Recap - Innovatieve oplossingen voor chronisch zieken
BLOG: How i got involved in Recap
Written by: Erik Korsten
Partner: Catharina Ziekenhuis
This is my first (and probably also my last) blog. Being an internet-user from the start (took an hour to get online, using a 300 baud modem), social media never interested me. I’m an anaesthesiologist-intensivist in the Catharina Hospital in Eindhoven, and also a part-time professor at the Technical University of Eindhoven, The Netherlands (Dpt of Electrotechnical Engineering, I work there with a Signal Processing Group). I’m sixty years old, which may explain my lack of experiences with social media (as one of my daughters once told me:”facebook is not for you, dad”). My two major research-topics are Signal-processing in Images (Ultrasound, and MRI) and Clinical Decision Support. A major part of the work of an anaesthesiologist-intensivist is (early) signal processing in order to prevent deterioration of a patient, which may explain my interest in Signal Processing at the University. Clinical Decision Support may be helpful in this respect. First of all, all electronic signals (from monitors, pumps, devices and ventilator) can be analysed and appropriate intelligent warnings generated. But also – and probably more important – the doctor, nurse and even patients – can be warned if the standard of care is sub-optimal (for instance a medication is not given, while it is indicated; a medication dose is not adjusted when renal function is not optimal and thousands of other so called clinical rules). In fact, practicing medicine has become so complicated; the pressure on the system has increased so much (due to cost-reduction, increased workload, elderly patients, elderly doctors(!), part-time doctors etc. etc.) combined with an ever increasing medical knowledge, that it is almost impossible for an individual general practitioner, specialist or nurse to do it right. CDSS may help; in the hospital, but also at home. At the Technical University, we developed a CDSS and my PhD candidate started – 10 years ago – based on his scientific work, his own Company (Medecs BV, Eindhoven, The Netherlands). The timing was right, because he is now one of the most successful spin-offs of the University and we created – together with the Department of Pharmacy in the hospital) a real “knowledge industry”, with several PhD’s and master-students. In June 2013, my PhD candidate Carolien van der Linden, a medical specialist in geriatrics, successfully defended here thesis “Adverse Drug Reactions in Individual Patient Care”. She noted that she “detoxicated” an elderly patient in the hospital, by stopping a drug that caused for example, renal insufficiency, but the same drug was represcribed by the GP a few months later. Apparently, the Health Care System does not provide the right information right moment at the point of care. Van der Linden is one of the first to use a transmural Clinical Decision Support System ( a system in use in the hospital as well as the home-care situation). She documents the reason for discontinuation of a specific drug in a specific patient and the GP (or another specialist) will get an alert, that this specific drug is contraindicated in this specific patient. One of the challenges is what type of warning is acceptable to the user. For instance, a pop-up on a screen may be irritating, leading to alert-fatigue. Another PhD-candidate (Anne-Marie Scheepers-Hoeks), will defend here thesis early 2014 on this topic.
This work has generated some interest and that is how I got involved in RECAP. Progress is slow; it always is in Medicine. Home-care monitoring, less visits to the hospital and prevention of hospitalization is of coarse key in the near future (both economically, but also socially). Using intelligent technology, (remote) monitoring and CDSS may help to achieve this goal. Within RECAP, I have met colleagues and partners in Industry, from different countries, with whom we discuss these goals and are now in the process of starting – initially small – patient studies. These contacts are extremely useful and motivating.