Waiting lists, staff shortages, exploding demand for care, administrative burden. The challenges in mental health care (GGZ) are many. Can digitization provide a solution? Perhaps the use of digital tools is not a panacea. But with solutions for both the treatment room and the back office, digitization definitely contributes to a sustainable, future-proof mental health care. This is the widely shared outcome of the recent HCI Inspiration Sessions for the GGZ. Over two hundred professionals gave substance to the event's motto in Singer Laren: 'Together for better mental healthcare through digitization!'
"Digitization may not be the solution to all challenges in the GGZ, but it is an important part of that solution," said HCI director Marc Prette. "There are big gains to be made in the back office, for example by digitally routing clients to the right type of care. But also by facilitating networks through which healthcare providers can efficiently exchange data with each other. So from that perspective, I say a resounding 'yes' to the question of whether digitization can help solve waiting lists. But digitization goes much broader. It can also make treatment itself not only more efficient, but better."
Meaningful solutions
With a broad portfolio that includes e-health modules and a digital patient environment in addition to an electronic patient record, Health Cloud Initiative (HCI) serves over 40,000 healthcare providers and -via the Your Care Online environment- millions of patients in primary care. Software may be the core business, but HCI wants to be more than a supplier of digital gimmicks. Ultimately, HCI is about meaningful, effective solutions that actually contribute to a better mental health care. For that reason, HCI explicitly seeks dialogue with key stakeholders. In Laren, this dialogue revolved around questions such as: will digitization shorten waiting lists in healthcare? Do professionals and clients have sufficient input in digital innovation? And: is digitization the fastest route to a good, accessible and future-proof mental health care?
GGZ without borders
The perspective of healthcare providers was expressed on the stage of the Singer Theater by director Jennifer van den Berg of SOL Psychotherapy. As a care provider who works completely digitally, the advantages of this way of working are obvious as far as Van den Berg is concerned. Both practitioner and client are no longer bound by boundaries in time and space. "We provide care throughout the country. If a practitioner is needed on Texel who speaks Turkish, that is no problem for us. If necessary, we also cross the border. For example, if mental health care is needed for a soldier on a mission abroad, that is no problem for us."
To underscore the effectiveness of digital mental health care, Van den Berg cited a few telling figures. "In four regions where waiting lists were running out of steam, we managed to reduce them considerably. Instead of eight months, we were able to get people into therapy within two weeks."
Not aloof
A common reservation regarding digital mental health care is that it would be impersonal and distant. According to Van den Berg, the opposite is the case. "In fact, there is a lot of contact with the client and precisely at those moments when the client wants it. By video calling, chatting, exercises, questionnaires or a digital diary, we can not only involve the client more actively in the treatment, but the practitioner also has much more information than in a regular setting, where a practitioner sees a client only once in a while."
Client as a starting point
Director Dienke Bos of interest group MIND also sees positive aspects to digital mental health care. But she does formulate some important reservations from a client perspective. For example, as far as she is concerned, the quality of treatment should always be the starting point. "Digitization can really improve mental health care. In addition, it can certainly contribute to cost reduction and workload reduction. But we should not reverse the two. Cost reduction should not be the primary goal."
Physical alternative
Accessibility and inclusiveness of digital care also deserve serious attention, as far as Bos is concerned. "More than half of people with serious psychiatric problems live around or below the poverty line. The chances that a working laptop and stable Internet are present there are not that great. Moreover, not everyone is digitally literate. So a full-fledged physical alternative must always be present."
Sensitive information
And then, of course, there is the issue of privacy and data security. Especially in a sector like mental health care where highly sensitive, personal information is at stake, these issues deserve extra attention. According to Bos, the best recipe for preventing accidents is client inclusion. "Developing digital solutions should always be done together with the end user. Not just test it at the end of the process, but involve that client from development to implementation."
Scaling up
In another area, too, digital tools are not yet sufficiently exploited, in her opinion. "Digital tools are often used for the one-on-one relationship with the client, but how do we ensure that care providers find each other in digital networks. We will really have to invest in digital network care."
Of the care providers Van de Pol encounters in the CZ working area, about a third are really working on digital care paths. This suggests that digitization is an irreversible process. "We really can't and don't want to do without digital care anymore," Van de Pol said. "Given the growing care gap, we really need to organize care differently, but we don't yet see an effect on accessibility and costs. Many innovations fail at scale-up."
