Healthcare is experiencing a growing shortage of physicians, from GPs to nurses and specialists in disciplines such as geriatrics. As a result, intramural healthcare institutions are finding it increasingly difficult to assure everyday medical care for their clients. CLEO SmartCare (CLEO) offers a solution for so-called low-complexity medical care that GPs are qualified to offer. With a nurse on site, a remote CLEO physician and a smart communication platform between the two, CLEO provides residents of institutions with the necessary basic care in an efficient and personal way. Here is how it works: the nurse uses certified questionnaires and telediagnostics to collect the right information and prepare for a consultation with the CLEO physician. This information is shared via the CLEO platform. If necessary, the physician can request an additional examination, offer medical advice about diagnostics or treatment or even prescribe medication directly. This puts the nurse, the CLEO physician and the physician of the institution in contact asynchronously and remotely, allowing for more clients to be provided with proper basic care within the same time frame. Part of the treatment team, the CLEO physician is always someone the institution knows and they perform routine assessments together. Communication lines between the triage nurse, CLEO physician and the physician of the institution are short and the nurses are properly trained to work with the CLEO platform and all the instruments. A pilot is being conducted at the time of writing in the elderly care institution Liberein in Enschede, investigating whether and in what way teleconsultation can offer a technological solution to the capacity problem.
Implementation (pilot) and experiences/challenges
CLEO’s co-founder Rudi de Goede had worked as a GP with Liberein for some time when he decided to actively pursue making the healthcare system future-proof. He had spent several years in the United States where he gained prior experience with digital healthcare, but he had been working with the Swedish digital GP service Docly in the Netherlands as well, at the Eemland GP service. Rudi believed that he could use IT to create a more appealing environment for nurses and physicians while keeping high-quality healthcare accessible and affordable for vulnerable patients. His enthusiasm for digital healthcare innovation quickly took over Liberein, which led to a pilot with CLEO. ”It started with a clarification of the technology and its underlying processes. In May 2021, we were divided into two groups and submitted a fictitious clinical picture in preparation for our CLEO training. During the actual training, they showed us how to manage the process in CLEO via PC or iPad. Getting used to a new technology applied within the context of our current working method, was a great experience’’, Martijn Buursink, triage nurse at Liberein explains.
It did not take long for Liberein to realise that CLEO can help organise healthcare in a more sustainable way. ‘’We have been noticing for some time that more and more people knock on our door with a complex health issue while it is becoming increasingly difficult to finding high-quality staff to meet that demand. That is why our triage nurses were curious and enthusiastic about a new, more efficient working method from the start. At Liberein, we view the CLEO pilot as an initial exploration of teleconsultation as one of the potential solutions for our capacity issue. In our experience CLEO saves us time with one client, allowing us to spend more time on clients in need of more complex care. Thanks to digital assistance, we can continue to offer all our clients high-quality, personal care. A pleasant experience for clients, nurses and physicians alike, who experience more flexibility in their work’’, says Nienke de Haan, project leader innovation & healthcare technology at Liberein.
‘’Initial responses are very positive, but there is also plenty of room for improvement’’, De Haan adds. De Goede admits that it remains difficult to communicate back from the CLEO platform to the floor: ‘’The connection with software systems associated with healthcare dossiers remains suboptimal. You want the ability to upload the details of the consultation with the CLEO physician to the electronic client dossier, but the only way to do that for now is by making a copy. In addition, communication with the in-house physician via the ECD has yet to be automated.” Triage nurse Petra Pahlplatz anticipates that these challenges may lead to problems in the future: ‘’Completing and uploading the substantive questionnaires is very easy, but the ability to relay your actions back to the organisation is missing. This is not too big of an issue as long as the number of CLEO users remains low, but if we intend to double the use of the platform, this needs to become a lot clearer and more transparent.” Experiences gained with CLEO in this pilot are openly shared and discussed in a focus group with CLEO data analyst Kirsty ten Have and Liberein’s triage nurses. This allows for co-creation to take place between the wishes voiced by our users on the one hand and technical capabilities on the other, in order to establish appropriate iterations.
Despite the fact that plenty of room for improvement remains, CLEO is pleased with the pilot at Liberein. It offers them the ability to gain practical experience, identify the positives and negatives and take these things into account while continuing to develop the product. Meanwhile, the social business case of the CLEO platform is being formulated, though it remains difficult to estimate for now. ‘’This process is one of true pioneering but we also need to focus on the business case in order to turn CLEO into a sustainable solution. We are analysing, for example, how many on-site physicians (in terms of FTE) could be spared with the number of daily remote consultations that can be conducted with CLEO. In certain situations, this would make it easy to demonstrate CLEO’s added value’’, De Goede clarifies.
Future perspective
CLEO is now CE certified and has proven to be scalable. Still, CLEO will keep investing in continued development steps heavily in order to realise sustainable and national scaling. But according to Paul de Kort, CLEO’s co-founder, a cultural shift within the healthcare industry will have to take place as well: ‘’On a regular basis, I see columns and articles that treat the use of digital technology and the provision of warm-hearted healthcare as mutually exclusive. I believe the two can go hand in hand if we instigate an industry-wide change in how we think. This is going to take some time.” De Kort also believes that insurers carry a responsibility to invest in the early stages of potentially disruptive technology more often. This is one aspect where CLEO is seeking the financial means to keep growing and expand its functionalities. Until that time, CLEO and Liberein will keep learning from each other in order to find the perfect solution to the capacity problem facing the healthcare industry. De Haan concludes: “We still see some roadblocks ahead, which is why we are happy to continue to experiment together with CLEO. Because we believe in the potential of digital remote healthcare to keep healthcare accessible and high quality.”