We propose a national digital health research infrastructure with the main objective to facilitate upscaling of digital health products & services in the Netherlands. This infrastructure will enable synergy and complementarity of existing initiatives of multiple academic institutions and key stakeholders (government bodies, healthcare insurers, large enterprises). With this infrastructure we can overcome the most important bottlenecks of development, implementation and upscaling of eHealth. These bottlenecks – hereafter indicated as digital health challenges – are as follows:
1. Ethical & legal implications of use of personal (health) data and use of digital health for the development of digital health products & services. These activities will be linked with national initiatives regarding the use of novel analytical methods for secure data use (i.e. distributed learning within the Personal Health Train initiative).
2. User-centered design/ implementation: low uptake of digital health services by citizens/ patients is a sustaining problem. Therefore one of the core principles of NeLL is co-creation of digital health technology with the end user. This not only ensures sustained use of technology by citizens/ patients, but also optimal implementation in the workflow of the healthcare professional.
3. Scientific validation: traditional methodologies such as randomized controlled trials often do not fit the needs of quickly evolving digital health products & services. Short-cyclic scientific validation trajectories are possible, and should be further investigated and implemented.
Besides gathering evidence for the health claim of a digital health intervention, also validation of cost-effectiveness is of the essence.
4. Structural financing: for validated, cost-effective digital health products & services the path to structural financial compensation should be made easier and quicker. This means that clear indicators for quality of digital health products & services should be created and consensus among important regulating bodies (Zorginstituut Nederland [ZiN], Nationale Zorgautoriteit [NZa]) and healthcare insurers should be reached on these indicators.
5. Education: for knowledge on the above four themes to disseminate to healthcare professionals and patients, digital health should be introduced in curricula of healthcare professionals and made available for patients/ citizens on a large scale.
Concretely, this digital health research infrastructure consists of the following:
- Expert group per theme digital health challenge: expert groups contain all relevant stakeholders for a certain challenge. These expert groups will work on structural solutions for digital health developers and users, and perform scientific research on these topics.
- National eHealth Living Lab: for digital health developers (albeit academic research groups, SMEs, or large health technology enterprises) to overcome digital health challenges, test locations in healthcare will have to be found. Living labs generally offer a safe environment for innovations to be further developed. However, regarding innovation in the complex healthcare sector, it is of the essence that innovations are tested within clinical practice in healthcare processes and institutions themselves. This is also how NeLL currently functions: as a broker between digital health developers and healthcare practice, depending on the need. Thus instead of focusing resources on new physical Living Labs, we will facilitate pilot and scaleup studies that are carried out in healthcare practice by creating the right legal, ethical and scientific validation framework.
- Public-private partnerships/ use cases: together with our partners we will select several use cases throughout the healthcare domain, that consist of readily validated digital health products & services that are ready for scaleup steps. Together with expert groups we will find solutions for digital health challenges that are being encountered, and these solutions found for these use cases will be generalized and made available in the knowledge platform. First
o Telemonitoring/Box/Innovatic, Aivido, Philips/LUMC
o Decision support on intensive care/Pacmed/AMC
- eHealth knowledge platform: the knowledge platform is used to disseminate learnings from use cases and concrete output from expert groups to digital health developers, healthcare professionals, healthcare insurers, and other relevant stakeholders
- National eHealth app library. VWS/ landelijk toetsingskader
Commissioned by the Dutch ministry of Health Wellbeing and Sport (VWS) NeLL set out to collaborate with a broad array of players in both the Dutch and international field of eHealth testing, to come to a widely supported national framework for testing and storing eHealth applications. This framework will be based on the CEN-ISO standard, which is an international and EU-supported initiative in which NeLL has had an key role during the conceptualization phase.
Our national eHealth infrastructure contains three focus areas, in which collaboration with relevant networks and stakeholders will be actively created.
- Artificial intelligence (AI): AI has many applications within the digital health domain, aimed primarily at precision prediction/ personalization of treatment/ pattern recognition. Especially now wearable data streams are increasing and routine clinical data are becoming increasingly abundant, AI will be a powerful tool in improvement of digital health products & services. We already collaborate within the Dutch AI coalition, and have a close collaboration with CAIRELab in the LUMC.
- Lifestyle: one of the most important conditions of a sustainable healthcare system is effective prevention. The majority of high volume, high impact diseases in the Western world are strongly lifestyle related, thus lifestyle change is an essential topic within prevention. Although a large portion of digital health applications target lifestyle change, it remains a great challenge.
- Population health management. Digital health offers unprecedented opportunities for proactive population health management, enabling proactive and thus more efficient prevention. In this we collaborate with the Campus The Hague of Leiden University, an expert in this field.