The amount of people with a chronic disease, such as diabetes, is on the rise. At the moment, chronic care is offered mostly through set guidelines. In secondary healthcare, many applications are visible to make care more flexible, remote or digital. But we are seeing the possibilities increase in primary care as well. MiGuide offers guidance on the most important aspects of a healthy lifestyle for people with type 2 diabetes through an app. The app is aimed especially at attainable lifestyle and behavioural changes. With the app, the patient receives personal coaching and advice in terms of nutrition, exercise, glucose, and relaxation. “With the app, patients can easily gain insight into their disease at home, and learn to make lifestyle changes. They can also easily fill out a questionnaire, register their weight, and find tips and tricks surrounding healthy living. Things that would normally happen during a visit with a healthcare professional, ” says Arjen Huizinga, co-founder of MiGuide.

MiGuide is prescribed by the general practitioner, and provides the assistant practitioner with insight on what happens with a patient in between quarterly consultations. Now, determining the lifestyle and medication use of the patient is often a guessing game for both the general practitioner and assistant practitioner. MiGuide, using NHGdoc, can now link to all GP information systems (huisartsen informatiesystemen / HIS) except (for now) Medicom and HiX, and thus combines data from the HIS with data from wearables, PGO Uw Zorg Online!, digital food diaries, and goals the user sets themselves. Eventually, it becomes a digital buddy. MiGuide provides the GP with more insight, too: how is the patient outside of their quarterly consultations? How is the support during lifestyle changes? In order to make it as accessible as possible for the users, as much as possible was automated. The MiGuide app gives the patient control, whilst the healthcare professional remains actively involved. This way, it becomes simpler to comment directly on the most important points of interest during the consultation. Huizinga: “Besides saving healthcare professionals time, the app increases the patients’ quality of life. It also decreases healthcare expenses because less complications arise and less medication is necessary in the long run. In this way, the app is the digital extension of the GP surgery, at the patient’s home.”

MiGuide emerged from a collaboration between Expertdoc, Pexlife, and TNO, because bundling the powers and expertises could result in an enormous added value for the healthcare professional and patient with diabetes. Eventually, it took more than a year to formulate the business plan – a period during which many GPs, healthcare professionals, assistant practitioners, and diabetics were consulted. The umbrella organisations DiHag and NDF were also closely involved. Huizinga: “We were attracted by the combination of both a specific problem in practice (create a specific method for lifestyle medicine), and the opportunity to offer that solution with, in this case, technology.”

Building an innovation from A to Z is incredibly complex and resource-intensive. Whilst technology often doesn’t have the distinctive capability of the solution . That is why MiGuide spends a lot of time on UX-design, stimulating support for the application within healthcare, based their technology on proven technology in the field, is CE certified, and build on NHGdoc, which GPs already use often. Exactly because the content and advice of MiGuide are based on proven, effective interventions and guidelines of the NHG and the NDF, it’s receiving much support from the field. MiGuide also works with an independent medical advisory board in order to safeguard the voice from the field.

Eventually, a pilot launched in 2019, in collaboration with insurance provider Zilveren Kruis, in order to research whether new suppliers such as MiGuide can become a part of chain healthcare for chronic patients. Because of the single sign on link with the HIS, MiGuide is included in the regular work process of practitioners, which also allows patients with MiGuide to view the information their GP file. This allows MiGuide to give smart advice, based in part on the data in the patient file.

However, only support from the field and a functioning and accessible concept doesn’t get you all the way. MiGuide is therefore consciously focussing on decreasing the workload of the healthcare professional as much as possible when they use the platform. Think of the application of a smart assistant (NOOR) with information from Thuisarts, a service desk, and a full onboarding programme. MiGuide also supports GPs in conversations with insurance providers in order to reach suitable performance deals, so that MiGuide becomes a part of the reimbursement chain. Because the insurance provider is closely involved from the start, they also have a good idea of their wishes and needs. A few insurance providers has now agreed to keep the reimbursement for GPs the same, even though they spend less time with a patient by using MiGuide. This gives GPs the opportunity to work with MiGuide. “These conversations are just not easy. There are about 7000 active GPs in the Netherlands, so it’s quite a chore. For the long term, we’ll have to look into a fitting reimbursement structure, in order to structurally create the necessary room for innovation,” says Huizinga.

Besides support from healthcare professionals, MiGuide can also count on much support amongst diabetic patients. Huizinga: “With MiGuide, we have a 360 image of a patient. We expected this to be a sensitive topic for the patients. Do I think it’s acceptable that my GP can look at my pedometer and food diary? However, conversations with patient councils and patient groups have shown that this is a non-issue. After all, if a patient wants to work on their health, they also want to know their GP’s thoughts on that. Although the condition often soon arises: it has to be done well.”

By now, over 120 GPs are connected to the MiGuide, and the platform is in the process of scaling up. They are, amongst other things, rolling out within several groups of care. In the summer of 2020, the platform attracted a sizeable investment from two investment funds for expanding the platform, so it can also cater to other diseases. In the first phase, mostly GPs were attracted in the area of lifestyle medicine. What is important now is to let other  GPs experience the added value. Several multi-annual validation studies have started to that end. Huizinga: “Eventually, we aim to have MiGuide facilitate the shift from care to self-care. And from reactive to proactive care. You could say we’re a “Digital Therapeutic” for chronic patients.”