Every year, about 45.000 people have a stroke (CVA). It’s necessary to exercise, both physically and mentally, in order to combat the effects of a stroke. But exercises isn’t always easy to combine with day-to-day life. This is why Basalt thinks it’s important that support isn’t only available in rehabilitation centres, but also at home. In 2016, Basalt started research that lead to the development of a digital rehabilitation platform, called FAST@Home, in collaboration with the Haagse Hogeschool and the Leids Universitair Medisch Centrum. A web environment which allows patients that are rehabilitating easy access to digital interventions. Several eHealth applications were integrated with the platform and can be personalised. Based on the positive results, it was decided to optimise the digital environment, and scale it up to ikoefenzelf.com. In September 2019, the financial space for this scale-up was created by the Stimuleringsregeling E-health Thuis. The scale-up is happening in collaboration with regional insurance provider Zorg en Zekerheid, and primary CVA networks that founded the Innovatiecluster eRevalidatie CVA together. The objective of the ikoefenzelf.com project is to improve the rehabilitation and revitalisation of CVA patients, by sustainably implementing and scaling up blended care, based on selective, effective eHealth applications. ” Thanks to this platform, patients who are in rehabilitation have one place, with only one log-in code, where customised healthcare from several healthcare professionals is offered in a clear way. Because it is available everywhere, at all times, they are more able to continue the learned healthy behaviour under their own control, which contributes to the ability to live at home, healthy, for longer,”  states Sander Houdijk.

To facilitate the use of ikoefenzelf.com, a careful implementation strategy was developed. In order to scale up the intervention, Basalt adheres to a few crucial conditions. Houdijk: “First of all, the added value of the application must be experienced. The great added value of scaling up eHealth is that more citizens can look after their own health and quality of life with more control and responsibility. However, it remains difficult to convince users of the need for eHealth applications, especially medical professionals. At the same time, the shortage of practitioners is becoming more tangible, and waiting lists for patients are getting longer. Remodelling healthcare the conventional way is simply no longer a solution. The COVID-19 pandemic has, however, hugely increased the urgency of the desired wave of digitalisation,” says Felicie van Vree. Basalt is therefore also involving consumers in the development and implementation of ikoefenzelf.com. Wants, needs, and existing issues were systematically inventoried with them.

Th next step was scaling up eHealth within Basalt. For this, internal support from the board of directors, management, and medical personnel is essential. Eventually, genuine implementation touches every department and layer of a company. That’s why flexibility in the IT, procurement, and education departments are also very important in order to succeed. Van Vree: ‘This might feel scary, but you have to dare to get started. Sometimes that requires some nerve.’ For the scale-up, attention was paid to the necessary system adjustments within Basalt. Basalt consciously chooses existing and functioning applications from relatively large suppliers. This way, they could ensure that the application is supported when it adapts to the rapid technological advancement. A good relationship with suppliers is essential to get the application up and running in the desired way, especially in a pioneering phase. By now, the Physitrack, Minddistrict, and TOPwoordvinding applications, by different suppliers, are marketed white label and integrated, and the implementation was prepared and then tested at the Zoetermeer location (January 2020). The implementation strategy consists of a two-month educational programme for practitioners, the creation of a helpdesk for users, the ikoefenzelf.com website, the appointment and support of power-users in each medical team, eHealth blogs and continuous monitoring and feedback of use and experiences within and between medical teams. In June 2020, four other Basalt also started using the platform.

Based on the experiences of medical teams and patients in rehabilitation, the intervention is secured in the treatment programmes and healthcare trajectory of Basalt, in collaboration with the medical personnel. The final step is connecting their online supply to the online supply in the primary CVA networks in the innovation cluster. ‘In the next three years we hope to ensure that 50% of new CVA patients that are treated through Basalt can utilise blended care at home, based on the selected digital interventions,’ spoke Houdijk. With their living lab (the SmartLab), Basalt is also exploring possibilities for expanding blended care within all healthcare trajectories, and is continuously looking to expand the supply of applications linked with ikoefenzelf.com. ‘At the same time, the current project is also an interim product in the movement towards blended care.’ To achieve a sustainable integration of blended care into regular healthcare trajectories, a business case is being developed in collaboration with insurance providers.