One result of population ageing is an increasing number of people with long-term illnesses. That leads to heavier workloads in the health system, and these are further exacerbated by growing shortages in the health care workforce. To ensure that every individual will still have access to excellent-quality care in the future, health care needs restructuring. The starting point for such a transformation must be the care needs and wishes of the individual patients.

Patients do not think that way about health care. We need to start by focusing squarely on individual patients. We need to enable them, in line with their capabilities, to gain more self-direction over their health and over their utilisation of services. Even if the only motive were to encourage more compliance with lifestyle recommendations and medicine use, the new focus would make them more inclined to change their behaviours.

The prime focus in blended care is on the needs of the individual

Research has found that most patients have generally positive attitudes to the use of digital applications in health care. We can use such applications to get patients involved in their own health care, and to furnish them with reliable information so they can make wise decisions about their own illnesses and health. Digital options like these must serve as supplements to traditional care, not as a full substitute. This is also known as blended care. In our Saltro Diagnostic Centre, for example, we have developed a patient outcomes portal in cooperation with patients and general practitioners. Patients can view test results such as blood levels there, complete with low-threshold explanations. This gives them more insights into their own health situation. They feel more engaged in the health care process and are better prepared during consultations with their doctors.

Here, too, the needs and wishes of individual patients must be the guiding principle. Such needs and wishes are diverse. Whereas large numbers of patients may embrace technology in its entirety, others will prefer a trusted practitioner.

One complication is that we will essentially be unable to sustain the older organisational arrangements in the face of the growing labour market shortages. Technological applications could generate tremendous efficiency improvements in health services, for instance in support of clerical and administrative tasks.

Reliability of technologies cannot be taken for granted

We are currently seeing a proliferation of health applications involving do-it-yourself (DIY) diagnostics. I also welcome that development. Reliable home devices are already available for tasks such as blood glucose and coagulation monitoring. However, many DIY devices are now entering the market, and we often do not know whether they are reliable or not. A host of commercial websites are also offering online diagnostics. By and large, many such tests have not been validated and their reliability has not been demonstrated. One problem is that Europe has no mark of approval comparable to those issued by the US Food and Drug Administration (FDA). It is not easy for consumers to separate the wheat from the chaff. If people put their trust in outcomes from non-validated DIY diagnostic devices, that poses risks. The Dutch motoring association ANWB, for example, once offered a test for Lyme’s disease that turned out not to work. And the Silicon Valley health tech firm Theranos failed to make good on its promises for a ‘unique’ blood test needing but a drop of blood.

When a new digital application is in development, it is important to co-create it from the start with patients, service users and health professionals. If possible, health insurers should be involved as soon as possible, too, so as to facilitate scale expansion in a later stage. The observable effects of new applications need to be systematically validated. Knowledge gained from testing and research should also be made widely available. Other developers can then put it to use in devising or refining integrated care programmes and eHealth applications. The Saltro Diagnostic Centre therefore works closely with the National eHealth Living Lab.

Successful innovation requires perseverance

To ensure that innovations get successfully embedded into practice, one needs to bolster the innovation capabilities of the organisation itself. In recent years we at Saltro have worked hard to become an innovative front-runner. That requires considerable perseverance.

Successful innovation entails a great deal of repetition, further refinement and initiative. It requires courageous leadership and stamina. We have refocused our organisational strategy several times, engaging all sections of the organisation in the process. Considerable attention has also been devoted to our organisational structure and culture. Staff members have received further training and their inspiration has been maintained.

Continuing collaboration in the future

Saltro will continue to move with the flow in the changing world around us. It is to gradually develop from a laboratory into a data centre. Between now and five years hence, we will be receiving diagnostic data from health care patients who have opted for self-monitoring or are recording data on doctor’s advice. In addition, we will be obtaining traditional data from hospitals, primary care practices and blood labs. Consumers and potential patients will also be collecting more and more diagnostic data via DIY applications. Our role will be to integrate all that data and convert it into usable information – personalised, customised and close at hand.

That will pose further challenges. To safely collect and share data, the IT infrastructure will have to securely and effectively safeguard the privacy of personal data. Many organisations are also still struggling with practical aspects of legal and regulatory frameworks, such as the recently implemented General Data Protection Regulation (GDPR). Measures will need to be agreed with all stakeholders in the health care domain in order to be jointly prepared for the future.