CMO doctor Tijs: Digital data exchange must become the norm
The multi-talented and energetic Tijs Stehmann is Chief Medical Officer at Founda Health. After obtaining his two master degrees in math and marketing, he decided to become a doctor. Currently he is a pediatrician in training at Emma Children’s Hospital (in the Netherlands, ed.). Additionally, he is co-founder of Dokter Media – an online platform where medical reports in the media are given understandable explanation and interpretation. We interviewed him about the combination of all these activities and his vision on interoperability in healthcare.
He has a lot of plates spinning, but for ‘doctor Tijs’ (as his Founda colleagues like to call him) that’s no issue. “I’m a lucky guy”.
Old-fashioned and inefficient work in healthcare
“When I started working as a doctor, I was struck by how old-fashioned we still work. Much information was – and still is – shared on paper, via fax, and only to a limited extent digitally. This inefficient way of working not only takes a lot of time, it also leads to a loss of information and decrease in the quality of care. It puzzled me, and together with fellow physician and friend Lester du Perron, I began to question this. After several visits to the Ministry of Health, Welfare and Sport, we noticed that the various initiatives from the government involved hardly any, if any, doctors.”
Information deliberation: too slow for real change
Some years ago, we were able to give presentations during the Information deliberation, an initiative of the Ministry of Health, Welfare and Sport to speed up data exchange in healthcare. We heard about the wildest and sometimes advanced plans, but these didn’t match up to what was happening in practice. Based on our real-life experiences, we let the policy makers experience first-hand what it’s like to work with the current – often make-do – ways of data exchange. Partly because we noticed that the information deliberation missed the speed to lead to real change, we stopped with our contribution to the deliberation.”
Healthcare professionals in the lead
“I strongly believe that we as healthcare professionals should take the lead. We have to make clear that we want to work in different ways and how. And that can be quite challenging if you haven’t completely figured that out for yourself yet. Like for every other human, technology has a pretty prominent place in my life. But as soon as I walk through the doors of a hospital, I get the feeling to be going back in time 20 years.”
Founda Health – Adyen of healthcare
Still feeling the urgency to change something in healthcare, Tijs went looking for examples from other industries. That's how the idea of building the 'Adyen of healthcare' came about. “Instead of building a new, all-encompassing system again, we wanted to connect existing and new systems”, Tijs explains. “The same way it was done in the financial industry years ago. And then I found out about Founda Health – people from fintech that wanted to change healthcare ICT. They didn’t have a doctor on board yet, and could use someone with an opinion – and who could and would explain that opinion to healthcare providers.”
What does your role as CMO at Founda look like?
“I keep in contact with ‘digital doctors’ in hospitals for Founda. Mostly, they are Chief Medical Information Officers (CMIOs) and other enthusiast doctors and nurses, although it can just as well be the CEO. Currently, my work consists of explaining a lot. We don’t build the applications ourselves, neither are we an EHR. We take care of a smart connection between those two.
Although ‘application’ might be a bit misleading, because when we speak about applications that doesn’t necessarily mean an application on your phone. It can also be a software on your desktop, or an additional software in the EHR. Currently, applications have to connect to each hospital individually. That costs time and money, and often each hospital requires a slightly different method of connecting. It’s similar for hospitals the other way around.
The Founda Health Platform really brings something to the table in that aspect. For hospitals it’s easily deployable for hospitals, and great to use for application developers. In addition, it’s a scalable solution. Both parties just have to connect once to the Founda Platform and our bright minds (developers) take care of the rest. They can think of and create anything and everything, which in return strengthens my belief that the whole interoperability issue is solvable.”
Do you also experience this in practice?
“Generally doctors are quite positively critical, although they have many questions. I often see the same recurring topics; the limited time to take care of integrations, the unclarity about the added value of applications, or a proliferation of applications that has been slowly emerging. If not everything is properly connected, or you introduce an application and don’t connect it to other systems or don’t involve doctors and patients, it won’t work. Developing or integrating an application isn’t a stand-alone goal. It has to be the means, and only if that leads to working more efficiently and better care it brings the added value. Founda Health can fill a role as a ‘trustworthy power outlet’ here.
We work hard on our position in the industry. It’s understandable that it’s exciting for hospitals, since they will be working with a third party. Up to us to show that we can do that well and safely. It would be amazing if more and more parties granted us that trust.”
A part of healthcare
“Even though Founda Health doesn’t deliver care itself, it is important that we realize we are a part of healthcare. So to what extent does what we develop lead to better care? With the Founda Health Platform we’d like to facilitate both patients as healthcare providers, making it possible to use new digital solutions without it being ‘another new system’. On the contrary, we want to ensure it becomes part of – and I hate this word – workflow.”
How do you feel about Wegiz (Law of Electronic Health Data Exchange in the Netherlands)?
“In my opinion a law shouldn’t be the cause of innovation to take place, but the other way around. At Founda Health I experience that when you can think of something, it is technically feasible. If a law is needed to make sure that it happens in a safe manner, so be it. But it starts at thinking about what is necessary. Grants, on the one hand, ensure that innovation projects are initiated, but on the other hand, there is a danger of simply checking off a list. Thinking from the doctor’s, patient’s and usability point of view is a step beyond that. So a law on its own will never be the solution.”
Do patients, and in your case probably the parents of patients, like having access to their own records?
“Your file is yours, that premise is very evident as far as I’m concerned and is also entirely appropriate in this day and age. Studies also show that people like that self-direction. Healthcare professionals (in the Netherlands) are also being trained in ‘taking decisions together’. Together you create a care plan, and as a doctor you also have to make room for the desires of the (parents of) patient. Yet I also find that many people don’t want that space at all, or do not want to spend all day with their personal records. So the idea that people really enjoy interacting with their personal files, does not hold true for everyone. If you’re young and healthy you generally don’t end up in a hospital. For those people I don’t see immediate added value in a personal health environment.”
Can you give an example from your own experience as a pediatrician, in which digitization provided added value?
“When you have small children, you visit the doctor quite frequently in the first 4 years for check-ups. Parents that come to me, for whatever reason, are surprised that I manually have to copy-paste information from the doctor's check-up file into my system. They often say: “Yeah, but, doctor, that's in your system, isn’t it?”. Well, it’s not. It would be very nice if something as concrete as information about a child’s growth can be transferred directly to the EHR and I could add information the other way around.”
Why isn’t that possible yet?
“It is a big, fragmented landscape full of outdated systems. Often there is no time to stop and see that things can be simpler. Besides, in healthcare everything is a bit slower. I want to nuance that right away, because that is certainly not true for all facets in healthcare, and we have really good quality healthcare in the Netherlands.”
How do you see Founda Health evolving?
“It would be ideal if in a few years’ time it would be a matter of course that medical data is exchanged, and that new digital developments find their place in the healthcare landscape more quickly. A large network in which medical data can flow easily and safely. Hopefully Founda Health will then have contributed to making this digital data exchange a matter of course in healthcare.”