inclusion of more disease areas.

Innovation Description

What Makes Your Project Innovative?

The project is innovative in both the novelty of offering digital solutions instead of traditional services in public healthcare, the involvement of patients in both the design and the testing of the technology and the fact that it follows the general paradigm-shift in healthcare, with focus on the patients’ needs as oppose to the design of the healthcare system.

Organisers believe that innovation must start with the user’s needs. The Digital Health Centre has therefore been developed and tested in an iterative process involving patients. Their definition of user involvement is in alignment with the national definition, which means that importance is placed on the inclusion of the users’ knowledge, opinions and needs, and that they have a direct influence in the development of solutions. In this case the users are citizens with diabetes or heart disease, their relatives and the healthcare professionals. Both technologies and workflows were adapted during the project based on their inputs.

What is the current status of your innovation?

At this point the Digital Health Centre is running in the Region of Southern Denmark and from 2020 seventeen municipalities will be actively using the platform. At the same time both the functionality and the content is under continued development following the feedback from the users. The plan is to spread knowledge about the project and include more disease areas.

Innovation Development

Collaborations & Partnerships

The Digital Health Centre is a partnership between 12 municipalities, The Danish Diabetes Association, The Danish Heart Association, The Steno Diabetes Center and the Region of Southern Denmark through the Health Innovation Centre and the department of cross-sectional cooperation. The partnership started in 2013 and from 2018 the project has been in operation in the South Denmark area. Municipalities from other Danish Regions have also shown interest and will start using the solution in 2020.

Users, Stakeholders & Beneficiaries

The overall project management was done by a joint steering committee and the day-to-day management of the project was handled by the Health Innovation Centre of Southern Denmark in close collaboration with a project group made up of leaders from all involved municipalities. All partners have contributed economically either by direct financing or work hours. The operation of the solution is done in a partnership with shared resources and coordination of further development. (Also see the Evaluation below)

Innovation Reflections

Results, Outcomes & Impacts

Organisers have looked at the results of the project in several areas:
- User satisfaction (80 % are pleased with the digital service as documented in a user questionnaire)
- Business case (shows that the digital version is more cost-effective than the traditional services, especially when more municipalities join)
- Self-reported effects on health and behavior:
o 62 % reply that using the digital health centre services has helped them eat healthier
o 44 % suggest that they are more capable of handling their symptoms and also implementing lifestyle changes
o 59 % have changed their eating habits and 81 % of heart patients have changed their exercising routines for the better
o A third of the participants in the diabetes program have made an appointment to get their eyes and feet checked thereby preventing complications

We can also see that the service reaches a wide target group in relation to age, gender and social background, and that users are generally more IT-ready than expected.

Challenges and Failures

In the project, organisers found quite a difference in the IT-literacy of the health professionals, which was both a strength and a challenge. It meant that the training needed to be differentiated. The development of the solutions proved to be time consuming for some of the involved health professionals, who were already busy handling patients. Some health professionals also raised concern that they did not have the same contact with the citizens when they did not see them in person as often. This suggests that the use of technology also entails a change of culture and behavior that is more long-term. There are typically ambassadors in each organization, which are the carriers of the vision and sometimes also the most knowledgeable about the solutions – these professionals are very important, but they also poses a risk if they change jobs or get sick in the middle of the project. So it is important to make sure that more people are involved and that the solutions are adequately intuitive.

Conditions for Success

One requirement is of course internet access and a computer. Based on the profiles of the participants in the project, along with interviews with the health professionals, organisers see what kind of patients benefit the most from the digital service. There is not really a high level of IT-literacy required and if the citizen can manage an e-mail account they will also be able to use the solution. It also seems that people of very different educational backgrounds and age-groups can benefit from the digital patient education; however it seems that the service appeals more to men than women. It also indicates that the digital version is specifically well suited for newly diagnosed patients and people that in general prefer to access information from their own home. The conclusion is that the digital patient education program should be a supplement to the traditional and physical services offered in the public healthcare sector to ensure the involvement of as many patients as possible.

Replication

The Digital Health Centre is a generic platform with components such as webinars, chat functionality, information texts and videos, etc. These components can be used by many other disease areas and could apply to all types of patients that are currently using the traditional services of the health centres. The content for the patient education needs to be tailored to a digital version according to the disease area in question. This can be done relatively easy using existing materials or professional knowledge. For other languages the content needs to be translated. The platform itself is easy to navigate and maintain – and the only requirement is internet access. The health professionals also need a short introduction to the platform to feel comfortable using it with patients.

Lessons Learned

The great strength of the Digital Patient Education is the fact that it is a digital innovation, which includes a differentiated target group and involves citizens in their treatment in a way that is adjusted to the their needs instead of the systems. The solution enables more citizens to get an insight into their own health as well as tools to handle and prevent diseases. It is a good example of a project where technology is used in a way to support the needs of patients. At the same time it is a good example of cross-sectorial collaboration in both the design and operation of a public digital solution. The lessons learned from this project is therefore most of all that it is possible to re-design a public service with involvement of all users and the use of technology as a supplement to the traditional services.

Another important lesson learned is that the majority of citizens are ready to use these digital solutions and that the expected target group is much broader than anticipated. All age groups, social levels and disease areas are able to use the solution that provides flexibility for the patients. This also means that people who are not able to attend traditional patient education because of their work schedules, physical or social limitations or logistical challenges are now able to join online from their homes instead.

For the professionals the project has put a focus on their understanding and use of technology in their interaction with patients and also allowed smaller municipalities to join forces and thereby reach more patients and heighten the quality of the online courses.

All in all the project has been a success and the following work will be to share the experiences and knowledge gained with both national and international partners as well as include more users and disease areas.

Anything Else?

The results described above are based on an evaluation done to determine whether or not to put the solution into operation and as a result the project was implemented and is now ready to be scaled up. The evaluation was also completed in order to understand which users benefitted from the digital service and to contribute with input for further development. The evaluation was made as a feasibility study with a focus on challenges and possibilities of the Digital Patient Education. 150 citizens participated in the testing of the solution. The evaluation was based on data from:

- Five focus group interviews with 29 participants
- Online questionnaires at the end with a focus on satisfaction and lifestyle changes
- Workshops and interviews with health professionals
- Telephone interviews with approx. 30 citizens
- Data from the municipalities regarding the economics for the business case

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