Artificial intelligence
At least scaling up is not the problem with the newest shoot on the tree of digital transformation: artificial intelligence. After the introduction of ChatGPT in 2023, the number of users grew to 200 million a week in no time. With the rise of generative ai, also known as general purpose ai or large language models (LLMs), also comes big budgets; Elon Musk's LLM Grok is reportedly worth $18 billion.
Given its meteoric rise and disruptive nature, no discussion of digital healthcare is complete without talking about ai, said Gideon Kreytz, innovation director at HCI. "Whether you're a consumer, client or healthcare provider, we're going to use it more and more," Kreytz said. "Right now it's mostly about speech-to-text. If you as a practitioner want to explain something in understandable language, ChatGPT can do that. But there are also already models that tell the practitioner when they forget to ask something. Automatic pattern recognition is already widely used in radiology. Soon the anamnesis will already have been done online and follow-up appointments will be scheduled without you having to do anything as a practitioner."
Staying critical
Kreytz also sees dangers. Bias in source files and data models can negatively affect access and quality in healthcare. Privacy is a constant concern with data-eaters like LLMs. And then, within the context of healthcare, there is also an emphatic question of who is responsible for the outcomes: the creator of the model, the healthcare provider or perhaps the client? Kreytz's advice: "Stay curious, but critical. We at HCI will certainly help you with that."
Voice reporting
Maarten Timmers' presentation made it very clear what ai can do in practice. As a general practitioner, he noticed to his frustration that he was increasingly glued to his screen during patient encounters. "Because I constantly had to fill out forms, I hardly had any attention left for the patient across from me." So Timmers took the initiative with an ai developer under the name Juvoly to develop his own application for voice-based reporting. "The software listens in, transcribes and makes a summary for the record," Timmers said. "The computer is no longer on the table; it hangs on the wall. When a patient or client comes in, the file opens automatically. Any treatment plan or referral letter is ready in the background. Keyboard and mouse are no longer necessary. A referral follows automatically to someone further down the chain. This further improves collaboration."
Challenge
With Juvoly, Timmers has not only made his own work fun again, but also that of colleagues in five hundred other general practices. Together with HCI, Juvoly is now also setting its sights on hospitals and the mental health sector. With more than a thousand healthcare providers using the HCI GGZ EPD, HCI is a logical partner to scale up. One of the technical challenges the two parties are working on is further streamlining information transfer, which ideally will ensure that the spoken word automatically lands in the right place in the EHR.
To underline the scope, functionality and agility of this EPD, Chris-Jan van Schendel, mental health segment lead at HCI, had users from different domains speak in his presentation. All three noted that they had found a listening supplier in HCI, with an open ear for their context-specific needs and requirements.
In addition to this EHR, HCI also offers a wide range of e-health applications under the Embloom brand name. Embloom bills itself as an efficient, user-friendly online platform that helps healthcare providers and caregivers with questionnaires, e-health modules and image calling. "Embloom stands for enriching and improving care for people with psychological and physical complaints," said Sanne Vrijhoeven, Embloom consultant. The underlying mission is to ensure accessibility and affordability of high-quality care.
Patient journey
For Quli director Hans ter Brake, "quality of care" always starts with the client or -better said- the citizen. "Actually, as a care provider, you are a temporary passerby in your client's life," Ter Brake reminded the mental health professionals at Singer Laren. "That person is the only constant in all care processes. You are occasionally part of his or her life journey."
Ter Brake's choice of words is a deliberate one. For years he has been making the case for a digital environment in which citizens can direct their own care and health journey. And that with the same ease of use that has been taken for granted in the travel world for years. "I don't know how you book your vacation, but I do it through a travel app. Within that environment, I can book a flight and a hotel, as well as a bus or excursions."
Because of all the partitions, silos and domains, there is often no such seamless experience in healthcare, Ter Brake said. "If you come out of the hospital with a broken leg, where do you get your crutches?"
People-oriented platform
Ter Brake's ideal of an online "people-centered platform" where all lines -from informal support to social domain to formal care- come together has recently moved a step closer. Under the umbrella of HCI, Quli and Uw Zorg Online are working on an integration. This will give both the functionality and reach of the platform a huge boost.
The search for synergy between Quli and Your Care Online makes clear what HCI wants to stand for: making impact through scale without growing so large that the end user disappears from the picture. "We as HCI have a lot of contact with our customers," director Prette said in his closing remarks. "But often that conversation is about specific platforms or solutions. I see this inspiration session as a first step to continue talking about digitalization on a higher level."
Source: Dutch Health Hub