Dutch telecare projects need flexible funding and centralised co-ordination

Amsterdam 24 May 2002The Dutch Electronic-Highway Platform (EPN) has made an inventory of telecare projects in The Netherlands. The use of Information and Communications Technology (ICT) tends to reduce the pressure on health care professionals, saves time and delivers better quality for the patient. The research is based on seven projects in which tele-consultation facilities between dermatologists, general practitioners, physiotherapists, ophthalmologists, and radiologists are playing a key role. Projects in Almere, Salland, and the Gouda region serve as leading models but the overall co-ordination in Dutch telecare still has to be improved.


Tele-consultation includes the use of e-mail services to ask for a second opinion among medical specialists, to answer patient questions, and to transmit medical images. According to the EPN study, tele-consultation is highly valued by both patients and physicians, since it amounts 2,5 times less in a second visit to the specialist. Tele-consultation with a specialist allows the patient to spend less time in waiting rooms, minimise travelling, and obtain a faster diagnosis. Since the use of ICT is easy and inexpensive, thus reducing the break-even point, the EPN strongly promotes the implementation of broadband applications in order to bring video-conferencing at the doorstep of the physician.

"Telecare is rather an organisational than a technical issue", stated Arthur van Buitenen, senior programme manager telecare at EPN. "The parties involved have to agree on the objectives at which the project is aiming." The majority of telecare projects in The Netherlands is lacking a centralised co-ordination as well as mid- and long-term planning. Good planning constitutes a priority in building a healthy "care chain" because lots of the devices in health care are obsolete and therefore difficult to integrate into the current Internet applications.

According to EPN, telemedicine is able to optimise the organisation of health care initiatives at a regional level. At present, it is not easy however to determine where the highest cost-effectiveness can be reached so government, industry, and health insurance companies are sitting on the fence. EPN thinks the government should undertake action by funding projects, covering financial risks, and investing directly in health care ICT projects. Professor Theo de Vries, president of the Dutch Institute for Telemedicine (NITEL), endorses the conclusions of the EPN study and sees the financial cost as the most difficult hurdle to take.

The government has to act now, according to Dr. de Vries. "The shortage in medical staff will rise to some 20 or 30 percent in 2010, with severe problems already occurring in 2005. Health care personnel currently is spending forty percent of working time on administrative tasks. The use of ICT can reduce this caseload with 25 to 50 percent. This requires heavy investments which have to be compensated by reducing the costs of absenteeism from 9 to 6 percent."

According to EPN, the most successful telecare projects are characterised by a tight collaboration between hospitals, general practitioners, home care agencies and other involved health care parties. In the Salland region, the focus lies on the improvement of the organisation and technical infrastructure in which the Deventer Regional Hospital has a key role. In the Mid-Holland region, there is a strong co-operation between health care providers beyond the hospital walls, and in Almere, general practitioners, pharmathicians, and social workers are the leading force.

Arthur van Buitenen also indicated the necessity to create new processes through the formation of a virtual team of specialists from different medical centres to care for one patient. Up to now, medical teams often only collaborated within the walls of a single hospital with each institution having its own collection of patient records. The use of health telematics allows to create one single record managed by a central co-ordinator, which is preferably the patient.

In Almere, each inhabitant receives access to his own health portal. Authorised health care providers can consult the data which are relevant to them. Almost every general practitioner has become a member of the Care Group Almere. The city supplies funding for the development of personal health care portals. In addition, the municipality likes to promote the city of Almere as knowledge town and is actively stimulating the provision of a contemporary telecommunications infrastructure, including an accelerated implementation of optic fibre to each home address.

In Mid-Holland, precisely those organisations which are involved in chronic disease management such as asthma and diabetes, have taken steps towards a joint approach. The problem is that legally, all these care services are funded in a different way. As a result, a model has been implemented to manage the funding of a telecare project to treat patients suffering from the effects of cerebral haemorrhage. "Experiments with flexible financial legislation are very important given the fact that many projects land in a dead-end street because of legal obstacles", stated Mr. van Buitenen.

The Deventer Hospital, in collaboration with a regional health insurance agency, has taken the initiative to build a local technical infrastructure in which all institutions jointly can use the provided facilities. In turn, the Society of General Practitioners in Salland is stimulating the co-operation among home care agencies, physicians, and hospitals, according to the Automatisering Gids which served as a news source for this article.

Leslie Versweyveld

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